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，可通过长期阿片类药物替代疗法（ORT）有效治疗。美沙酮维持治疗（MMT）是ORT中使用最广泛的一种，用于治疗阿片类药物成瘾已有30多年的历史。MMT已被证明可以减少注射毒品使用，艾滋病毒风险行为和累犯，但囚犯在监禁时通常会从美沙酮中解毒，从而导致其阿片类药物依赖治疗中断。即使囚犯在释放后被转介到社区美沙酮项目，他们也有可能推迟或放弃重新进入，或者在返回美沙酮维持治疗之前做出使他们面临艾滋病毒感染或重新监禁高风险的行为。在短期监禁期间维持囚犯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，最大限度地减少药物复发，艾滋病毒风险行为和过量的风险。因此，本研究的目的是检查美沙酮维持治疗（MMT）在短期监禁（监狱）中断的影响，因为这是在美国几乎所有的惩教设施的标准做法。我们将使用随机试验比较美沙酮脱毒与持续美沙酮维持治疗，并检查释放后的持续治疗，药物使用复发，HIV风险行为，重新监禁以及与持续MMT与美沙酮脱毒相关的费用。目标人群将是450人，他们在社区美沙酮治疗中登记，被监禁不到6个月。随访访谈将在从监禁中释放后1个月以及基线后6、12和18个月在独立研究中心进行。这两个群体将接受风险行为减少咨询干预和联系社区美沙酮治疗后释放。如果这个项目能够证明，维持美沙酮的囚犯短期监禁是更有益的和/或更便宜的比戒毒，那么这可以告知矫正政策，鼓励与社区物质使用治疗提供者的合作，并尽量减少中断的治疗在短期监禁。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，并且这种传统上难以接触的人群中有相当大的比例每年都通过惩教设施，因此存在着巨大的机会，可以在惩教环境中参与成瘾和艾滋病毒的相互关联的流行病。美沙酮维持疗法已被证明可以减少注射毒品使用、艾滋病毒风险行为和累犯，但囚犯在监禁后通常会从美沙酮中解毒，从而导致其阿片类药物依赖治疗中断。在短期监禁期间维持囚犯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，最大限度地减少药物复发，艾滋病毒风险行为和过量的风险。

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.