Kinlock T.W. , Gordon M.S. , Schwartz R.P. et al.
Criminal Justice and Behavior: 2008, 35(1), p. 34–47.
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US study shows the value of immediate post-release transfer to an awaiting methadone maintenance slot for formerly heroin dependent prisoners willing to try this treatment but is less clear on the value of actually starting the treatment in prison.
Summary The study aimed to examine the benefits of methadone maintenance among pre-release prison inmates. 197 incarcerated males with pre-incarceration heroin dependence were randomly assigned to (a) group educational counselling (counselling only); (b) counselling, with opportunity to begin methadone maintenance on release (counselling + transfer); or (c) counselling and methadone maintenance in prison, with opportunity to continue methadone maintenance on release (counselling + methadone). At 90-day follow-up, counselling + methadone participants were significantly more likely than counselling-only and counselling + transfer participants to attend drug treatment (p = .0001) and less likely to be re-incarcerated (p = .019). Counselling + methadone and counselling + transfer participants were significantly less likely (all ps < .05) to report heroin use, cocaine use, and criminal involvement than counselling-only participants. Follow-up is needed to determine whether these findings hold over a longer period.
commentary Opinion is divided on programmes to (re)introduce formerly heroin dependent prisoners to methadone maintenance while in prison. The aim is to protect newly released prisoners at high risk of relapse, crime and fatal overdose, but perhaps at the cost of reinstating dependence among some who could have used their enforced break to construct a life free of dependence on opiate-type drugs. For Britain this US study
can't decide the issue
Results from such programmes are likely to be highly dependent on the context. In Baltimore (personal communication from Timothy W. Kinlock, 10 December 2008) applicants typically have to wait for treatment and pay fees dependent on their ability to pay. Without these impediments, more of the prisoners without a pre-arranged methadone slot might nevertheless have taken up treatment on release.
but it does gives a rare clue to what might happen. Compared to just referring prisoners to services, in the Baltimore context it convincingly showed the value of immediate post-release transfer to an awaiting methadone slot. Without this few ex-prisoners started treatment, more used illegal opiates and cocaine, and more committed crimes. The extra benefits of also starting methadone in prison were
increased treatment uptake
A possible incentive was that methadone-maintained prisoners left on 60mg methadone a day, an amount which would have led many to experience an uncomfortable withdrawal unless they continued treatment on release or topped up with illegal opiates.
on release and a more than halved
risk of re-imprisonment.
Unless prisoners started their methadone treatment in prison, around 30% were back in prison within three months even if they had a methadone treatment slot awaiting them on release.
However, this did little to further affect the number of prisoners who committed at least some crimes or the amount of
illegal opiate use.
The proportion who admitted using opiates was only slightly less than among the group who could transfer to methadone but did not start it in prison, and as many tested positive for opiates, a proxy for frequent use.
Only half the formerly opiate dependent prisoners approached for the study were keen enough on methadone maintenance to participate. Despite expressing an interest in this treatment, even without an arranged methadone slot over a fifth of prisoners said they had remained opiate free in the first three months after release and just under a fifth 14 of 62 counselling-only patients said they had not used opiates of whom two had been re-imprisoned and one had entered treatment (personal communication from Timothy W. Kinlock, 10 December 2008). had done so without treatment or a further spell in prison. Whether the major benefit from starting treatment in prison – reduced re-imprisonment – is considered sufficient to warrant it depends on how much weight is given to the minority of prisoners started on methadone who would have remained opiate free At least for the first three months after release. in any event. Whatever the post-release benefits, within prison methadone programmes improve the climate and reduce in-prison drug use, injecting and infection risk behaviour.
Thanks for their comments on this entry in draft to Timothy W. Kinlock of the Friends Research Institute Inc. Commentators bear no responsibility for the text including the interpretations and any remaining errors.
Last revised 10 December 2008
STUDY 2005 Continuity vital after prison treatment