Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Randomized Trail of Continues Methadone Maintenance Versus Detoxification in Jail
Brief Summary: Methadone maintenance treatment (MMT) has been shown to be effective in reducing drug use, criminal activity and recidivism. Given this effectiveness, maintaining individuals who are enrolled in community MMT when committed to the Department of Corrections for short term incarceration would improve post release outcomes. However, this is rarely practiced in the United States. Current practice at the Rhode Island Department of Corrections is to detox inmates on methadone within 30 days of being incarcerated. More than 75% of these individuals are incarcerated for less than six months. The period immediately after release from incarceration is a particularly high-risk time for HIV and other problems including drug relapse and overdose.

The investigators hypothesize that inmates who are incarcerated for 6 months or less will have better outcomes and cost the state less money if they are maintained on their methadone dose and relinked to their community clinic at release, than the current practice of detoxification.


Options:
A: Inclusion Criteria:

* Report injection drug use in the 6 months before screening
* Possess a Thai National Identification Card
* Laboratory values as follows within 2 weeks before enrollment:
* HIV oral fluid test non-reactive at screening and pre-enrollment visits
* Hemoglobin 9 gm/dL
* ALT and AST 2.5 x upper limit of normal (ULN)
* Total bilirubin 1.5 mg/dL
* Serum amylase 1.5 x ULN
* Serum phosphorus 2.2 mg/dL
* No evidence of current or chronic Hepatitis B infection by serology
* Calculated creatinine clearance 60 mL/min by the Cockcroft-Gault formula where creatinine clearance in mL/min = Male: (140 - age in years) x (wt in kg)/72 x (serum creatinine in mg/dL) Female:(140 - age in years) x (wt in kg) x 0.85/72 x (serum creatinine in mg/dL)
* Willing to abstain from sexual intercourse or use effective contraception during the trial (oral, injection, or barrier), for women
* Willing and able to provide informed consent for study participation
* Available and committed to DOT or monthly follow-up for at least 12 months

Exclusion Criteria:

* Clinic physicians will determine if a subject with chronic illness requiring prescription medication can not enroll (medication used for drug treatment is allowed)
* Positive urine pregnancy test
* Breastfeeding
* History of significant renal, liver, or bone disease
* Any other clinical condition or prior therapy that, in the opinion of the clinic physician, would make the subject unsuitable for the study or unable to comply with the dosing requirements
* Concurrent participation in any other HIV prevention trial or drug/vaccine safety trial. AIDSVAX B/E HIV vaccine trial (CDC protocol #2076) participants and Extension Study (CDC protocol #3750) participants may be screened for enrollment in the Bangkok Tenofovir Study.
B: Inclusion Criteria:

(a) Substance abuse or dependence disorder requiring outpatient treatment, and (b)after consulting with his or her attorney, the youth and family voluntarily agrees to enter juvenile drug court.

Exclusion Criteria:

(a) Their current offense is the sale of drugs, a gun offense, a violent offense, or sexual battery,(b) their current offense is likely to merit commitment to a secure or locked juvenile justice facility or (c) they have severe mental illness or retardation according to their intake MJDC evaluation.
C: Inclusion Criteria:

* Adults incarcerated in NYC jails with known release date
* DSM-IV criteria for current opioid dependence
* No current agonist (methadone, buprenorphine) treatment
* Currently opioid free by history ('detoxed') and with a negative urine for all opioids
* General good health as determined by complete medical interview and physical examination
* Age 18-60 years.

Exclusion Criteria:

* History of liver failure, cirrhosis, or recent liver function test levels greater than three times normal
* Pregnancy, lactation, or planning conception
* Active medical illness that might make participation hazardous
* Untreated psychiatric disorder
* History of allergic reaction to naltrexone, PLG (polylactide co-glycolide), carboxymethylcellulose, or any other components of the diluent.
* Current chronic pain condition treated with opioids.
D: Inclusion Criteria:

* currently incarcerated at the RI Department of Corrections
* enrolled in a Rhode Island methadone treatment program at the time of incarceration
* currently maintained at the pre-incarceration methadone dosage level
* estimated total incarceration time of \< 6 months and \> 1 week
* willing to be randomized and to conduct follow-up interviews for 12 months
* English or Spanish-speaking
* able to give informed consent
* age 18 years or older
* willing to remain on MMT and continue MMT after release.

Exclusion Criteria:

* pregnancy (pregnant women are maintained on pre-incarceration levels of methadone throughout their pregnancy for their health and the health of the fetus by the RI DOC, so are NOT eligible to be randomized to Arm 2)
* not fulfilling all of the inclusion criteria.

Answer: D