Opiate Replacement Therapy at Release from Incarceration

出狱后的阿片替代疗法

• 批准号: 7394449
• 负责人: JOSIAH D RICH
• 金额: $ 41.03万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-15 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7394449
• 关键词: AIDS/HIV problem; Aftercare; Buprenorphine; Caring; Clinic; Communities; Counseling; Country; Crime; Data; Drug abuse; Drug usage; Effectiveness; Employment; Funding; Grant; HIV; Heroin; Homelessness; Housing; Imprisonment; Individual; Infection; Injection of therapeutic agent; Intervention; Interview; Jail; Letters; Link; Maintenance; Measures; Medical; Methadone; Minority; NIH Program Announcements; Naloxone; National Institute of Drug Abuse; Numbers; Occupations; Opiates; Overdose; Participant; Persons; Pharmaceutical Preparations; Population Study; Prisoner; Prisons; Provider; Purpose; Randomized Controlled Trials; Rate; Recording of previous events; Replacement Therapy; Research; Research Personnel; Resources; Rhode Island; Risk; Risk Behaviors; Risk Reduction Behavior; Seasons; Site; System; Target Populations; Time; Training Programs; United States; Upper arm; Week; Work; addiction; base; burden of illness; concept; criminal behavior; drug relapse; experience; follow-up; methadone clinic/center; payment; recidivism; reincarceration; response; social integration; transmission process; treatment program

DESCRIPTION (provided by applicant): This study will evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors. Individuals who inject opiates are at increased risk for HIV through both injection and sexual practices. A substantial proportion of opiate-dependent persons are incarcerated while addicted and a majority of the nearly 8 million individuals released from a correctional setting each year have a history of addiction. Minorities are both over represented in the corrections system and carry a disproportionately higher burden of disease. The period immediately after release from incarceration is a particularly high-risk time for HIV and drug relapse. Methadone is the most widely used opiate replacement therapy in the United States and has been shown to decrease HIV risk, drug use, crime, and reincarceration. Other benefits include the stabilization of employment, housing, and increased contact with medical care providers. Most prisons in the country do not offer opiate replacement therapy or refer to treatment upon release. Preliminary data from our CSAT-funded project linking opiate-dependent prisoners with methadone treatment after release from incarceration reveal that this approach is feasible and promising, but with lower-than-expected clinic attendance rates. A randomized, controlled trial will determine whether initiating methadone prior to release is a more effective strategy than referral to methadone treatment programs on release from incarceration. The primary aims will be to determine the effects of each study arm on reducing HIV risk behaviors, reducing recidivism, and increasing drug treatment attendance. The population of this study will be prisoners with multiple prior drug-related incarcerations and previous experience with methadone treatment. If this project is able to demonstrate that the use of induction of methadone treatment prior to release from incarceration is effective, this may be a "proof of concept" for other forms of opiate replacement therapy, such as buprenorphine/naloxone, to reduce HIV transmission.

描述（由申请人提供）：本研究将评估出狱前开始阿片替代治疗对减少艾滋病毒风险行为的有效性。注射阿片类药物的人通过注射和性行为感染艾滋病毒的风险增加。很大一部分依赖阿片类药物的人是在成瘾的情况下被监禁的，每年从惩教机构释放的近800万人中，大多数都有成瘾史。在惩教系统中，少数民族的人数过多，而且他们的疾病负担也高得不成比例。出狱后的一段时间是艾滋病毒和毒品复发的高危时期。美沙酮是美国使用最广泛的阿片类药物替代疗法，已被证明可以降低艾滋病毒风险、吸毒、犯罪和再监禁。其他福利包括稳定就业、住房和增加与医疗服务提供者的联系。该国大多数监狱不提供阿片替代疗法，也不提及释放后的治疗。我们的csat资助项目将阿片类药物依赖的囚犯在出狱后与美沙酮治疗联系起来，初步数据表明，这种方法是可行的，而且很有希望，但诊所的上座率低于预期。一项随机对照试验将确定释放前开始使用美沙酮是否比释放后转介美沙酮治疗方案更有效。主要目的是确定每个研究组在减少HIV风险行为、减少再犯和增加药物治疗出勤率方面的效果。本研究的人群将是有过多次毒品相关监禁的囚犯，并且有过美沙酮治疗的经验。如果这个项目能够证明在释放之前使用美沙酮诱导治疗是有效的，这可能是其他形式的阿片类药物替代疗法的“概念证明”，例如丁丙诺啡/纳洛酮，以减少艾滋病毒的传播。