Diversion to Treatment for Injection Drug Users Arrested for Possession of Heroin
Status:
Completed
Trial end date:
2014-08-01
Target enrollment:
Participant gender:
Summary
More Americans are arrested for drug offenses than for any other crime. In 2009, over 294,000
arrests were made for possession of cocaine or heroin. Incarceration does not address the
root problems and is frequently followed by relapse and re-arrest after release. In the case
of opiate-dependent adults arrested for possession of heroin, one potentially effective
alternative is to divert offenders to methadone maintenance treatment (MMT) as an alternative
to adjudication of their case. MMT is an effective treatment for heroin dependence, and
appears very effective for criminal offenders. However, cocaine use is common in MMT
patients, including those with recent criminal justice involvement, and MMT alone is
ineffective in addressing cocaine use. Continued cocaine use carries a substantial health
burden and necessarily entails continued criminal activity. Thus, treatment for diverted
opiate-dependent offenders should be designed to address cocaine use as well as opiate use. A
Stage 1 Behavior Therapy Development project is planned over 2 years to adapt, manualize and
pilot test the Therapeutic Workplace intervention for adults charged with heroin possession
and offered diversion to methadone maintenance treatment as an alternative to adjudication of
their case. The Therapeutic Workplace is a novel, employment-based contingency management
intervention that has been very effective in promoting cocaine abstinence in adults who use
cocaine persistently during methadone treatment. In the Therapeutic Workplace, participants
are hired in a model workplace and required to provide drug-free urine samples to work and to
earn maximum pay. Once we develop and manualize the adapted version of the Therapeutic
Workplace for adults arrested for heroin possession, a pilot test will be conducted.
Individuals identified by the State Attorney's office as candidates for diversion will be
assessed for study eligibility. Given the high rates of injection drug use and
injection-related transmission of HIV in Baltimore, this study will be restricted to
injection drug users to evaluate the potential utility of this intervention in reducing HIV
risk. Eligible individuals will be offered methadone maintenance in lieu of prosecution and
will be required to remain in methadone treatment for 90 days. All participants will receive
standard MMT, independent of whether they decide to participate in the pilot study. After
beginning MMT, participants will be invited to enroll in the pilot study and randomly
assigned to two study groups. Participants assigned to the Usual Care Diversion group will
receive the standard MMT. Participants assigned to the Therapeutic Workplace Enhanced
Diversion group will receive the standard MMT and the Therapeutic Workplace intervention. The
data from this pilot study will serve as the foundation for a full-scaled randomized
controlled trial. Overall, the Therapeutic Workplace could serve as a novel and ideal
intervention for many heroin dependent adults involved in the criminal justice system. The
use of MMT in lieu of adjudication in combination with the Therapeutic Workplace could
increase drug abstinence and employment and decrease HIV risk and criminal activity in this
refractory high-risk population.