Feasibility and Effectiveness of Continuing Methadone Maintenance Treatment During Incarceration Compared With Forced Withdrawal.

Abstract

Methadone maintenance treatment (MMT) is underutilized in correctional settings, and those receiving MMT in the community often undergo withdrawal upon incarceration. Federal and state regulations present barriers to providing methadone in correctional facilities. For this investigation, a community provider administered methadone to inmates who had been receiving methadone prior to incarceration. We hypothesized that inmates continued on MMT would have improved behavior during incarceration and post-release. This open-label quasi-experimental trial (n = 382) compared MMT continuation throughout incarceration (n = 184) to an administrative control group (ie, forced withdrawal; n = 198) on disciplinary tickets and other program attendance during incarceration. Post-release, re-engagement in community-based MMT and 6-month recidivism outcomes were evaluated. Inmates in the MMT continuation group versus controls were less likely to receive disciplinary tickets (odds ratio [OR] = 0.32) but no more likely to attend other programs while incarcerated. MMT continuation increased engagement with a community MMT provider within 1 day of release (OR = 32.04), and 40.6% of MMT participants re-engaged within the first 30 days (vs 10.1% of controls). Overall, re-engagement in MMT was not associated with recidivism. However, among a subset of inmates who received MMT post-incarceration from the jail MMT provider (n = 69), re-engagement with that provider was associated with reduced risk of arrest, new charges, and re-incarceration compared with those who did not re-engage. Results support interventions that facilitate continuity of MMT during and after incarceration. Engagement of a community provider is feasible and can improve access to methadone in correctional facilities.