Diversion to Treatment for Injection Drug Users Arrested for Possession of Heroin
Condition: Cocaine-Related Disorders; HIV; Heroin Dependence
MeSH terms: Cocaine-Related Disorders; Heroin Dependence
Study type: Interventional
Phase: Phase 1

Summary: 
      More Americans are arrested for drug offenses than for any other crime. In 2009, over 294,000
      arrests were made for possession of cocaine or heroin. Incarceration does not address the
      root problems and is frequently followed by relapse and re-arrest after release. In the case
      of opiate-dependent adults arrested for possession of heroin, one potentially effective
      alternative is to divert offenders to methadone maintenance treatment (MMT) as an alternative
      to adjudication of their case. MMT is an effective treatment for heroin dependence, and
      appears very effective for criminal offenders. However, cocaine use is common in MMT
      patients, including those with recent criminal justice involvement, and MMT alone is
      ineffective in addressing cocaine use. Continued cocaine use carries a substantial health
      burden and necessarily entails continued criminal activity. Thus, treatment for diverted
      opiate-dependent offenders should be designed to address cocaine use as well as opiate use. A
      Stage 1 Behavior Therapy Development project is planned over 2 years to adapt, manualize and
      pilot test the Therapeutic Workplace intervention for adults charged with heroin possession
      and offered diversion to methadone maintenance treatment as an alternative to adjudication of
      their case. The Therapeutic Workplace is a novel, employment-based contingency management
      intervention that has been very effective in promoting cocaine abstinence in adults who use
      cocaine persistently during methadone treatment. In the Therapeutic Workplace, participants
      are hired in a model workplace and required to provide drug-free urine samples to work and to
      earn maximum pay. Once we develop and manualize the adapted version of the Therapeutic
      Workplace for adults arrested for heroin possession, a pilot test will be conducted.
      Individuals identified by the State Attorney's office as candidates for diversion will be
      assessed for study eligibility. Given the high rates of injection drug use and
      injection-related transmission of HIV in Baltimore, this study will be restricted to
      injection drug users to evaluate the potential utility of this intervention in reducing HIV
      risk. Eligible individuals will be offered methadone maintenance in lieu of prosecution and
      will be required to remain in methadone treatment for 90 days. All participants will receive
      standard MMT, independent of whether they decide to participate in the pilot study. After
      beginning MMT, participants will be invited to enroll in the pilot study and randomly
      assigned to two study groups. Participants assigned to the Usual Care Diversion group will
      receive the standard MMT. Participants assigned to the Therapeutic Workplace Enhanced
      Diversion group will receive the standard MMT and the Therapeutic Workplace intervention. The
      data from this pilot study will serve as the foundation for a full-scaled randomized
      controlled trial. Overall, the Therapeutic Workplace could serve as a novel and ideal
      intervention for many heroin dependent adults involved in the criminal justice system. The
      use of MMT in lieu of adjudication in combination with the Therapeutic Workplace could
      increase drug abstinence and employment and decrease HIV risk and criminal activity in this
      refractory high-risk population.
    


Intervention name(s): Methadone; Buprenorphine; Employment-based drug abstinence reinforcement
Intervention type(s): Drug; Drug; Behavioral
Intervention description(s): Clinic-Based Methadone Maintenance Treatment; Clinic-Based Buprenorphine Maintenance Treatment
Other intervention name(s): Therapeutic Workplace
Intervention MeSH terms: Buprenorphine; Methadone
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cocaine; Heroin; HIV; Contingency Management; Incentives; Criminal Justice; Methadone; Buprenorphine; Employment; Job Training; Wage Subsidies