Jail inmates who continue to receive methadone treatment for opioid use disorder have better outcomes both during and after incarceration, according to a new Yale study conducted in conjunction with several state agencies.
People receiving methadone treatment are often forced to withdraw from treatment when they go to jail, which can induce severe withdrawal symptoms and hamper their abilities to successfully reenter society after incarceration. To evaluate the impacts of forced withdrawal, the researchers investigated the effects of providing methadone in the New Haven Correctional Center. Published on Jan. 16 in the Journal of Addiction Medicine, the study was conducted in partnership with the APT Foundation and the Connecticut Department of Mental Health and Addiction Services.
“What this study has shown, from a policy perspective, is that if you maintain people on an evidence-based, FDA-approved medication for the disease of substance use disorder, then you can improve people’s lives when they leave [prison],” said Kathleen Maurer, director of Health and Addiction Services for Connecticut’s correctional system, who led the methadone program.
Maurer began the program in 2012 at the New Haven Correctional Center. In the study, which collected data beginning in 2013, the researchers studied a group of 184 people who had been on methadone treatment before entering the criminal justice system and received methadone from the same provider while imprisoned.
Compared to a control group of 189 people, the study found that participants who received methadone were more likely to continue methadone treatment with a community-based provider both one day after release and within 30 days. The treatment group also received fewer disciplinary reports during incarceration.
Maurer noted that this finding may be particularly relevant to correction facilities and departments. By maintaining methadone treatment, prisoners will be easier to handle and will not display symptoms associated with withdrawal like vomit and diarrhea, she said.
Importantly, the study demonstrated that participants who re-engaged in methadone treatment after release had lower rates of recidivism — or relapse into criminal activity — according to Kelly Moore, postdoctoral fellow at the School of Medicine and first author of the study.
Whether or not methadone maintenance treatment reduces crime and recidivism has been highly disputed, Moore said, but this study has consistently shown that people who receive methadone from the same provider before, during and after incarceration have better outcomes during incarceration and after their release.
The findings suggest that implementing a methadone treatment in more prisons may be advantageous, according to the researchers.
“Engaging a community provider to dispense methadone in a jail facility is feasible and effective,” said Sherry McKee, the senior author of the study. “Other jail and prison facilities could collaborate with a local provider to implement a methadone program in their facilities.”
Methadone treatment remains limited in the correctional system — only 12 percent of jails offer continued methadone during incarceration — for multiple reasons, the study’s coauthors noted. Methadone is subjected to several levels of regulatory control, limiting the implementation of methadone programs in correctional facilities.
Moreover, stigma and misperceptions about medication-assisted treatments for opioid use disorder limit the implementation of methadone in jails and prisons, McKee said.
“The justice system doesn’t really understand or appreciate the value of opioid-antagonist treatments for patients, and people in the criminal justice system often don’t recognize addiction as a disease,” Maurer said.
More broadly, Moore said, researchers must still tackle the stigma against addiction that exists within both the criminal justice system and society at large as well as work toward more widespread support for medication-assisted treatments.
She added that McKee’s lab is continuing to investigate the impact of methadone maintenance, particularly in prison settings where people must be kept on methadone for longer periods of incarceration — rather than the shorter periods that the study focused on.
In 2015, 723 people died from drug overdoses in Connecticut, of whom 44 percent had a state Department of Correction record, according to the New Haven Register.
Amy Xiong | amy.xiong@yale.edu