Prisoners forced to withdraw from methadone less likely to seek community treatment

June 2015
Rich J D., McKenzie M., Larney S., Zaller N., et al. Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial, The Lancet. Published Online: 28 May 2015. DOI: 10.1016/S0140-6736(14)62338-2

This study published in The Lancet by US researchers and NDARC NHMRC postdoctoral fellow Dr Sarah Larney has provided further evidence for the effectiveness of methadone maintenance treatment in prisons.

The randomised controlled trial of 283 US inmates in prison for six months or less found that prisoners receiving methadone on release were seven times more likely than those not on methadone to seek community based treatment in the first month following release from prison. Conversely those prisoners forced to withdraw from methadone were likely to delay receiving community treatment on release or cease treatment altogether. The forced withdrawal group were also more likely to return to injecting drug use following release and more likely to participate in behaviours putting them at risk of HIV and hepatitis.

The study also found that medical costs, such as hospital ED presentations, for prisoners who stayed on methadone were lower in the month after release even after accounting for cost of methadone.

Dr Larney who worked on the study with lead author Professor Josiah Rich as an NMHRC postdoctoral research fellow at Brown University Rhode Island said the results provided further support for the Australian policy of offering methadone treatment in prisons which is available in all states and territories apart from Queensland.

“In the US 90 per cent of prisoners stop methadone treatment while in prison,” said Dr Larney. “The results of this study are of particular concern because other cohort studies have shown that there is increased risk of death in the first few weeks after release from prison. This is significantly reduced if prisoners continue on methadone in prison and following release.

“As well there is substantial evidence of public health and social benefits of methadone treatment in prison and the community including reduced rates of communicable disease; lower rates of reincarceration and lower crime rates.”

An accompanying editorial in The Lancet describes the American policy on methadone in prisons as “unusual and cruel”.