Randy Brown1, Michele Gassman, Scott Hetzel, Lisa Berger. 1. Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Wisconsin 53715, USA. randy.brown@fammed.wisc.edu
Abstract
BACKGROUND:Primary care opioid substitution treatment (OST) has not been compared to program-based OST for community-supervised offenders. OBJECTIVE: The purpose of this project was to compare primary care to specialist supervised OST for opioid dependent offenders in terms of substance use and HIV risk outcomes. METHODS: This project randomly assigned 15 jail diversion participants to either: (i) primary care buprenorphine OST, (ii) specialist facility buprenorphine OST, or (iii) specialist facility methadone OST. Participation lasted 13.5 months (12-month active treatment plus a post-participation visit). RESULTS: All subjects endorsed 0 days of opioid use in the previous 14 at follow-up. Specialty care reduced HIV risk (Risk Assessment Battery composite score) over 6 months (-.24 ± .17) compared to primary care (.02 ± .14; p = .032). CONCLUSION: Findings support primary care OST feasibility for a community-supervised offender sample. Specialist care may facilitate improvements in secondary outcomes, such as HIV risk behaviors. SCIENTIFIC SIGNIFICANCE: Further research is needed to clarify (i) the role of primary care in addicted offender management, and (ii) the matching of offenders, based upon history and co-morbidity, to care coordination conditions.
RCT Entities:
BACKGROUND: Primary care opioid substitution treatment (OST) has not been compared to program-based OST for community-supervised offenders. OBJECTIVE: The purpose of this project was to compare primary care to specialist supervised OST for opioid dependent offenders in terms of substance use and HIV risk outcomes. METHODS: This project randomly assigned 15 jail diversion participants to either: (i) primary care buprenorphine OST, (ii) specialist facility buprenorphine OST, or (iii) specialist facility methadone OST. Participation lasted 13.5 months (12-month active treatment plus a post-participation visit). RESULTS: All subjects endorsed 0 days of opioid use in the previous 14 at follow-up. Specialty care reduced HIV risk (Risk Assessment Battery composite score) over 6 months (-.24 ± .17) compared to primary care (.02 ± .14; p = .032). CONCLUSION: Findings support primary care OST feasibility for a community-supervised offender sample. Specialist care may facilitate improvements in secondary outcomes, such as HIV risk behaviors. SCIENTIFIC SIGNIFICANCE: Further research is needed to clarify (i) the role of primary care in addicted offender management, and (ii) the matching of offenders, based upon history and co-morbidity, to care coordination conditions.
Authors: G Fischer; W Gombas; H Eder; R Jagsch; A Peternell; G Stühlinger; L Pezawas; H N Aschauer; S Kasper Journal: Addiction Date: 1999-09 Impact factor: 6.526