Continuing Methadone Treatment During Incarceration Results in More Treatment Re-Engagement, Less Opioid Use, and Less Injection Drug Use After Release from Jail or Prison

Most US correctional facilities discontinue opioid agonist treatment for people with opioid use disorder when they are incarcerated. Researchers randomized 283 Rhode Island inmates who wanted to continue methadone throughout incarceration to receive either continued methadone treatment or undergo standard forced withdrawal. The main outcome was re-engagement with a methadone clinic after release. Secondary outcomes included self-reported opioid use, injection drug use, reincarceration, and adverse events. Since withdrawal in RI jail and prison is tapered over several weeks, some patients in the forced withdrawal group were released while still receiving methadone.

• 96% of participants in the continued methadone group returned to a community methadone clinic within 1 month of release, compared with 78% in the withdrawal group. 100% of those receiving methadone at the time of release returned to a methadone clinic within 1 month of release, compared with 48% of those not receiving methadone.
• Participants in the continued methadone group were less likely than those in the forced withdrawal group to have opioid use (8% versus 18%) and injection drug use (17% versus 32%).
• There were no significant differences in re-incarceration or serious adverse events between groups.

Comments:

This study provides strong evidence that continuing methadone treatment during incarceration among people with opioid use disorder increases the likelihood of re-engagement with methadone treatment after release, and decreases opioid and injection drug use.

Jamie K. Lim, BSc† and Alexander Y. Walley, MD, MSc

Reference:

Rich JD, McKenzie M, Larney S, et al. Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial. Lancet. 2015;386(9991):350–359.