Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial

• Published in: The Lancet (British edition) 2015-07, Vol.386 (9991), p.350-359
• Main Authors: Rich, Josiah D, Prof, McKenzie, Michelle, MPH, Larney, Sarah, PhD, Wong, John B, MD, Tran, Liem, MS, Clarke, Jennifer, MD, Noska, Amanda, MD, Reddy, Manasa, BA, Zaller, Nickolas, PhD
• Format: Article
• Language: English
• Subjects: Adult; Drug abuse; Drug addiction; Drug Administration Schedule; Female; Heroin; Humans; Internal Medicine; Male; Methadone; Methadone - administration & dosage; Methadone - therapeutic use; Middle Aged; Opiate Substitution Treatment - methods; Opioid-Related Disorders - rehabilitation; Overdose; Patient Acceptance of Health Care - statistics & numerical data; Prisoners; Prisoners - psychology; Prisons; Rhode Island; Risk reduction; Risk taking; Substance abuse treatment; Substance Abuse Treatment Centers - statistics & numerical data
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(14)62338-2

Summary Background Methadone is an effective treatment for opioid dependence. When people who are receiving methadone maintenance treatment for opioid dependence are incarcerated in prison or jail, most US correctional facilities discontinue their methadone treatment, either gradually, or more often, abruptly. This discontinuation can cause uncomfortable symptoms of withdrawal and renders prisoners susceptible to relapse and overdose on release. We aimed to study the effect of forced withdrawal from methadone upon incarceration on individuals' risk behaviours and engagement with post-release treatment programmes. Methods In this randomised, open-label trial, we randomly assigned (1:1) inmates of the Rhode Island Department of Corrections (RI, USA) who were enrolled in a methadone maintenance-treatment programme in the community at the time of arrest and wanted to remain on methadone treatment during incarceration and on release, to either continuation of their methadone treatment or to usual care—forced tapered withdrawal from methadone. Participants could be included in the study only if their incarceration would be more than 1 week but less than 6 months. We did the random assignments with a computer-generated random permutation, and urn randomisation procedures to stratify participants by sex and race. Participants in the continued-methadone group were maintained on their methadone dose at the time of their incarceration (with dose adjustments as clinically indicated). Patients in the forced-withdrawal group followed the institution's standard withdrawal protocol of receiving methadone for 1 week at the dose at the time of their incarceration, then a tapered withdrawal regimen (for those on a starting dose >100 mg, the dose was reduced by 5 mg per day to 100 mg, then reduced by 3 mg per day to 0 mg; for those on a starting dose >100 mg, the dose was reduced by 3 mg per day to 0 mg). The main outcomes were engagement with a methadone maintenance-treatment clinic after release from incarceration and time to engagement with methadone maintenance treatment, by intention-to-treat and as-treated analyses, which we established in a follow-up interview with the participants at 1 month after their release from incarceration. Our study paid for 10 weeks of methadone treatment after release if participants needed financial help. This trial is registered with ClinicalTrials.gov , number NCT01874964. Findings Between June 14, 2011, and April 3, 2013, we randomly ass