Diversion to treatment for injection drug users arrested for possession of heroin

描述（由申请人提供）：美国因毒品犯罪被捕的人数超过其他任何犯罪。2009年，超过294,000人因持有可卡因或海洛因而被捕。监禁并不能解决根本问题，而且往往是在释放后再犯和再次被捕。对于因持有海洛因而被捕的依赖阿片类药物的成年人，一个可能有效的替代方案是将罪犯转移到美沙酮维持治疗（MMT），作为对其案件裁决的替代方案。MMT是一种有效的治疗海洛因依赖的方法，对罪犯似乎非常有效。然而，可卡因使用在MMT患者中很常见，包括那些最近有刑事司法参与的患者，单独的MMT在解决可卡因使用方面是无效的。持续使用可卡因会给健康带来沉重负担，并必然导致持续的犯罪活动。因此，对被转移的阿片剂依赖罪犯的治疗应设计成既解决可卡因使用问题，也解决阿片剂使用问题。一个第一阶段的行为治疗发展项目计划在两年的时间里，对被控持有海洛因的成年人进行调整、手动操作和试点测试治疗场所干预，并将其转移到美沙酮维持治疗中，作为对其案件裁决的替代方案。治疗工作场所是一种新颖的、以就业为基础的应急管理干预，在促进美沙酮治疗期间持续使用可卡因的成年人戒断可卡因方面非常有效。在治疗工作场所，参与者被雇佣在一个模范工作场所，并被要求提供无毒品的尿液样本来工作，并获得最高工资。一旦我们为因持有海洛因而被捕的成年人开发和操作改良版的治疗场所，我们将进行试点测试。由州检察官办公室确定为转移候选人的个人将被评估其学习资格。鉴于巴尔的摩注射吸毒和注射相关艾滋病毒传播的高比率，本研究将仅限于注射吸毒者，以评估这种干预措施在降低艾滋病毒风险方面的潜在效用。符合条件的个人将提供美沙酮维持代替起诉，并将被要求继续美沙酮治疗90天。所有参与者都将接受标准的MMT，无论他们是否决定参加试点研究。开始MMT后，参与者将被邀请参加试点研究，并随机分配到两个研究组。被分配到常规护理转移组的参与者将接受标准的MMT。被分配到治疗工作场所强化转移组的参与者将接受标准的MMT和治疗工作场所干预。该初步研究的数据将作为全面随机对照试验的基础。总的来说，治疗工作场所可以作为一个新的和理想的干预许多海洛因依赖成年人参与刑事司法系统。使用MMT代替审判与治疗场所相结合可以增加戒毒和就业，并降低艾滋病毒的风险和犯罪活动在这一难治性高危人群。

DESCRIPTION (provided by applicant): More Americans are arrested for drug offenses than for any other crime. In 2009, over 294,000 arrests were made for possession of cocaine or heroin. Incarceration does not address the root problems and is frequently followed by relapse and re-arrest after release. In the case of opiate-dependent adults arrested for possession of heroin, one potentially effective alternative is to divert offenders to methadone maintenance treatment (MMT) as an alternative to adjudication of their case. MMT is an effective treatment for heroin dependence, and appears very effective for criminal offenders. However, cocaine use is common in MMT patients, including those with recent criminal justice involvement, and MMT alone is ineffective in addressing cocaine use. Continued cocaine use carries a substantial health burden and necessarily entails continued criminal activity. Thus, treatment for diverted opiate-dependent offenders should be designed to address cocaine use as well as opiate use. A Stage 1 Behavior Therapy Development project is planned over 2 years to adapt, manualize and pilot test the Therapeutic Workplace intervention for adults charged with heroin possession and offered diversion to methadone maintenance treatment as an alternative to adjudication of their case. The Therapeutic Workplace is a novel, employment-based contingency management intervention that has been very effective in promoting cocaine abstinence in adults who use cocaine persistently during methadone treatment. In the Therapeutic Workplace, participants are hired in a model workplace and required to provide drug-free urine samples to work and to earn maximum pay. Once we develop and manualize the adapted version of the Therapeutic Workplace for adults arrested for heroin possession, a pilot test will be conducted. Individuals identified by the State Attorney's office as candidates for diversion will be assessed for study eligibility. Given the high rates of injection drug use and injection-related transmission of HIV i Baltimore, this study will be restricted to injection drug users to evaluate the potential utility f this intervention in reducing HIV risk. Eligible individuals will be offered methadone maintenance in lieu of prosecution and will be required to remain in methadone treatment for 90 days. All participants will receive standard MMT, independent of whether they decide to participate in the pilot study. After beginning MMT, participants will be invited to enroll in the pilot study and randomly assigned to two study groups. Participants assigned to the Usual Care Diversion group will receive the standard MMT. Participants assigned to the Therapeutic Workplace Enhanced Diversion group will receive the standard MMT and the Therapeutic Workplace intervention. The data from this pilot study will serve as the foundation for a full-scaled randomized controlled trial. Overall, the Therapeutic Workplace could serve as a novel and ideal intervention for many heroin dependent adults involved in the criminal justice system. The use of MMT in lieu of adjudication in combination with the Therapeutic Workplace could increase drug abstinence and employment and decrease HIV risk and criminal activity in this refractory high-risk population. PUBLIC HEALTH RELEVANCE: We propose to conduct a stage 1 behavior therapy development project to evaluate the efficacy of the Therapeutic Workplace as the central element in a drug abuse treatment for unemployed injection drug users who have been arrested for possession of heroin and diverted from prosecution to treatment. The Therapeutic Workplace is a motivational intervention of proven efficacy that uses routine drug testing and contingent access to stipend-supported job training or employment to promote drug abstinence. The Therapeutic Workplace could serve as a novel and ideal intervention for diverted drug dependent arrestees, which could increase abstinence and employment, and reduce HIV risk and recidivism.