Buprenorphine Maintenance for Opioid Addicted Persons in Jail and Post-Release

描述(由申请人提供)： 海洛因和其他阿片类药物滥用仍然是刑事司法人员中的一个重大问题。2002年，刑事司法系统是所有药物滥用治疗入院的36%的转介来源，这是转介的最大来源。罪犯使用海洛因会造成严重的健康和社会后果。注射仍然是海洛因使用者的主要给药途径，与艾滋病毒、丙型肝炎和其他血液传播疾病的传播密切相关。1997年，美国20%至26%的艾滋病毒携带者和29%至43%的丙型肝炎感染者通过惩教机构。海洛因使用与犯罪活动之间的关系已被广泛记录在案。尽管自20世纪70年代S以来，美沙酮维持治疗一直是慢性阿片依赖的主要治疗方法，但美国的惩教系统，除了极少数例外，没有提供美沙酮维持的制度性途径。令人遗憾的是，对美沙酮的消极态度在刑事司法专业人员、公众、治疗提供者和阿片类药物依赖者本身中很普遍；这种情况不太可能很快改变。丁丙诺啡维持治疗是最近批准的一种治疗方法，由于几个原因，它可能比美沙酮更容易被刑事司法系统和阿片类药物依赖者接受。除了一个很小的例外，丁丙诺啡在美国从未作为阿片类药物替代疗法在美国被系统地使用。这项探索性/发展性研究的具体目的如下：1.确定在监狱环境中向不再治疗的阿片依赖者提供丁丙诺啡维持治疗的可行性，以及在释放后将这些患者过渡到社区维持丁丙诺啡治疗的可行性。2.进行丁丙诺啡维持治疗(N=50)与美沙酮维持治疗(N=50)的随机临床试验。3.确定罪犯在释放或退出社区治疗后没有报告以社区为基础的丁丙诺啡或美沙酮治疗的原因。同意的符合条件的囚犯将被随机分配到监狱中接受丁丙诺啡或美沙酮的维持治疗，并在获释后被转介到相应的社区治疗。结果将在出狱后6个月通过图表审查、个人访谈和滥用药物的毒理学进行评估。

DESCRIPTION (provided by applicant): Heroin and other opioid abuse continue as a significant problem among the criminal justice population. In 2002, the criminal justice system was the source of referral for 36% of all substance abuse treatment admissions, the largest source of referrals. Heroin use among offenders has serious health and social consequences. Injection, still the primary route of administration among heroin users, is strongly associated with the transmission of HIV, Hepatitis C, and other blood-borne diseases. During 1997, 20% to 26% of all people living with HIV in the United States, and 29% to 43% of all those infected with Hepatitis C, passed through a correctional facility. The relationship between heroin use and criminal activity has been extensively documented. Although methadone maintenance has been the primary treatment for chronic opioid dependence since the 1970's, correctional systems in the U.S., with very few exceptions, have not provided institutional access to methadone maintenance. Regrettably, negative attitudes to methadone are prevalent among criminal just professionals, the public, treatment providers and opioid-dependent offenders themselves; there is little prospect of that changing soon. Buprenorphine maintenance is a recently approved therapy that may be more acceptable for several reasons than methadone to the criminal justice system and opioid-dependent offenders. With one minor exception, buprenorphine has never been systematically administered as an opioid replacement therapy in a correctional setting in the U.S. The specific aims of this exploratory/developmental study are as follows: 1. to determine the feasibility of providing buprenorphine maintenance to out-of-treatment opioid-dependent offenders in a jail setting and of transitioning those patients to buprenorphine maintenance in the community after release. 2. To conduct a randomized clinical trial of buprenorphine maintenance (N = 50) vs. methadone maintenance (N =50) initiated in the jail setting and continuing in community programs. 3. To determine the reasons that offenders fail to report for community-based buprenorphine or methadone treatment after release or drop out of community treatment. Consenting eligible inmates will be randomly assigned to buprenorphine or methadone maintenance in jail and will be referred to a corresponding community treatment at release. Outcomes will be assessed at 6 months after release from jail by chart review, personal interviews and toxicologies for drugs of abuse.