Opiate Replacement Therapy at Release from Incarceration

出狱后的阿片替代疗法

• 批准号: 6947585
• 负责人: JOSIAH D RICH
• 金额: $ 36.12万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-15 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6947585
• 关键词: AIDS; AIDS education /prevention; HIV infections; behavior modification; behavioral /social science research tag; clinical research; clinical trials; correctional institutions; criminal behavior; drug addiction antagonist; heroin; high risk behavior /lifestyle; human subject; human therapy evaluation; interview; intravenous drug abuse; longitudinal human study; methadone; outcomes research; patient care management; sex behavior; therapy compliance

DESCRIPTION (provided by applicant): This study will evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors. Individuals who inject opiates are at increased risk for HIV through both injection and sexual practices. A substantial proportion of opiate-dependent persons are incarcerated while addicted and a majority of the nearly 8 million individuals released from a correctional setting each year have a history of addiction. Minorities are both over represented in the corrections system and carry a disproportionately higher burden of disease. The period immediately after release from incarceration is a particularly high-risk time for HIV and drug relapse. Methadone is the most widely used opiate replacement therapy in the United States and has been shown to decrease HIV risk, drug use, crime, and reincarceration. Other benefits include the stabilization of employment, housing, and increased contact with medical care providers. Most prisons in the country do not offer opiate replacement therapy or refer to treatment upon release. Preliminary data from our CSAT-funded project linking opiate-dependent prisoners with methadone treatment after release from incarceration reveal that this approach is feasible and promising, but with lower-than-expected clinic attendance rates. A randomized, controlled trial will determine whether initiating methadone prior to release is a more effective strategy than referral to methadone treatment programs on release from incarceration. The primary aims will be to determine the effects of each study arm on reducing HIV risk behaviors, reducing recidivism, and increasing drug treatment attendance. The population of this study will be prisoners with multiple prior drug-related incarcerations and previous experience with methadone treatment. If this project is able to demonstrate that the use of induction of methadone treatment prior to release from incarceration is effective, this may be a "proof of concept" for other forms of opiate replacement therapy, such as buprenorphine/naloxone, to reduce HIV transmission.

描述（由申请人提供）：本研究将在释放因减少艾滋病毒风险行为的监禁之前评估起鸦片替代疗法的有效性。注射阿片类药物的人通过注射和性行为都有增加艾滋病毒的风险。大量依赖阿片类药物的人被监禁，而在上瘾的同时，每年从惩教环境中释放的近800万个人中，大多数人都有成瘾的历史。少数民族在矫正系统中的代表性过高，并且承受着疾病负担的不成比例。从监禁中释放后的时期是艾滋病毒和药物复发的特别高风险时间。美沙酮是美国使用最广泛的鸦片替代疗法，已被证明可以降低艾滋病毒风险，吸毒，犯罪和再碳化。其他好处包括稳定就业，住房以及与医疗服务提供者的联系增加。该国的大多数监狱都不提供鸦片替代疗法或释放时参考治疗。我们由CSAT资助的项目的初步数据将依赖鸦片依赖的囚犯与美沙酮治疗联系起来后的初步数据表明，这种方法是可行的和有希望的，但诊所的出勤率低于预期。一项随机，对照试验将确定在释放前启动美沙酮是否比转介在释放监禁时更有效的策略。主要目的是确定每个研究部门对减少艾滋病毒风险行为，减少累犯和增加药物治疗的影响。这项研究的人口将是具有多个先前与药物有关的监禁和美沙酮治疗经验的囚犯。如果该项目能够证明在从监禁中释放前美沙酮治疗的使用是有效的，那么这可能是其他形式的鸦片替代疗法的“概念验证”，例如二甲苯吗啡/纳洛酮，可以减少艾滋病毒的传播。