A Randomized Trial of Continued Methadone Maintenance vs. Detoxification in Jail

描述（由申请人提供）：阿片类药物成瘾是一种慢性、复发性疾病，可以通过长期阿片类药物替代疗法（ORT）有效治疗。美沙酮维持疗法（MMT）是ORT最广泛使用的形式，已被用于治疗阿片成瘾超过30年。MMT已被证明可以减少注射毒品的使用、艾滋病毒风险行为和再犯，但囚犯在监禁后通常会从美沙酮中脱毒，从而导致对阿片类药物依赖的治疗中断。即使囚犯在释放后被转到社区美沙酮项目，他们也有可能推迟或放弃重新进入监狱，或者在重新接受美沙酮维持治疗之前，会从事使他们面临感染艾滋病毒或再次入狱高风险的行为。让囚犯在短期监禁期间继续接受美沙酮治疗，可能有助于他们在释放后迅速重新进入社区美沙酮维持计划，从而最大限度地降低药物复发、艾滋病毒风险行为和过量服用的风险。因此，本研究的目的是研究在短期监禁（监狱）期间中断美沙酮维持治疗（MMT）的影响，因为这是美国几乎所有惩教机构的标准做法。我们将通过一项随机试验比较美沙酮解毒与持续美沙酮维持治疗，并检查释放后的持续治疗、吸毒复发、艾滋病毒风险行为、再监禁以及持续MMT与美沙酮解毒相关的成本。目标人群将是450人，他们在接受社区美沙酮治疗时被监禁不到6个月。随访访谈将在出狱后1个月以及基线后6个月、12个月和18个月在一个独立的研究地点进行。两组都将接受风险行为减少咨询干预，并在释放后与社区美沙酮治疗联系。如果这个项目能够证明让囚犯在短期监禁中使用美沙酮比戒毒更有益和/或成本更低，那么这可以为惩教政策提供信息，以鼓励与社区药物使用治疗提供者合作，并尽量减少短期监禁期间治疗的中断。公共卫生相关性：在美国，注射吸毒者继续在艾滋病毒传播中发挥重要作用，而且每年有相当一部分传统上难以接触到的人口通过惩教设施，因此在惩教设施中处理成瘾和艾滋病毒相互关联的流行病存在着巨大的机会。美沙酮维持治疗已被证明可以减少注射毒品的使用、艾滋病毒风险行为和再犯，但囚犯在监禁后通常会从美沙酮中解毒，从而导致对阿片类药物依赖的治疗中断。让囚犯在短期监禁期间继续接受美沙酮治疗，可能有助于他们在释放后迅速重新进入社区美沙酮维持计划，从而最大限度地降低药物复发、艾滋病毒风险行为和过量服用的风险。

DESCRIPTION (provided by applicant): Opiate addiction is a chronic, relapsing medical condition that can be effectively treated through long-term opiate replacement therapy (ORT). Methadone maintenance therapy (MMT) is the most widely used form of ORT and has been used to treat opiate addiction for over thirty years. MMT has been proven to reduce injection drug use, HIV risk behaviors and recidivism, yet inmates are routinely detoxified from methadone upon incarceration, thus causing an interruption in the treatment of their opiate dependence. Even if inmates are referred to community methadone programs upon release, there is a chance that they will delay or forgo re-entry or will engage in behaviors that put them at high risk for HIV infection or reincarceration before returning to methadone maintenance treatment. Maintaining inmates on methadone therapy during short-term incarceration may facilitate their prompt re-entry into community methadone maintenance programs after release, minimizing the risk of drug relapse, HIV risk behaviors and overdose. Thus, the purpose of this study is to examine the impact of interruption of methadone maintenance treatment (MMT) during short-term incarceration (jail) as this is the standard practice in nearly all correctional facilities in the United States. We will compare methadone detoxification with continued methadone maintenance treatment using a randomized trial and examine continuing treatment post release, relapse to drug use, HIV risk behaviors, reincarceration, and the costs associated with continued MMT vs. methadone detoxification. The targeted population will be 450 individuals who, while enrolled in community methadone treatment, become incarcerated for less than 6 months. Follow-up interviews will occur 1 month post release from incarceration and 6, 12, and 18 months from baseline at an independent study site. Both groups will receive a risk behavior reduction counseling intervention and linkage to community methadone treatment upon release. If this project is able to demonstrate that maintaining inmates on methadone for short-term incarcerations is more beneficial and/or less costly than detoxification, then this can inform correctional policy to encourage collaboration with community substance use treatment providers and to minimize disruption of treatment during short term incarceration. PUBLIC HEALTH RELEVANCE: With injection drug users continuing to play an important role in the transmission of HIV in the US and a substantial proportion of this traditionally hard-to-reach population passing through correctional facilities each year, a tremendous opportunity exists to engage the interconnected epidemics of addiction and HIV in the correctional setting. Methadone maintenance therapy has been proven to reduce injection drug use, HIV risk behaviors and recidivism, yet inmates are routinely detoxified from methadone upon incarceration thus causing an interruption in the treatment of their opiate dependence. Maintaining inmates on methadone therapy during short-term incarceration may facilitate their prompt re-entry into community methadone maintenance programs after release, minimizing the risk of drug relapse, HIV risk behaviors and overdose.