Analyzing Mmt Programs' Rate of Success in Curing Opiate Addiction and Preventing Relapse at Inmates

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What if I told you that Methadone and Buprenorphine treatment programs for opiate offenders in prisons have been shown to be effective in lowering post-release opiate abuse, but 75% of these inmate’s nation-wide do not receive this treatment. Is it wrong that so many prisons across the nation do not provide this proper treatment for these inmates? It most certainly is. Programs such as Methadone Maintenance Treatment (MMT) and Buprenorphine Maintenance Treatment (BMT) are not necessarily designed to reduce recidivism, but to get the offender off of the opiate, which in most cases is heroin. With over 4000 prisons currently being run in the United States alone, it’s no surprise that MMT and BMT programs do not reach every opiate offender. Such treatment programs are designed to slowly get the offender off of the drug by; “relieving the craving of the drug, building up a mental tolerance, and suppressing opioid abstinence” (Joseph et al., 2000, p. 349). The necessity of these programs is evident when looking at their effectiveness and outcomes. Repeat heroin offenders that are processed through prison-based drug treatment programs such as MMT and BMT have a much lesser chance of re-abusing heroin than those who do not go through the treatment programs.

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The history of prison-based drug treatment programs can be traced back to the 60s’ when it was undertaken as a research project at the Rockefeller University in New York according to Joseph et al. In his review of the history of MMT programs he tells us that the research project came about because in the 50s’ in New York, heroin injection became the leading cause of death for individuals ages 15-35. The research project started with a small sample size of just 6 male heroin addicts that have suffered with their addiction for more than eight years. Through trial and error with different drugs substitutes such as morphine and other drugs, the research team then investigated a “long-term narcotic” such as methadone. They realized that at that time, methadone treatment was shown to be most effective. Not every person who qualified for the program received the same dose and method of treatment. That all depended on their different levels of heroin dependency. Joseph also stated that physician and staff “must evaluate patients in order to determine the proper initial dose of methadone”. It was important that patients received proper amounts of methadone in order to properly be rehabilitated.

After many years of development and evolution of MMT programs across New York and many other states, a study was conducted in 1980 by Ball and Ross. “Seventy seven percent of the patients stopped their intravenous use of heroin over a period of six months. After 4.5 years of treatment, 92% had stopped heroin use, 96% reported no use of barbiturates and amphetamines, and 83% were not using cocaine.” (Joseph et al., 2000, p. 352). At this point in time it was evident that MMT programs were serving their purpose in aiding offenders get over their addiction to opiates. It was also stated in Josephs’ article that dosage, length of treatment, and length of opiate abuse are all important factors in determining the effectiveness of the intervention. “Medical studies have shown that methadone maintenance is medically safe and nontoxic, can be used effectively in pregnancy, and does not impair intellectual, cognitive or motor functioning” (Joseph et al., 2000 p. 362). So why not implement such programs as MMT and BMT into all prisons across the US? It’s an undertaking that would be difficult to attain due to the lack of knowledge of the effectiveness of these programs. But looking at similar programs in different nations could help us in understanding its’ value and importance.

“In ex-prisoners in Taiwan with a history of opiate injecting, enrollment and continued participation in methadone maintenance treatment is associated with substantially lower mortality” (Huang et al., 2011 p. 1437). Reading a statement such as this one certainly makes you wonder why all opiate offenders are not provided with such treatment. Huang noted that in their research they, “conducted a prospective cohort study of the 4357 released prisoners with a history of drug use; nearly all had a history of injecting heroin and all were released from prison on the same day.” Note that this program was carried out post-release and not did not mandate that all released prisoners enroll in the program. This made for a very large study in which the results clearly showed that, participants who dropped out of the program, or refused to partake in it suffered a mortality rate much higher than those who stayed throughout the duration of the treatment. After 18 months post-release, 142 of the 4357 had passed away, with many (69) dying from drug abuse related causes as reported by Huang. The re-incarceration rate for those who stayed with the program for the full 18 months was significantly lower than those who dropped out; 3.4% as opposed to 61.1%. This program although carried out in Taiwan, which has a different crime rate, mortality rate, and drug abuse rate from the United States, has proven that the program is effective. Its main goal was to rehabilitate the individual and get them off of the drug, and that is exactly what it had intended to accomplish.

Another country that has implemented the MMT program has been Ireland, but the question of ‘is this program effective enough to reduce re-abuse of opiates’ is still in limbo in a nation that has dissimilar rates of mortality, drug abuse, and crime. The difference with the program carried out in Mountjoy Male Prison was that it was done while the offender was still incarcerated as opposed to receiving the treatment post-release. The research and interviews conducted by Tony Carlin looked at how the staff and prisoners viewed the program within the prison. “The study was conducted over a four-month period in 2003. It comprised thirty-one individual semi-structured interviews with prisoners and prison staff (fifteen with the former and sixteen with the latter)” (Carlin, 2005, p. 409) Interviews from both the inmates and staff of the prison were limited due to the lack of cooperation and time constraints. The interviews Carlin conducted concluded that, “Prisoners perceived it as leading to an improvement in their relationships with their families, while staff viewed it as facilitating a more stable and safer working environment” This is very important in knowing that the individuals who take part in this program, whether it be inmate or staff, are supportive of its outcome. One thing that Carlin found out was that both parties had negative views on how the methadone was distributed to them. “There were negative views expressed by both groups about the manner in which methadone is dispensed within the prison, and also because methadone was viewed as being as addictive as heroin” (Carlin, 2005, p. 405). Some of the prisoners who enrolled in the program said that the methadone at some points was distributed “as candy and a free-for-all”. This issue would certainly not be allowed in prisons if it was to be effective. Carlin also concluded that many inmates described the fact that their dependence on methadone, was described to be as bad if not worse than heroin dependence.

Follow-up studies are conducted to see how individuals that enrolled in a specific program are doing months, if not years after their conclusion of the treatment program. In two research articles reviewed, the findings of 6 month post-release follow up, and 4 year follow up showed just how effective these MMT programs are. The 6 month post-release research done by Gordon et al. in a Baltimore based prison examined how 3 different groups compared to one another.

“Participants were assigned randomly 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).”

Gordons’ findings of these 3 separate groups showed that the group that received both counseling and methadone showed the lowest rate of drug abuse in urine tests at a 6 moth post-release follow up. He also noted that simply just counseling opiate offenders did little to prevent them from re-offending. As compared to the findings of Dolan et al.

In the empirical study done by Carmen E. Albizu-Garcia et al. used data that was obtained over an 8 month period with input from the Department of Correction and Rehabilitation (DCR) of Puerto Rico (PR). The researchers looked at and addressed the fact that the Medication-Assisted Treatment was far used far less than its’ effectiveness shows. In this research they studied a total of 10,849 sentenced inmates, most of which were randomly selected; the institutions were selected dependent on their size, security level, and use of lifetime drug dependency amongst inmates. They found that 21% to 55% of all adult males and 12% to 68% of all adult females in various prisons were categorized as lifetime drug dependent individuals. In addition they found that 36% of males and 31% of females under the age of 35 were categorized as lifetime opiate dependent individuals without proper treatment. It was estimated that only 1.9% of inmates were opiate dependent, but results showed that that number was indeed 10 to 20 times greater.

A few limitations listed were addressed in this article is that future research should be “cautious in interpreting prevalence estimates, since the true prevalence of infection is likely underestimated.” Also future research should be mindful of the fact that HIV or HCV testing is not carried out, an alternative that reduces cost is to obtain linked data from a sub-sample of a larger study.

The systematic review of the effectiveness of opioid maintenance treatment (OMT) in prison settings by Hedrich et al. looked to determine how effective these in-prison programs really are. By observing a total of 21 programs and studies they concluded that if the prison program provides the right doses, that the program can be very effective. With 4 of 5 studies showing significantly lower rates of post-release heroin use, the programs are indeed effective. Programs such as these OMT’s are needed in more prisons across the nation to reduce re-imprisonment rates not only associated with heroin use but also other crimes. Although the studies did not show evidence of lowered HIV/HCV rates in these programs, one can conclude that the halted use of heroin amongst prisoners in these institutions would certainly lead to a lower rate of HIV/HCV transmission. Studies have shown that enrolling an offender in OMT programs pre-release tends to aid them in treatment uptake post-release. Clearly programs such as these are intended to stop opioid abuse and they are clearly effective in the institutions/programs reviewed.

Some limitations listed in the review are that future studies should get more emphasis on larger designs and by reviewing the probable impact of bias on those outcomes. Biases that could arise would be “baseline differences between groups, especially selection bias in observational studies, bias due to attrition and differential rates of follow-up and social acceptability bias in self-report data.” As well there was little to no evidence to support the idea that OMT programs have a significant impact on HIV transmission. Future research should look to address those issues in order to come up with more accurate findings regarding the effectiveness of OMT programs.

The research study of the necessity of drug treatment and recovery for the female population, particularly in Illinois is done by Horton. Seeing as to how the percentage of incarcerated females has nearly tripled in the past decade, prisons have not been able to provide treatment and recovery programs for all or in some cases, any women. Recidivism in Chicago for females has risen to an all-time high at 53% within 3 years of their release. History has shown that prison based needs have only been focused on the male population due to the fact that the increase of a female incarcerated population has just recently grown so large. Some discussed reasons as to why the female incarcerated population has grown so much are because females get abused at a much higher rate than males, as well as the fact that female inmates report higher use of drugs at the time of the arrest than males. Although this study of female drug abuse only looks at a certain population (Chicago), it looks at a metropolitan that exhibits the highest rate of heroin abuse in the whole nation.

A few shortcomings of this research study are that it looks at too small and concentrated of a population. Studies should be evaluated from different cities in different parts of the country in order to determine the effectiveness of programs for females and how to make more of those programs. There were no limitations listed in the article. Future research should look to build off of this and help acknowledge the fact that females are being incarcerated at a higher rate than ever in history.

The article written and researched by Kinlock et al. looks to inform us on how prison-based Buprenorphine treatment programs differ from Methadone treatment programs, and how to implement them. A large clinical trial showed that pre-release prison-initiated Methadone treatment programs, were far more effective in a 12 month post-release examination than counseling on the use and abuse of heroin. Few prisons across the US carry well-structured MMT programs; 12% according to large scale surveys of jail officials. The biggest thing about Buprenorphine treatment is that it can be administered outside treatment programs unlike Methadone treatment. This is very important because people within the program would be able to administer the drug themselves with no street value of it. Many previous studies have shown that Buprenorphine treatment is as effective, if not more so effective, than Methadone treatment. This article further speaks to how to administer the treatment, dose amounts, planning, logistics, medical staff training, and release from prison. The main noted disadvantage of Buprenorphine treatment as opposed to Methadone treatment is that a patient could try to divert a tablet of Buprenorphine than liquid Methadone.

With no limitations listed in this research paper, the author does inform us on how to better help these programs grow and develop into more prisons. In order to get this type of treatment to grow, “researchers, treatment providers, and corrections officials should not be limited to reporting outcomes on the effectiveness of their interventions, but on the unique challenges they faced and how they overcame them.” Subsequent researchers and agencies would certainly use the research done by previous journalists and researchers to help build Buprenorphine programs in their prison.

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