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Feasibility and Effectiveness of Continuing Methadone Maintenance Treatment During Incarceration Compared With Forced Withdrawal

Moore, Kelly, E., PhD; Oberleitner, Lindsay, PhD; Smith, Kathryn, M.Z., PhD; Maurer, Kathleen, MD; McKee, Sherry, A., PhD

doi: 10.1097/ADM.0000000000000381
Original Research
CME/MOC

Background: Methadone maintenance treatment (MMT) is underutilized in correctional settings, and those receiving MMT in the community often undergo withdrawal upon incarceration. Federal and state regulations present barriers to providing methadone in correctional facilities. For this investigation, a community provider administered methadone to inmates who had been receiving methadone prior to incarceration. We hypothesized that inmates continued on MMT would have improved behavior during incarceration and post-release.

Methods: This open-label quasi-experimental trial (n = 382) compared MMT continuation throughout incarceration (n = 184) to an administrative control group (ie, forced withdrawal; n = 198) on disciplinary tickets and other program attendance during incarceration. Post-release, re-engagement in community-based MMT and 6-month recidivism outcomes were evaluated.

Results: Inmates in the MMT continuation group versus controls were less likely to receive disciplinary tickets (odds ratio [OR] = 0.32) but no more likely to attend other programs while incarcerated. MMT continuation increased engagement with a community MMT provider within 1 day of release (OR = 32.04), and 40.6% of MMT participants re-engaged within the first 30 days (vs 10.1% of controls). Overall, re-engagement in MMT was not associated with recidivism. However, among a subset of inmates who received MMT post-incarceration from the jail MMT provider (n = 69), re-engagement with that provider was associated with reduced risk of arrest, new charges, and re-incarceration compared with those who did not re-engage.

Conclusions: Results support interventions that facilitate continuity of MMT during and after incarceration. Engagement of a community provider is feasible and can improve access to methadone in correctional facilities.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT (KEM, LO, SAM); Department of Psychiatry, Columbia University, New York, NY (KMZS); Department of Corrections, State of Connecticut, Wethersfield, CT (KM).

Send correspondence to Sherry A. McKee, PhD, 2 Church St. South, Suite 109, New Haven, CT 06519. E-mail: sherry.mckee@yale.edu.

Received 11 September, 2017

Accepted 13 December, 2017

This work was supported by the Connecticut Department of Correction, Connecticut Department of Mental Health and Addiction Services, APT Foundation of New Haven, and TI026330 (SAMSHA to SAM). The work described in this article does not express the views of the State of Connecticut, the APT Foundation, or SAMSHA. The views and opinions expressed are those of the authors.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.journaladdictionmedicine.com).

© 2018 American Society of Addiction Medicine