Effect of Methadone Treatment on Incarceration Rates among Injection Drug Users

Abstract

Background: Methadone maintenance treatment (MMT) has been shown to dramatically reduce illicit opioid use and criminal activity among injection drug users (IDU). However, questions remain concerning the effect of MMT in reducing rates of incarceration among IDU. We therefore sought to investigate the long-term effect of MMT on rates of incarceration. Methods: We performed a generalized estimating equation longitudinal analysis of factors associated with incarceration among participants in the Vancouver Injection Drug Users Study (VIDUS). We also recorded whether participants reported having difficulty accessing drug treatment during the study period. Results: Among 1,247 active IDU, 624 (50.0%) reported being incarcerated at least once during the 6-year study period. In multivariate analysis, there was a strong negative association between methadone treatment and incarceration (adjusted odds ratio = 0.64, 95% CI: 0.54–0.76, p < 0.001) despite intensive covariate adjustment. Conclusions: Given our findings concerning the strong negative association between MMT and incarceration, and the reported high-risk injection practices of incarcerated IDU, limiting the availability of MMT has the potential to further exacerbate the high levels of HIV transmission found among IDU who are in need of treatment both in their communities and in correctional facilities.

Methadone Maintenance Therapy Decreases the Rate of Antiretroviral Therapy Discontinuation Among HIV-Positive Illicit Drug Users

“…Third, enrollment in MMT may provide opportunities for monitoring and adjustment of ART [21]. Fourth, engagement in MMT has been shown to reduce the risk of incarceration, which has been shown to be strongly associated with premature discontinuation of ART, as well as non-adherence [35, 36]. Prior analyses of treatment interventions that address the common psychological and medical co-morbidities of drug use highlight the need for multifaceted and interdisciplinary treatment delivery systems to HIV-infected drug users [37].…”

The Trouble with Morality: The Effects of 12-Step Discourse on Addicts’ Decision-Making

“…Extensive research documents methadone’s efficacy in treating opiate addicts and studies have consistently found reduced levels of opioid misuse, transmission of STDs, and prisoner recidivism among methadone maintenance patients (Ball et al 1988; Kleber 2008; Werb et al, 2008; Marsch 1998; Nadelmann 1996). However, methadone is also shackled with largely negative perceptions among addicts, treatment providers, and the public that are associated with high dropout rates or addicts avoiding methadone-based treatment entirely (Fisher et al 2002; Gourlay, Ricciardelli & Ridge 2005; Forman, Bovasso & Woody 2001; Zweben & Sorensen 1988) 3 Methadone patients consistently report high rates of “stigma,” which Erving Goffman (1963) defined as “the situation of the individual who is disqualified from full social acceptance” resulting from a gap between an individual’s true attributes and societies expectations.…”

Les effets indésirables des médicaments de substitution dans le traitement de la dépendance aux opioïdes

“…Au cours des cinquante dernières années, une abondante littérature scientifique est d'ailleurs venue documenter la validité des traitements de substitution (Ball & Ross, 1991) en termes de rétention en traitement, de réduction d'usage d'opioïdes illicites, de réduction de la mortalité (Bell & al., 2009 ;Brugal & al., 2005 ;Smyth, 2007) et de réduction des activités criminelles et d'insertion sociale (Werb, Kerr, Marsh, Montaner & Wood, 2008). On a de plus noté une diminution des comportements à risque pour l'acquisition d'infections transmises sexuellement ou par le sang (ITSS) (Emmanuelli & Desenclos, 2005 ;Ghitza, Epstein & Preston, 2008 ;Gowing & al., 2006 ;Sullivan, Metzger, Fudala, & Fiellin, 2005).…”