Reducing Drug Use and HIV Risk in Drug-dependent Adults Arrested for Prostitution
Condition: Substance-related Disorders; HIV Risk Behavior
MeSH terms: Substance-Related Disorders
Study type: Interventional
Phase: Phase 1

Summary: 
      The combination of using injection drugs, smoking crack cocaine, having multiple sex
      partners, and inconsistent condom use results in substantial risk for acquiring and
      transmitting HIV, and many drug dependent adults who have been arrested on charges of
      prostitution fit this profile. Existing interventions for reducing HIV risk have had limited
      efficacy in drug-dependent sex workers, and criminal justice approaches have been ineffective
      despite their high cost. A potentially ideal alternative is to divert drug-dependent
      arrestees from prosecution to a treatment that reduces drug use and HIV sex risk behaviors,
      while providing job skills training and promoting community employment to alleviate the
      financial need to continue sex work. In order to provide an effective therapeutic alternative
      to criminal prosecution, the investigators propose to develop a multifaceted intervention
      that includes opiate agonist treatment (i.e., methadone OR buprenorphine) and the Therapeutic
      Workplace. The Therapeutic Workplace is a supported environment in which participants are
      required to provide drug-free urine samples to access paid job skills training or employment
      and to maintain the maximum rate of pay. The overall intervention is designed to reduce drug
      use and HIV risk behaviors, and simultaneously promote employment. The proposed project is a
      2-year Stage I behavior therapy development effort that will include the development,
      manualization and pilot testing of a Therapeutic Workplace intervention tailored to
      drug-dependent adults arrested for prostitution. In the pilot study, the investigators will
      recruit opiate- and cocaine-dependent adults arrested for prostitution from the Eastside
      District Court in Baltimore. Eligible individuals will be offered methadone treatment in lieu
      of prosecution and will be required to remain in methadone treatment for 90 days to have the
      charges against them dropped. After enrolling in opiate agonist treatment, the diverted
      individuals will be invited to participate in the pilot study. Interested individuals will be
      randomly assigned to receive the standard opiate agonist treatment services or these services
      plus the Therapeutic Workplace. The Therapeutic Workplace has two phases. In Phase 1,
      participants will be offered four months of stipend-supported job training in the Therapeutic
      Workplace. In Phase 2, participants will be encouraged to seek employment in a community job
      and will receive wage subsidies for four months for maintaining community employment or
      engaging in supervised job seeking. Throughout both phases, participants will be required to
      provide drug-free urine samples to receive Therapeutic Workplace wages (training stipends in
      Phase 1 and wage subsidies in Phase 2). The wage subsidy program will include drug testing
      managed by a national supplier of drug-free workplace services. Overall, this treatment could
      serve as a novel and ideal intervention for drug-dependent adults arrested for prostitution
      while reducing criminal justice costs.
    


Intervention name(s): Therapeutic Workplace; Methadone; Buprenorphine
Intervention type(s): Behavioral; Drug; Drug
Intervention description(s): Participants can access stipend supported academic and job skills training for adults and/or receive wages or wage subsides for actual employment. Access to training and employment is contingent upon meeting therapeutic targets. Potential targets include, but are not limited to, drug abstinence and medication adherence.; Methadone in liquid form, with the dosage determined by physician on an individual basis. Anticipated dose range 30mg to 100mg daily. Methadone is administered daily at a methadone clinic for as long as enrollment in the methadone clinic is maintained.; Subutex (buprenorphine hydrochloride) and Suboxone tablets (buprenorphine hydrochloride and naloxone hydrochloride) are approved for the treatment of opiate dependence. Subutex and Suboxone treat opiate addiction by preventing symptoms of withdrawal from heroin and other opiates.
Other intervention name(s): Suboxone, Subutex
Intervention MeSH terms: Buprenorphine; Methadone
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment