A randomized clinical trial of methadone maintenance for prisoners: findings at 6 months post‐release

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Abstract
Aims This study examined the effectiveness of methadone maintenance initiated prior to or just after release from prison at 6 months post‐release.Design A three‐group randomized controlled trial was conducted between September 2003 and June 2005.Setting A Baltimore pre‐release prison.Participants Two hundred and eleven adult pre‐release inmates who were heroin‐dependent during the year prior to incarceration.Intervention Participants were assigned randomly to the following: counseling only: counseling in prison, with passive referral to treatment upon release (n = 70); counseling + transfer: counseling in prison with transfer to methadone maintenance treatment upon release (n = 70); and counseling + methadone: methadone maintenance and counseling in prison, continued in a community‐based methadone maintenance program upon release (n = 71).Measurements Addiction Severity Index at study entry and follow‐up. Additional assessments at 6 months post‐release were treatment record review; urine drug testing for opioids, cocaine and other illicit drugs.Findings Counseling + methadone participants were significantly more likely than both counseling only and counseling + transfer participants to be retained in drug abuse treatment (P = 0.0001) and significantly less likely to have an opioid‐positive urine specimen compared to counseling only (P = 0.002). Furthermore, counseling + methadone participants reported significantly fewer days of involvement in self‐reported heroin use and criminal activity than counseling only participants.Conclusions Methadone maintenance, initiated prior to or immediately after release from prison, increases treatment entry and reduces heroin use at 6 months post‐release compared to counseling only. This intervention may be able to fill an urgent treatment need for prisoners with heroin addiction histories.