Methadone maintenance in prison: Evaluation of a pilot program in Puerto Rico

Heimer, Robert; Catania, Holly; Newman, Robert G.; Zambrano, John A.; Brunet, Arlyn; Ortiz, Arturo

doi:10.1016/j.drugalcdep.2005.11.004

Cited by 42 publications

(37 citation statements)

References 19 publications

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“…Positive prisoner-centred outcomes associated with OST include reduced rates of drug abuse and infectious diseases. Prisoners receiving MMT have shown less drug-injecting [11,36,37] and less risk-taking behaviour (e.g. sharing of syringes) [11,38].…”

Section: Rationales For Drug Dependence Treatment In Prisonsmentioning

confidence: 99%

“…sharing of syringes) [11,38]. In one study, only 1 of 18 (5.6%) prisoners receiving MMT reported heroin use in the past 30 days compared with 15 of 40 (37.5%) prisoners not receiving MMT ( P < 0.05) [36]. After 4 months in prison, the rate of illicit use of morphine was 27% for MMT-treated prisoners and 42% for controls ( P = 0.05) [39].…”

Section: Rationales For Drug Dependence Treatment In Prisonsmentioning

confidence: 99%

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Drug use and opioid substitution treatment for prisoners

Stöver

Michels

2010

Harm Reduction Journal

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Drug use is prevalent throughout prison populations, and, despite advances in drug treatment programmes for inmates, access to and the quality of these programmes remain substantially poorer than those available for non-incarcerated drug users. Because prisoners may be at greater risk for some of the harms associated with drug use, they deserve therapeutic modalities and attitudes that are at least equal to those available for drug users outside prison. This article discusses drug use by inmates and its associated harms. In addition, this article provides a survey of studies conducted in prisons of opioid substitution therapy (OST), a clinically effective and cost-effective drug treatment strategy. The findings from this overview indicate why treatment efforts for drug users in prison are often poorer than those available for drug users in the non-prison community and demonstrate how the implementation of OST programmes benefits not only prisoners but also prison staff and the community at large. Finally, the article outlines strategies that have been found effective for implementing OST in prisons and offers suggestions for applying these strategies more broadly.

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Section: Rationales For Drug Dependence Treatment In Prisonsmentioning

confidence: 99%

Section: Rationales For Drug Dependence Treatment In Prisonsmentioning

confidence: 99%

Drug use and opioid substitution treatment for prisoners

Stöver

Michels

2010

Harm Reduction Journal

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“…Nowadays, MMT is used in different parts of the world to reduce harm among PWIDs inside and outside prisons. MMT is one of the most important measures of harm reduction programs, and has led to effectively reduction or termination of drug injection and shared practices (12)(13)(14) and also highrisk sexual behaviors (12,(15)(16)(17)(18)(19). This medication improves mental and physical conditions of patients and reduces the risk of diseases such as HIV/AIDS and hepatitis (20,21).…”

Section: Key Messagesmentioning

confidence: 99%

Methadone maintenance treatment program in prisons from the perspective of medical and non-medical prison staff: a qualitative study in Iran

Moradi

Farnia²,

Shokoohi

et al. 2015

Int J Health Policy Manag

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Background: As one of the most important components of harm reduction strategy for high-risk groups, following the HIV epidemics, Methadone Maintenance Treatment (MMT) has been initiated in prisoners since 2003. In this paper, we aimed to assess the advantages and shortcomings of the MMT program from the perspective of people who were involved with the delivery of prison healthcare in Iran. Methods: On the basis of grounded theory and through conducting 14 Focus Group Discussions (FGDs), 7 FGDs among physicians, consultants, experts, and 7 FGDs among directors and managers of prisons (n= 140) have been performed. The respondents were asked about positive and negative elements of the MMT program in Iranian prisons.Results: This study included a total of 48 themes, of which 22 themes were related to advantages and the other 26 were about shortcomings of MMT programs in the prisons. According to participants' views "reduction of illegal drug use and high-risk injection", "reduction of potentially high-risk behaviors" and "making positive attitudes" were the main advantages of MMT in prisons, while issues such as "inaccurate implementation", "lack of skilled manpower" and "poor care after release from prison" were among the main shortcomings of MMT program. Conclusions: MMT program in Iran's prisons has achieved remarkable success in the field of harm reduction, but to obtain much more significant results, its shortcomings and weaknesses must be also taken into account by policy-makers.

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“…Several studies in Europe, Australia, Puerto Rico, and Canada have now shown that MMT in prison leads to reduced drug use, drug injection, and needle sharing; that it produces improvements in institutional behaviour; and that it has a positive effect on release outcomes (117)(118)(119)(120).…”

Section: Maintenance Treatmentmentioning

confidence: 99%

Evidence-Based Treatment of Opioid-Dependent Patients

2006

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Objective:To provide an overview of treatment options for opioid-dependent patients. Method:We screened all published studies on the treatment of opioid dependence, with a special focus on systematic literature reviews, formal metaanalyses, and recent trials. Results:Both clinical experience and neurobiological evidence indicate that opioid dependence is a chronic relapsing disorder. Treatment objectives depend on the pursued goals: crisis intervention, abstinence-oriented treatment (detoxification and relapse prevention), or agonist maintenance treatment. The high quality of solid evidence in the literature demonstrates that there are numerous effective interventions available for the treatment of opioid dependence. Crisis intervention, frequently necessary owing to the high overdose rate, can be effectively handled with naloxone. Abstinence-oriented interventions are effective for only a few motivated patients with stable living conditions and adequate social support. Agonist maintenance treatment is considered the first line of treatment for opioid dependence. Numerous studies have shown efficacy for methadone and buprenorphine treatment, while maintenance with other agonists is also becoming available to a greater extent. Maintenance treatment with diamorphine should be made available for the small group of treatment-resistant, severely dependent addicts. Other harm-reduction measures can serve to engage individuals with opioid addiction who are not in treatment. Conclusion:Opioid dependence is a chronic relapsing disease that is difficult to cure, but effective treatments are available to stabilize patients and reduce harm, thereby increasing life expectancy and quality of life. (Can J Psychiatry 2006;51:635-646) Information on funding and support and author affiliations appears at the end of the article. Clinical Implications· Agonist maintenance treatment plus psychosocial support should be widely available and freely accessible for all opioid-dependent individuals. · New extended release antagonist maintenance treatments are promising but should be reserved for internally motivated and stabilized opioid-dependent patients. · Prison sentences should be regarded as windows of opportunity for the start or continuation of maintenance treatment and psychosocial rehabilitation. Limitations· The literature is based on patients with heroin dependence, whereas in many places, heroin has been replaced as the drug of abuse by illicit prescription opioids. · New interventions such as heroin-assisted treatment, SROM, and extended release naltrexone have not be studied extensively. · Many prison-based interventions and harm-reduction measures used with opioid-dependent individuals not seeking treatment have not been tested in RCTs.

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Methadone maintenance in prison: Evaluation of a pilot program in Puerto Rico

Cited by 42 publications

References 19 publications

Drug use and opioid substitution treatment for prisoners

Drug use and opioid substitution treatment for prisoners

Methadone maintenance treatment program in prisons from the perspective of medical and non-medical prison staff: a qualitative study in Iran

Evidence-Based Treatment of Opioid-Dependent Patients

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