Methadone Maintenance after Prison Release Reduces HIV Injection-Risk Behaviors but Not Sex-Risk Behaviors

This study analyzed HIV risk behaviors of 211 adult men with opioid dependence after release from prison in Baltimore, MD. Subjects were randomly assigned to 1 of 3 treatment conditions: counseling only (CO), counseling + opioid agonist treatment (OAT) after release (CR), or counseling + OAT initiated while in prison (CM). The primary outcome measure was self-reported participation in drug- and sex-risk behaviors as measured by Texas Christian University’s AIDS Risk Assessment (ARA) administered at baseline (30-day recall prior to incarceration) and at several intervals up to 12 months post-release.

• In the entire cohort, there was a significant decline in overall ARA sex-risk score but not in drug-risk score.

• When comparing the 3 treatment conditions, participants in the CR and CM groups had significantly lower drug-risk scores than those in the CO group. Those in the CM group had lower scores than those in the CR group, but the difference was not statistically significant.

• There was no significant difference in post-release sex-risk scores between the 3 groups.

Comments:

This study adds to established research on the benefits of providing OAT to opioid-dependent prisoners at the time of release. As would be expected, OAT was associated with less post-release injection-risk behaviors. Initiating OAT prior to release may be better in this regard, but this study failed to demonstrate it. As shown in other studies, OAT alone did not appear to have any effect on sex-risk behaviors, although the counseling all subjects received may have had a beneficial effect.

Darius A. Rastegar, MD

Reference:

Wilson ME, Kinlock TW, Gordon MS, et al. Postprison release HIV-risk behaviors in a randomized trial of methadone treatment for prisoners. Am J Addict. 2012;21(5):476–487.