Michael S Gordon1, Timothy W Kinlock2, Robert P Schwartz3, Terrence T Fitzgerald4, Kevin E O'Grady5, Frank J Vocci6. 1. Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA; Stevenson University, Department of Criminal Justice, 1525 Greenspring Valley Road, Stevenson, MD 21153, USA. Electronic address: mgordon@friendsresearch.org. 2. Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA; University of Baltimore, School of Criminal Justice, College of Public Affairs, 1420 N Charles Street, Baltimore, MD 21201, USA. 3. Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA; University of Maryland School of Medicine, Department of Psychiatry, 110 South Paca St., Baltimore, MD 21201, USA. 4. Glenwood Life Counseling Center, 516 Glenwood Avenue, Baltimore, MD 21212, USA. 5. University of Maryland, 8082 Baltimore Avenue, College Park, MD 20740, USA. 6. Friends Research Institute, Inc., 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
Abstract
BACKGROUND:Buprenorphine is a promising treatment for heroin addiction. However, little is known regarding its provision to pre-release prisoners with heroin dependence histories who were not opioid-tolerant, the relative effectiveness of the post-release setting in which it is provided, and gender differences in treatment outcome in this population. METHODS: This is the first randomized clinical trial of prison-initiated buprenorphine provided to male and female inmates in the US who were previously heroin-dependent prior to incarceration. A total of 211 participants with 3-9 months remaining in prison were randomized to one of four conditions formed by crossing In-Prison Treatment Condition (received buprenorphine vs. counseling only) and Post-release Service Setting (at an opioid treatment center vs. a community health center). Outcome measures were: entered prison treatment; completed prison treatment; and entered community treatment 10 days post-release. RESULTS: There was a significant main effect (p=.006) for entering prison treatment favoring the In-Prison buprenorphine Treatment Condition (99.0% vs. 80.4%). Regarding completing prison treatment, the only significant effect was Gender, with women significantly (p<.001) more likely to complete than men (85.7% vs. 52.7%). There was a significant main effect (p=.012) for community treatment entry, favoring the In-Prison buprenorphine Treatment Condition (47.5% vs. 33.7%). CONCLUSIONS:Buprenorphine appears feasible and acceptable to prisoners who were not opioid-tolerant and can facilitate community treatment entry. However, concerns remain with in-prison treatment termination due to attempted diversion of medication.
RCT Entities:
BACKGROUND:Buprenorphine is a promising treatment for heroin addiction. However, little is known regarding its provision to pre-release prisoners with heroin dependence histories who were not opioid-tolerant, the relative effectiveness of the post-release setting in which it is provided, and gender differences in treatment outcome in this population. METHODS: This is the first randomized clinical trial of prison-initiated buprenorphine provided to male and female inmates in the US who were previously heroin-dependent prior to incarceration. A total of 211 participants with 3-9 months remaining in prison were randomized to one of four conditions formed by crossing In-Prison Treatment Condition (received buprenorphine vs. counseling only) and Post-release Service Setting (at an opioid treatment center vs. a community health center). Outcome measures were: entered prison treatment; completed prison treatment; and entered community treatment 10 days post-release. RESULTS: There was a significant main effect (p=.006) for entering prison treatment favoring the In-Prison buprenorphine Treatment Condition (99.0% vs. 80.4%). Regarding completing prison treatment, the only significant effect was Gender, with women significantly (p<.001) more likely to complete than men (85.7% vs. 52.7%). There was a significant main effect (p=.012) for community treatment entry, favoring the In-Prison buprenorphine Treatment Condition (47.5% vs. 33.7%). CONCLUSIONS:Buprenorphine appears feasible and acceptable to prisoners who were not opioid-tolerant and can facilitate community treatment entry. However, concerns remain with in-prison treatment termination due to attempted diversion of medication.
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