Kinlock Timothy W, Gordon Michael S, Schwartz Robert P, O'Grady Kevin, Fitzgerald Terrence T, Wilson Monique
Social Research Center, Friends Research Institute, Baltimore, MD 21201, USA.
Drug Alcohol Depend. 2007 Dec 1;91(2-3):220-7. doi: 10.1016/j.drugalcdep.2007.05.022. Epub 2007 Jul 12.
Despite its effectiveness, methadone maintenance is rarely provided in American correctional facilities. This study is the first randomized clinical trial in the US to examine the effectiveness of methadone maintenance treatment provided to prisoners with pre-incarceration heroin addiction.
A three-group randomized controlled trial was conducted between September 2003 and June 2005. Two hundred eleven Baltimore pre-release inmates who were heroin dependent during the year prior to incarceration were enrolled in this study. Participants were randomly assigned to the following: counseling only: counseling in prison, with passive referral to treatment upon release (n=70); counseling+transfer: counseling in prison with transfer to methadone maintenance treatment upon release (n=70); and counseling+methadone: methadone maintenance and counseling in prison, continued in a community-based methadone maintenance program upon release (n=71).
Two hundred participants were located for follow-up interviews and included in the current analysis. The percentages of participants in each condition that entered community-based treatment were, respectively, counseling only 7.8%, counseling+transfer 50.0%, and counseling+methadone 68.6%, p<.05. All pairwise comparisons were statistically significant (all ps<.05). The percentage of participants in each condition that tested positive for opioids at 1-month post-release were, respectively, counseling only 62.9%, counseling+transfer 41.0%, and counseling+methadone 27.6%, p<.05, with the counseling only group significantly more likely to test positive than the counseling+methadone group.
Methadone maintenance initiated prior to or immediately after release from prison appears to have beneficial short-term impact on community treatment entry and heroin use. This intervention may be able to fill an urgent treatment need for prisoners with heroin addiction histories.
尽管美沙酮维持治疗有效，但在美国惩教机构中很少提供。本研究是美国首个随机临床试验，旨在检验对入狱前有海洛因成瘾的囚犯提供美沙酮维持治疗的效果。
2003年9月至2005年6月进行了一项三组随机对照试验。211名巴尔的摩即将获释的囚犯参与了本研究，他们在入狱前一年依赖海洛因。参与者被随机分配到以下组：仅咨询组：在监狱接受咨询，释放后被动转介接受治疗（n = 70）；咨询+转介组：在监狱接受咨询，释放后转介接受美沙酮维持治疗（n = 70）；咨询+美沙酮组：在监狱接受美沙酮维持治疗和咨询，释放后继续参加社区美沙酮维持治疗项目（n = 71）。
200名参与者被找到进行随访访谈并纳入当前分析。进入社区治疗的每组参与者百分比分别为，仅咨询组7.8%，咨询+转介组50.0%，咨询+美沙酮组68.6%，p<0.05。所有两两比较均具有统计学意义（所有p值<0.05）。释放后1个月时，每组中阿片类药物检测呈阳性的参与者百分比分别为，仅咨询组62.9%，咨询+转介组41.0%，咨询+美沙酮组27.6%，p<0.05，仅咨询组检测呈阳性的可能性显著高于咨询+美沙酮组。
在出狱前或出狱后立即开始美沙酮维持治疗似乎对进入社区治疗和海洛因使用有有益的短期影响。这种干预可能能够满足有海洛因成瘾史囚犯的紧急治疗需求。
