Much of the HIV/AIDS epidemic is driven by transmission from or to persons addicted to
opiates. Many of these individuals pass through a correctional setting each year, creating
an opportunity for linkage to substance abuse treatment. The purpose of this study is to
evaluate the effectiveness of initiating opiate replacement therapy prior to release from
incarceration on reducing HIV risk behaviors and drug relapse. In addition, this study will
evaluate the effectiveness of short-term payment versus non-payment of community opiate
replacement therapy immediately following release from incarceration.
A substantial proportion of individuals addicted to heroin are incarcerated while addicted
and a majority of individuals released from a correctional setting have a history of heroin
addiction. The period immediately after release from incarceration is a particularly
high-risk time for HIV transmission and other problems, including drug relapse and overdose.
Methadone treatment is the most widely used opiate replacement therapy in the United States
and has been shown to decrease HIV risk, as well as drug use, addiction relapse, and
criminal activity. The purpose of this study is to evaluate the effectiveness of initiating
opiate replacement therapy prior to release from incarceration on reducing HIV risk
behaviors and drug relapse. In addition, this study will evaluate the effectiveness of
short-term payment versus non-payment of community opiate replacement therapy immediately
following release from incarceration.
Participants in this 3-year study will be randomly assigned to 1 of 3 treatment groups.
Participants enrolled in Group 1 will initiate methadone opiate replacement therapy about 1
month prior to release from incarceration. They will then proceed with a methadone program
of choice upon release and receive short-term payment to cover treatment costs.
Participants enrolled in Group 2 will be referred to a methadone program of choice upon
release from incarceration with provision of short-term payment of treatment costs.
Participants enrolled in Group 3 will be referred to a program of choice upon release from
incarceration without receiving financial assistance. All participants will have the
opportunity to partake in existing support programs available at the Rhode Island Department
of Corrections while incarcerated and in the community upon release. Follow-up assessments
will occur at Months 1.5, 6, 12 and 24. These will include interviews and urine specimens
for toxicology analysis to verify self-reports.
- Currently incarcerated at the Rhode Island Department of Corrections with a scheduled
release date at least 28 days after enrollment
- Incarceration length not to have exceeded two years at the time of enrollment
- Heroin dependent with self-reported heroin injection in the month prior to
incarceration OR enrollment in a methadone treatment program prior to incarceration
for heroin addiction with a history of injection drug use
- Desire to enter methadone treatment upon release and plans to secure funding for
methadone treatment after study completion
- History of prior tolerance to methadone
- History of at least one drug-related incarceration
- Speaks English or Spanish
- Plans to remain in Rhode Island for the duration of the study (24 months)
- Ability to provide at least two names of individuals who can verify participant
- Currently receiving methadone at the Rhode Island Department of Corrections
- Currently undergoing a non-narcotic detoxification from illicit opiates at the Rhode
Island Department of Corrections
- Plans to leave Rhode Island within the two years following enrollment