• Treatment engagement [ Time Frame: 1.5, 6, 12, 18, 24 month follow-up interviews ] [ Designated as safety issue: No ]
• Time to Treatment engagement from prison release [ Time Frame: 1.5, 6 month follow-up interivews ] [ Designated as safety issue: No ]
• HIV risk behaviors [ Time Frame: 1.5, 6, 12, 18, 24 month follow-up interviews ] [ Designated as safety issue: No ]

• Treatment engagement
• Time to Treatment engagement from prison release
• HIV risk behaviors; measured at Months 1.5, 6, 12, and 24

• Drug use [ Time Frame: 1.5, 6, 12, 18, 24 month follow-up interviews ] [ Designated as safety issue: No ]
• Fatal overdose [ Time Frame: 1.5, 6, 12, 18, 24 month follow-up interviews ] [ Designated as safety issue: Yes ]
• Non-fatal overdose [ Time Frame: 1.5, 6, 12, 18, 24 month follow-up interviews ] [ Designated as safety issue: Yes ]

• Drug use; measured at Months 1.5, 6, 12, and 24
• Fatal overdose; measured at Months 1.5, 6, 12, and 24
• Non-fatal overdose; measured at Months 1.5, 6, 12, and 24

Much of the HIV/AIDS epidemic is driven by transmission from or to persons addicted to opiates. Many of these individuals pass through a correctional setting each year, creating an opportunity for linkage to substance abuse treatment. The purpose of this study is to evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors and drug relapse. In addition, this study will evaluate the effectiveness of short-term payment versus non-payment of community opiate replacement therapy immediately following release from incarceration.

A substantial proportion of individuals addicted to heroin are incarcerated while addicted and a majority of individuals released from a correctional setting have a history of heroin addiction. The period immediately after release from incarceration is a particularly high-risk time for HIV transmission and other problems, including drug relapse and overdose. Methadone treatment is the most widely used opiate replacement therapy in the United States and has been shown to decrease HIV risk, as well as drug use, addiction relapse, and criminal activity. The purpose of this study is to evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors and drug relapse. In addition, this study will evaluate the effectiveness of short-term payment versus non-payment of community opiate replacement therapy immediately following release from incarceration.

Participants in this 3-year study will be randomly assigned to 1 of 3 treatment groups. Participants enrolled in Group 1 will initiate methadone opiate replacement therapy about 1 month prior to release from incarceration. They will then proceed with a methadone program of choice upon release and receive short-term payment to cover treatment costs. Participants enrolled in Group 2 will be referred to a methadone program of choice upon release from incarceration with provision of short-term payment of treatment costs. Participants enrolled in Group 3 will be referred to a program of choice upon release from incarceration without receiving financial assistance. All participants will have the opportunity to partake in existing support programs available at the Rhode Island Department of Corrections while incarcerated and in the community upon release. Follow-up assessments will occur at Months 1.5, 6, 12 and 24. These will include interviews and urine specimens for toxicology analysis to verify self-reports.

• HIV Prevention
• Opioid-Related Disorders

• Behavioral: Pre-release Initiation of MMT
• Behavioral: Post Release Initiation of MMT.
• Behavioral: Standard of Care Plus

• Experimental: Participants enrolled in Group 1 will initiate methadone opiate replacement therapy about 1 month prior to release from incarceration. They will then proceed with a methadone program of choice upon release and receive short-term payment to cover treatment costs.
• Experimental: Participants enrolled in Group 2 will be referred to a methadone program of choice upon release from incarceration with provision of short-term payment of treatment costs.
• Active Comparator: Participants enrolled in Group 3 will be referred to a program of their choice upon release from incarceration without receiving financial assistance.

Inclusion Criteria:

• Currently incarcerated at the Rhode Island Department of Corrections with a scheduled release date at least 28 days after enrollment
• Incarceration length not to have exceeded two years at the time of enrollment
• Heroin dependent with self-reported heroin injection in the month prior to incarceration OR enrollment in a methadone treatment program prior to incarceration for heroin addiction with a history of injection drug use
• Desire to enter methadone treatment upon release and plans to secure funding for methadone treatment after study completion
• History of prior tolerance to methadone
• History of at least one drug-related incarceration
• Speaks English or Spanish
• Plans to remain in Rhode Island for the duration of the study (24 months)
• Ability to provide at least two names of individuals who can verify participant information

Exclusion Criteria:

• Currently receiving methadone at the Rhode Island Department of Corrections
• Currently undergoing a non-narcotic detoxification from illicit opiates at the Rhode Island Department of Corrections
• Plans to leave Rhode Island within the two years following enrollment