This study examined the effectiveness of methadone maintenance initiated prior to or just after release from prison at 6 months post-release.
A three-group randomized controlled trial was conducted between September 2003 and June 2005 at a Baltimore (Maryland) pre-release center. Study participants were 211 adult pre-release inmates who were heroin-dependent during the year prior to incarceration. Participants were randomly assigned to the following: 1) counseling only, which involved counseling in prison, with passive referral to treatment upon release (n - 70); 2) counseling plus transfer, which consisted of counseling in prison with transfer to methadone maintenance treatment upon release (n - 70); and 3) counseling plus methadone, which involved methadone maintenance and counseling in prison, continued in a community-based methadone maintenance program upon release (n - 71). Addiction Severity Index was determined at study entry and at follow-up. Additional assessments conducted at 6 months post-release were a treatment record review and urine drug testing for opioids, cocaine, and other illicit drugs. Counseling plus methadone participants were significantly more likely than both counseling only and counseling plus transfer participants to be retained in drug abuse treatment (P - 0.0001), and they were significantly less likely to have an opioid-positive urine specimen compared to counseling only (P - 0.002). Further, counseling plus methadone participants reported significantly fewer days of involvement in self-reported heroin use and criminal activity than counseling only participants. The study concluded that methadone maintenance initiated prior to or immediately after release from prison increases treatment entry and reduces heroin use at 6 months post-release compared to counseling only. This intervention may address an urgent treatment need for prisoners with heroin addiction histories. (publisher abstract modified)