A randomized trial of methadone initiation prior to release from incarceration.
McKenzie M., Zaller N., Dickman S.L. et al. Substance Abuse: 2012, 33(1), p. 19–29.

This US randomised trial in Rhode Island among formerly opiate dependent prisoners found that starting methadone treatment in prison radically improved treatment uptake on release and reduced heroin and cocaine use over the following six months, confirming results from Baltimore.

Summary
Just over half of US prison systems offer any methadone treatment to opioid-addicted prisoners and those which do, offer it to very few, while the patients face financial and other barriers to continuing treatment on release. The featured study sought to determine whether initiating methadone in prison and/or funding it on release would help opioid-addicted prisoners continue in treatment and reduce their drug use and associated risks after leaving prison. It was conducted across the US state of Rhode Island's prison/jail system, a system centralised at a single site. For prisoners on methadone at entry, generally the system maintains them for a further week and then tapers the dose, meaning that (depending on the sentence) their dose at release could be very low or zero.

Instead the study aimed to randomly allocate prisoners who were injecting drugs just before their imprisonment, and were on methadone or dependent on heroin, to one of three approaches to arranging methadone treatment on release (to enter the study this had to be their aim). Before their release all the prisoners in the study were counselled about the risks of HIV and overdose and helped to link up to their chosen post-release methadone programme. The first clinic appointment was arranged and help given with required documentation and arranging transport. For one set of randomly allocated prisoners (referral-only) this was the sole assistance. For another set (referral-plus-funding) their post-release methadone treatment was funded in full for 12 weeks and half-funded for another 12. Finally, another set (referral-plus-funding-plus-methadone) received all this assistance, and could also begin their methadone treatment (all on the basis of supervised consumption) whilst still in prison, which could be continued after release at their chosen programme.

Approaches to over 1500 inmates (the researchers could not know in advance who might qualify) netted 90 who could and did join the study and were randomised to one of the three release planning options. Two inmates were later found not to meet the study's criteria, and 19 transferred to the referral-plus-funding group. Four did so after being unable to start treatment in prison. Another 15 allocated to referral-only took advantage of a new federal scheme funding post-release treatment for six months, effectively making them referral-plus-funding patients. The result was that 25 patients were actually offered methadone in prison (of whom 21 could be assessed six months later), 48 were referred and had their treatment funded (of whom 32 were reassessed), and just 15 were left to be referred with no funding (of whom nine could be reassessed). Typically they were white men who had not completed high school, never been married, were not working before their imprisonment, and had no health insurance cover on their release.

The 22 patients who were not only offered but started methadone in prison averaged about a fortnight on the drug ranging up to a month. On release they averaged a dose of 33mg and at the most 38mg.