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

描述(由申请者提供)：阿片成瘾是一种慢性、复发性的医学状况，可以通过长期的阿片替代疗法(ORT)有效地治疗。美沙酮维持疗法(MMT)是ORT中应用最广泛的一种形式，用于治疗阿片成瘾已有30多年的历史。MMT已被证明可以减少注射毒品使用、艾滋病毒危险行为和再犯罪率，但囚犯在入狱后通常会戒除美沙酮，从而导致他们的阿片依赖治疗中断。即使囚犯在获释后被转介到社区美沙酮计划，他们也有可能推迟或放弃重新进入监狱，或者在返回美沙酮维持治疗之前从事使他们处于感染艾滋病毒或再次监禁的高风险的行为。囚犯在短期监禁期间继续接受美沙酮治疗，可能有助于他们在获释后迅速重返社区美沙酮维持计划，最大限度地减少药物复发、艾滋病毒危险行为和过量服药的风险。因此，这项研究的目的是检查在短期监禁(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。我们将使用随机试验比较美沙酮脱毒和美沙酮持续维持治疗，并检查出院后继续治疗、再次使用药物、艾滋病毒危险行为、再次监禁以及与持续MMT和美沙酮脱毒相关的成本。目标人群将是450人，他们在登记参加社区美沙酮治疗时，被监禁不到6个月。后续访谈将在出狱后1个月以及在独立研究地点从基线开始的6、12和18个月进行。出院后，两组患者都将接受减少危险行为的咨询干预，并与社区美沙酮治疗挂钩。如果该项目能够证明，在短期监禁期间继续服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的合作，并最大限度地减少短期监禁期间治疗的中断。公共卫生相关性：随着注射吸毒者继续在美国艾滋病毒的传播中发挥重要作用，以及这一传统上难以接触到的人口中每年有相当大一部分人通过惩教设施，存在着在惩教环境中参与吸毒和艾滋病毒这两个相互关联的流行病的巨大机会。美沙酮维持疗法已被证明可以减少注射毒品、艾滋病毒危险行为和复发率，但囚犯在监禁时通常会戒除美沙酮，从而导致他们对阿片类药物依赖的治疗中断。囚犯在短期监禁期间继续接受美沙酮治疗，可能有助于他们在获释后迅速重返社区美沙酮维持计划，最大限度地减少药物复发、艾滋病毒危险行为和过量服药的风险。

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.