Community-based treatment for opioid dependent offenders: a pilot study.

ABSTRACT

BACKGROUND: Primary care opioid substitution treatment (OST) has not been compared to program-based OST for community-supervised offenders. OBJECTIVE: The purpose of this project was to compare primary care to specialist supervised OST for opioid dependent offenders in terms of substance use and HIV risk outcomes. METHODS: This project randomly assigned 15 jail diversion participants to either (i) primary care buprenorphine OST, (ii) specialist facility buprenorphine OST, or (iii) specialist facility methadone OST. Participation lasted 13.5 months (12-month active treatment plus a post-participation visit). RESULTS: All subjects endorsed 0 days of opioid use in the previous 14 at follow-up. Specialty care reduced HIV risk (Risk Assessment Battery composite score) over 6 months (-.24 ± .17) compared to primary care (.02 ± .14; p = .032). CONCLUSION: Findings support primary care OST feasibility for a community-supervised offender sample. Specialist care may facilitate improvements in secondary outcomes, such as HIV risk behaviors. SCIENTIFIC SIGNIFICANCE: Further research is needed to clarify (i) the role of primary care in addicted offender management, and (ii) the matching of offenders, based upon history and co-morbidity, to care coordination conditions.