A Scoping Review of the Influence of Evidence-Based Program Resources (EBPR) Websites for Behavioral Health.

Evidence-based program resources (EBPR) websites evaluate behavioral health programs, practices or policies (i.e., interventions) according to a predetermined set of research criteria and standards, usually resulting in a summary rating of the strength of an intervention's evidence base. This study is a mixed-methods analysis of the peer-reviewed academic literature relating to the influence of EBPRs on clinical practice and policy in the behavioral health field. Using an existing framework for a scoping review, we searched for research articles in PubMed, Web of Science, SCOPUS, and ProQuest that were published between January 2002 and March 2022, referenced an EBPR or multiple EBPRs, and presented data showing the influence of one or more EBPRs on behavioral health. A total of 210 articles met the inclusion criteria and were classified into five distinct categories of influence, the most important of which was showing the direct impact of one or more EBPRs on behavioral health (8.1% of articles), defined as documenting observable changes in interventions or organizations that are at least partly due to information obtained from EBPR(s). These included impacts at the state legislative and policy-making level, at the community intervention level, provider agency level, and individual practitioner level. The majority of influences identified in the study were indirect demonstrations of how EBPRs are used in various ways. However, more studies are needed to learn about the direct impact of information from EBPRs on the behavioral health field, including impact on clinician practice and treatment outcomes for consumers.

Gender Differences in Drug Use among Individuals Under Arrest.

Background: Drug monitoring by drug testing of individuals under arrest provides an opportunity to detect drug use patterns within geographic areas. However, women have been omitted from large-scale monitoring efforts in criminal justice populations. The purpose of this study was to examine whether gender differences exist in drug use indicated by oral fluid collected in one U.S. jail. Methods: The study analyzed data collected in 2019-2020 from individuals under arrest (N = 191). Twenty-four percent of the sample identified as female. Oral fluid specimens were collected and then analyzed with enzyme-linked immunosorbent assay and liquid chromatography/tandem mass spectrometry. Logit regression models examined gender differences. Results: Women were more likely to test positive for methamphetamines than men (41% versus 22%, OR = 0.42, 95% CI 0.21-0.84). Significant gender differences were not found for other substances (marijuana, cocaine, and opioids), legality of drugs, or overall drug use. Conclusions: Because the National Institute on Drug Abuse aims to promote health equity, future drug monitoring in criminal justice populations should employ sampling approaches representing both women and men. This research would identify possible gender-based patterns of drug use and inform gender-based policies and clinical practices to prevent and treat drug misuse.

Visitors' Assessment and Utilization of Evidence-Based Program Resources (EBPR) Websites.

Background: Evidence-based program resources (EBPR) websites for behavioral health are a potentially useful tool to assist decision-makers and practitioners in deciding which behavioral health interventions to implement. EBPR websites apply rigorous research standards to assess the effectiveness of behavioral healthcare programs, models, and clinical practices. Method: Visitors to a convenience sample of six EBPR websites (N=369, excluding students) were recruited for telephone interviews primarily by means of a pop-up invitation on the sites. Results: The visitors view the EBPR sites as important sources of information to support the identification and adoption of evidence-based programs/practices (EBPs) in behavioral healthcare, which aligns with the primary mission of EBPRs. For repeat visitors, there was some indication that the information obtained helped effect certain changes in their agencies' programs and policies. However, increased or improved guidance on EBP implementation was also requested. Conclusion: EBPR websites should be better publicized to the behavioral healthcare field.

Surveillance by oral fluid of drugs subject to misuse among individuals under arrest.

Background: Between 1988 and 2013 the U.S. government conducted surveillance of national drug misuse use trends by collecting voluntary urine specimens from individuals under arrest in major counties. It was discontinued for financial reasons. The program was the only national survey that used a bioassay to measure drug use. Other national drug surveys continue to be based entirely on self-reports of drug use.Objective: Given the current opioid and incipient methamphetamine epidemics, this study aimed to demonstrate the feasibility of surveilling drugs subject to misuse among individuals under arrest using oral fluid collected anonymously by jail staff in one U.S. county. This method has never been previously employed with an offender population.Methods: The subjects were adults arrested for any reason and booked in one Midwest county jail in the U.S. between July 2019 - January 2020 (N = 196; 145 males). Oral fluid specimens were provided for research purposes voluntarily and anonymously.Results: 79% of individuals approached consented to participation. The most frequently detected drugs were cannabis (53%), methamphetamine (27%), cocaine (9%) and opioids (11%). Further, 74% tested positive for at least one drug; 36% tested positive for at least one illegal drug, 10% tested positive for at least one possibly illegal drug, and 54% tested positive for at least one legal drug (predominantly cannabis). (Tests for nicotine and ethanol were not included.)Conclusion: The feasibility of collecting oral fluid from individuals under arrest in a jail setting to measure the prevalence of drugs subject to misuse was demonstrated.

The Effectiveness of Interventions Intended to Improve Employment Outcomes for Persons with Substance Use Disorder: An Updated Systematic Review.

BACKGROUND: Employment is one of the strongest predictors of positive outcomes for persons with substance use disorder. Purpose: To conduct a systematic review of interventions intended to improve employment outcomes for persons with substance use disorder (SUD) at any stage of recovery. This is an update of a prior review published in 2004. Methods: Two bibliographic databases, PUBMED and PSYCHINFO, were searched for articles published in the period 2005-2018 that referenced employment, education, or vocational rehabilitation for people with SUD. Results: One hundred thirty-two articles were identified of which 14 met the criteria for inclusion, primarily a minimum of a quasi-experimental evaluation design. Each study was reviewed with the following format: setting (modality); subject characteristics; research procedures; results; limitations/comments. Results: Nine programs or models were represented among the 14 studies, with Individual Placement and Pupport (IPS) and its variant Customized Employment Supports (CES) having the most studies with positive results. But generally, the magnitude of any intervention effects on employment was small for all interventions; one outcome may have shown statistical significance while one or more other outcomes did not, and there was little consistency in how outcomes were measured among the studies. Conclusions/Importance: IPS/CES currently shows the most evidentiary support. But all the studies of interventions with positive outcome data should be replicated with larger samples in diverse settings.

Social capital, substance use disorder and depression among youths.

BACKGROUND: Social capital - the network of social connections that exists among people - is known to be related to depression and substance use among adults. However, little is known about these relationships among adolescents, even though this age group is vulnerable due to factors of peer pressure, family, neighborhood, and maturational changes. OBJECTIVES: To evaluate the associations among social capital, substance use disorder and depression on a sample of 17 705 respondents between the ages of 12 and 17 in the 2009 National Survey of Drug Use and Health. METHODS: Structural equation modeling was used to examine social capital; responses to 48 items differentiated into two factors that measured structural social and cognitive social capital. Adolescent depression and substance use disorder were measured as past-year major depressive episodes and substance use disorder according to DSM-IV criteria. RESULTS: Structural social capital was associated with substance use disorder (ß = -0.12; p = 0.001) and depression (ß = -0.19; p = 0.001). Cognitive social capital was associated with substance use disorder (ß = -0.17; p = 0.001), but not with depression (ß = -0.002; p > 0.005). Substance use disorder mediated the association between structural and cognitive social capital and depression (ß = 0.06; p = 0.001). CONCLUSION: There was support for associations among youth structural and cognitive social capital, substance use disorder and depression. These findings suggest that additional research of a longitudinal nature is needed to determine causal connections among social capital, depression and substance use disorder for adolescents.

Adding urine and saliva toxicology to SBIRT for drug screening of new patients.

BACKGROUND AND OBJECTIVES: To determine illicit drug use among new patients in primary medical care who denied using "street drugs" during Screening, Brief Intervention and Referral to Treatment (SBIRT). METHODS: 96 new patients who denied use of "street drugs" were tested for drugs as part of routine SBIRT screening. RESULTS: Of those tested, 14.6% of those with urine specimens and 4.1% of those with saliva specimens tested positive for illicit drugs. DISCUSSION AND CONCLUSIONS: Drug toxicology can detect unreported illicit drug use during SBIRT screening, with urine being superior to saliva. SCIENTIFIC SIGNIFICANCE: Drug toxicology can increase the effectiveness of SBIRT screening in primary care medical clinics.

Direct-To-Definitive Urine and Oral Fluid Test Results for Unscreened and Rarely Screened Drugs in Individuals Applying for Methadone Treatment in 7 U.S. States.

The standard protocol in addiction treatment/pain management is to conduct immunoassay screens for major drugs subject to misuse, followed by confirmatory testing of positive results. However, this may miss unscreened or rarely screened drugs that could pose risks, especially to polydrug users. We sought to determine the prevalences of unscreened/rarely screened drugs in a sample of individuals misusing drugs in 7 U.S. states, and to compare the results of urine vs. oral testing for these drugs by direct-to-definitive liquid chromatography/tandem mass spectrometry (LC-MS-MS). The five drugs with the highest prevalences were: gabapentin (16.8%), quetiapine (6.2%), chlorpheniramine (5.3%), hydroxyzine (4.9%), and ephedrine (3.5%). All have clinical significance as indicated by severity of possible side effects, interactions with other drugs, and/or misuse potential. Drugs were generally detected more frequently in oral fluid than urine, but gabapentin was more frequently detected in urine. The prevalences of the included drugs seem high enough, and their clinical significance important enough, to warrant consideration of expanding clinical drug test panels, either by direct-to-definitive testing or the addition of selected immunoassay screens when available. Oral fluid was usually more suitable than urine as the test matrix, given the higher rates of detection in oral fluid for most substances included in this study.

Discrepancies in Ratings of Behavioral Healthcare Interventions Among Evidence-Based Program Resources Websites.

Decision makers in the behavioral health disciplines could benefit from tools to assist them in identifying and implementing evidence-based interventions. One tool is an evidence-based program resources website (EBPR). Prior studies documented that when multiple EBPRs rate an intervention, they may disagree. Prior research concerning the reason for such conflicts is sparse. The present study examines how EBPRs rate interventions and the sources of disagreement between EBPRs when rating the same intervention. This study hypothesizes that EBPRs may disagree about intervention ratings because they either use different rating paradigms or they use different studies as evidence of intervention effectiveness (or both). This study identified 15 EBPRs for inclusion. One author (M.J.L.E.) coded the EBPRs for which "tiers of evidence" each EBPR used to classify behavioral health interventions and which criteria they used when rating interventions. The author then computed one Jaccard index of similarity for the criteria shared between each pair of EBPRs that co-rated interventions, and one for the studies used by EBPR rating pairs when rating the same program. The authors used a combination of chi-square, correlation, and binary logistic regression analyses to analyze the data. There was a statistically significant negative correlation between the number of Cochrane Risk of Bias criteria shared between 2 EBPRs and the likelihood of those 2 EBPRs agreeing on an intervention rating (r = -.12, P ≤ .01). There was no relationship between the number of studies evaluated by 2 EBPRs and the likelihood of those EBPRs agreeing on an intervention rating. The major reason for disagreements between EBPRs when rating the same intervention in this study was due to differences in the rating criteria used by the EBPRs. The studies used by the EBPRs to rate programs does not appear to have an impact.

Comparing presumptive with direct-to-definitive drug testing in oral fluid vs. urine for a U.S. national sample of individuals misusing drugs.

BACKGROUND: The aims are to compare the results of presumptive drug testing with confirmation of positives vs. direct-to-definitive drug testing, combined with investigation of urine vs. oral fluid as test matrices. METHODS: Paired oral fluid and urine specimens were collected voluntarily and anonymously from 1098 individuals applying for methadone treatment in 11 clinics across 7 U.S. states. All specimens were analyzed by immunoassay (IA) and liquid chromatography-tandem mass spectrometry (LC-MS-MS). RESULTS: Confirmed IA prevalences for urine were significantly higher than for oral fluid for 7 out of 10 drug classes - benzodiazepines, cannabis, cocaine, methadone, opiates, oxycodone and tramadol. Drug prevalences by direct-to-definitive LC-MS-MS were either the same or higher than prevalences by confirmed IA. Drug prevalences by LC-MS-MS were higher in urine for two drug classes (cocaine, methadone) and higher in oral fluid for two drug classes (buprenorphine, tramadol), but were equivalent in urine and oral fluid when averaged over all 10 drug classes. Certain drugs of special concern such as heroin and buprenorphine were more frequently detected in oral fluid than urine. CONCLUSIONS: Urine analysis showed some technical advantage over oral fluid in sensitivity to several drug classes within a confirmed IA testing protocol, but this may be outweighed if there is reason to believe that tampering with urine specimens is a significant problem. Overall drug detection by direct-to-definitive testing was similar for oral fluid and urine, but one matrix may be preferable if there is a particular drug of clinical or epidemiological interest.

The influence of evidence-based program registry websites for dissemination of evidence-based interventions in behavioral healthcare.

PURPOSE: Evidence-based program registries (EBPRs) are web-based databases of evaluation studies that summarize the available evidence for the effectiveness of behavioral healthcare programs, including programs addressing substance misuse, mental health, child welfare, or offender rehabilitation. The study determined the extent to which visitors to selected EBPRs accomplished the objectives of their visits and how often those visits resulted in the adoption of new or improved evidence-based interventions (EBIs). METHOD: A follow-up telephone survey was conducted with 216 visitors to a convenience sample of six EBPRs an average of six months after the visitors' incident visit to the EBPR. RESULTS: The most frequent objective was to identify evidence-based programs/services, curricula or assessments, followed by finding resources to implement or improve the preceding and writing a grant proposal including to comply with funding requirements; 71% of such objectives were achieved across the full set of objectives. Implementation of an EBI was completely achieved for 31% of relevant objectives and some progress on EBI implementation occurred for 19% of relevant objectives. CONCLUSIONS: This is the first study to document the usage of EBPRs as a modality to increase the utilization of EBIs in the actual practice of behavioral healthcare. The results support the continued use of web-based EBPRs for disseminating information on evidence-based interventions for behavioral healthcare.

Failure of intervention or failure of evaluation: a meta-evaluation of the National Youth Anti-Drug Media Campaign Evaluation.

The National Youth Anti-Drug Media Campaign was conducted during 1998-2004 and evaluated through a national, four-wave panel study of adolescents (n = 8,117 at baseline to 5,126 at three-year follow-up). The evaluation's results were unexpected and controversial, finding both no effects overall and a possibly harmful effect, namely inducing initiation of marijuana use. A meta-evaluation by the U.S. General Accounting Office (GAO) supported the original evaluation's major conclusions, but the Campaign's sponsor, the Office of National Drug Control Policy (ONDCP), contested both the original evaluation's findings and the GAO's assessment of them. This study presents an alternative meta-evaluation of the original evaluation, concluding that the Campaign probably was ineffective, but without sufficient evidence of harmful effects. However, had the Campaign been effective, the original evaluation would have been unable to determine that fact due to the possibility of socially desirable responding. The evaluation as designed should never have been conducted. A better try would have been a controlled design in multiple media markets, including a drug testing component.

Buprenorphine-naloxone maintenance following release from jail.

Primary care is understudied as a reentry drug and alcohol treatment setting. This study compared treatment retention and opioid misuse among opioid-dependent adults seeking buprenorphine/naloxone maintenance in an urban primary care clinic following release from jail versus community referrals. Postrelease patients were either (a) induced to buprenorphine in-jail as part of a clinical trial, or (b) seeking buprenorphine induction post release. From 2007 to 2008, N = 142 patients were new to primary care buprenorphine: n = 32 postrelease; n = 110 induced after community referral and without recent incarceration. Jail-released patients were more likely African American or Hispanic and uninsured. Treatment retention rates for postrelease (37%) versus community (30%) referrals were similar at 48 weeks. Rates of opioid positive urines and self-reported opioid misuse were also similar between groups. Postrelease patients in primary care buprenorphine treatment had equal treatment retention and rates of opioid abstinence versus community-referred patients.

Novel electronic refreshers for cardiopulmonary resuscitation: a randomized controlled trial.

BACKGROUND: Currently the American Red Cross requires that individuals renew their cardiopulmonary resuscitation (CPR) certification annually; this often requires a 4- to 8-hour refresher course. Those trained in CPR often show a decrease in essential knowledge and skills within just a few months after training. New electronic means of communication have expanded the possibilities for delivering CPR refreshers to members of the general public who receive CPR training. The study's purpose was to determine the efficacy of three novel CPR refreshers--online website, e-mail and text messaging--for improving three outcomes of CPR training--skill retention, confidence for using CPR and intention to use CPR. These three refreshers may be considered "novel" in that they are not typically used to refresh CPR knowledge and skills. METHODS: The study conducted two randomized clinical trials of the novel CPR refreshers. A mailed brochure was a traditional, passive refresher format and served as the control condition. In Trial 1, the refreshers were delivered in a single episode at 6 months after initial CPR training. In Trial 2, the refreshers were delivered twice, at 6 and 9 months after initial CPR training, to test the effect of a repeated delivery. Outcomes for the three novel refreshers vs. the mailed brochure were determined at 12 months after initial CPR training. RESULTS: Assignment to any of three novel refreshers did not improve outcomes of CPR training one year later in comparison with receiving a mailed brochure. Comparing outcomes for subjects who actually reviewed some of the novel refreshers vs. those who did not indicated a significant positive effect for one outcome, confidence for performing CPR. The website refresher was associated with increased behavioral intent to perform CPR. Stated satisfaction with the refreshers was relatively high. The number of episodes of refreshers (one vs. two) did not have a significant effect on any outcomes. CONCLUSIONS: There was no consistent evidence for the superiority of novel refreshers as compared with a traditional mailed brochure, but the low degree of actual exposure to the materials does not allow a definitive conclusion. An online web-based approach seems to have the most promise for future research on electronic CPR refreshers.

Variations in Definitions of Evidence-Based Interventions for Behavioral Health in Eight Selected U.S. States.

BACKGROUND: U.S. state legislatures fill a vital role in supporting the use of evidence-based interventions (EBIs) through statutes and regulations (mandates). OBJECTIVE: The study determined the terms used by selected states to describe EBIs and how those terms are defined in mandates. RESEARCH METHODS: The mandates of eight purposely selected states were accessed and coded using the Westlaw Legal Research Database. RESULTS: Considerable variation was found in the terms used by states to describe EBIs. Although "evidence-based" was the most frequently utilized term (60% of mandates), an additional 29 alternative terms appeared with varying frequencies. Most terms were simply mentioned, with no further definition or elaboration. When terms were further defined or elaborated, the majority were defined using numerous and different types of external sources or references. Three approaches were found in the mandates defining EBIs: "single definition," "hierarchies of evidence levels," and "best available evidence"; the states differed considerably in the approaches used in their mandates. CONCLUSIONS: The variations in EBI-related terminology across states and within states, coupled with a lack of elaboration on the meaning of important terms and the predominant use of external rather than internal guidelines, may be a source of confusion for behavioral health provider agencies that seek direction about what constitutes an EBI. Prior studies indicate that many agencies may lack staff with the technical ability to adequately evaluate what constitutes an EBI. Thus, lack of clear guidance from official state government mandates may impede the implementation of EBIs within states.

Utilization of Evidence-based Intervention Criteria in U.S. Federal Grant Funding Announcements for Behavioral Healthcare.

Recent U.S. federal government policy has required or recommended the use of evidence-based interventions (EBIs), so that it is important to determine the extent to which this priority is reflected in actual federal solicitations for intervention funding, particularly for behavioral healthcare interventions. Understanding how well such policies are incorporated in federal opportunity announcements (FOAs) for grant funding could improve compliance with policy and increase the societal use of evidence-based interventions for behavioral healthcare. FOAs for discretionary grants (n = 243) in fiscal year 2021 were obtained from the Grants.gov website for 44 federal departments, agencies and sub-agencies that were likely to fund interventions in behavioral health-related areas. FOAs for block/formula grants to states that included behavioral healthcare (n = 17) were obtained from the SAM.gov website. Across both discretionary and block grants, EBIs were required in 60% and recommended in 21% of these FOAs for funding. Numerous different terms were used to signify EBIs by the FOAs, with the greatest variation occurring among the block grants. Lack of adequate elaboration or definition of alternative EBI terms prominently characterized FOAs issued by the Department of Health and Human Services, although less so for those issued by the Departments of Justice and Education. Overall, 43% of FOAs referenced evidence-based program registers on the web, which are scientifically credible sources of EBIs. Otherwise, most of the remaining elaborations of EBI terms in these FOAs were quite brief, often idiosyncratic, and not scientifically vetted. The FOAs generally adhered to federal policy requiring or encouraging the use of EBIs for funding requests. However, an overall pattern showing lack or inadequate elaboration of terms signifying EBIs makes it difficult for applicants to comply with federal policies regarding use of EBIs for behavioral healthcare.

References to Evidence-based Program Registry (EBPR) websites for behavioral health in U.S. state government statutes and regulations.

Background and aim: U.S. state governments have the responsibility to regulate and license behavioral healthcare interventions, such as for addiction and mental illness, with increasing emphasis on implementing evidence-based programs (EBPs). A serious obstacle to this is lack of clarity or agreement about what constitutes "evidence-based." The study's purpose was to determine the extent to which and in what contexts web-based Evidence-based Program Registries (EBPRs) are referenced in state government statutes and regulations ("mandates") concerning behavioral healthcare. Examples are: What Works Clearinghouse; National Register of Evidence-based Programs and Practices; Cochrane Database of Systematic Reviews. Methods: The study employed the Westlaw Legal Research Database to search for 30 known EBPR websites relevant to behavioral healthcare within the statutes and regulations of all 50 states. Results: There was low prevalence of EBPR references in state statutes and regulations pertaining to behavioral healthcare; 20 states had a total of 33 mandates that referenced an EBPR. These mandates usually do not rely on an EBPR as the sole acceptable source for classifying a program or practice as "evidence-based." Instead, EBPRs were named in conjunction with internal state or external sources of information about putative program effectiveness, which may be less valid than EBPRs, to determine what is "evidence-based." Conclusion: Greater awareness of scientifically - based EBPRs and greater understanding of their advantages need to be fostered among state legislators and regulators charged with making policy to increase or improve the use of evidence-based programs and practices in behavioral healthcare in the U.S.

State Department and Provider Agency Utilization of Evidence-Based Program Registries in Behavioral Healthcare and Child Welfare.

Evidence-based program registries (EBPRs) are web-based compilations of behavioral healthcare programs/interventions that rely on research-based criteria to rate program efficacy or effectiveness for support of programmatic decision-making. The objective was to determine the extent to which behavioral health decision-makers access EBPRs and to understand whether and exactly how they use the information obtained from EPBRs. Single State Authorities (SSAs) and service provider agencies in the areas of behavioral health and child welfare were recruited nationally. Senior staff (n = 375) responsible for the selection and implementation of programs and/or policies were interviewed by telephone concerning their visits (if any) to 28 relevant EBPRs, the types of information they were seeking, whether they found it, and how they may have used that information to effect changes in their organizations. At least one EBPR was visited by 80% of the respondents, with a median of three different registers being visited. Most visitors (55%) found all the information they were seeking; those who did not desired more guidance or tools for individual program implementation or were unable to locate the program or practice that they were seeking. Most visitors (65%) related using the information obtained to make changes in their organizations, in particular to select, start or change a program, or to support the adoption or improvement of evidence-based clinical practices. EBPRs were shown to be important resources for dissemination of research-based program effectiveness data, leading to increased use of evidence-based practices in the field, but the study also identified needs for greater awareness of EBPRs generally and for more attention to implementation of specific recommended programs and practices.

State behavioral health agency website references to evidence-based program registers.

PURPOSE: Evidence-based program registers (EBPRs) are important tools for facilitating the use of evidence-based practices or programs (EBPs) by state statutory agencies responsible for behavioral healthcare, broadly defined as substance misuse, mental health, HIV/AIDS prevention, child welfare, and offender rehabilitation. There are currently no data on the purposes for which such state agencies reference EBPRs on their official websites. METHOD: A webscraping method was used to identify and classify relevant "hits", defined as a state behavioral health webpage with single or multiple references to a study EBPR. A total of 778 hits (unique combinations of webpage and register) were coded. Up to three codes were applied to each hit for the "reasons for the EBPR reference" (EBPR use) dimension, one code was applied to each hit for the "purpose of the EBPR reference" and "intended audience of the webpage containing the hit" dimensions, and up to two codes were applied to each hit for the "funding mentions" dimension. RESULTS: Three EBPRs out of 28 accounted for 73.6% of the hits. The most frequent reason for referencing EBPRs were as a resource for selecting EBPs or validating existing programs and practices. The references tended to appear in reports from the state, in training materials, or guidelines. The references tended to address broad groups of behavioral healthcare professionals. EBPRs were frequently referenced in the context of federal block grants or other federal funding. CONCLUSIONS: Increasing state agencies' awareness and use of the entire range of existing EBPRs may improve implementation of EBPs nationally.

Heroin-dependent inmates' experiences with buprenorphine or methadone maintenance.

Methadone and buprenorphine are both efficacious treatments for opioid dependency, but they also have different pharmacological properties and clinical delivery methods that can affect their acceptability to patients. This study was intended to increase our knowledge of heroin-dependent individuals' perceptions of methadone vs. buprenorphine maintenance based on actual experiences with each. The study sample consists of heroin-dependent men at the Rikers Island jail in New York City who were voluntarily randomly assigned to methadone or buprenorphine maintenance in jail. Methadone patients were more likely to report feeling uncomfortable the first few days, having side/withdrawal effects during treatment, and being concerned about continued dependency on medication after release. In contrast, buprenorphine patients' main issue was the bitter taste. All of the buprenorphine patients stated that they would recommend the medication to others, with almost all preferring it to methadone. Ninety-three percent of buprenorphine vs. 44% of methadone patients intended to enroll in those respective treatments after release, with an added one-quarter of the methadone patients intending to enroll in buprenorphine instead. These results reinforce the importance of increasing access to buprenorphine treatment in the community for indigent heroin-dependent offenders.