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Robert P Schwartz - One of the best experts on this subject based on the ideXlab platform.

  • Randomized trial of Methadone Treatment of arrestees: 24-month post-release outcomes.
    Drug and alcohol dependence, 2020
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Anjalee Sharma, Tiffany Duren, Jerome H Jaffe
    Abstract:

    Abstract Background We report on the 24-month post-release outcomes of arrestees with opioid use disorder (OUD) enrolled in a randomized trial comparing three Treatment approaches initiated in jail. Methods Adults (N = 225) receiving medically supervised withdrawal from opioids in the Baltimore Detention Center within a few days of arrest were randomly assigned to: (1) interim Methadone Treatment plus patient navigation (IM + PN) started in the Detention Center; (2) IM; or (3) Enhanced Treatment-as-Usual (ETAU) consisting of detoxification with Methadone and referral to Treatment in the community. Participants in both Methadone conditions could transfer to standard Methadone Treatment following release. Participants were interviewed at baseline, and 1, 3, 6, 12, and 24 months post-release. Urine was drug tested at follow-up and official arrest records were obtained. Results On an intention-to-treat basis, there were no significant differences among the three conditions over the 24-month post-release period in terms of opioid- or cocaine-positive urine test results or self-reported opioid or cocaine use, meeting opioid or cocaine use disorder criteria, self-reported criminal behavior, or the number of official arrests. There were 9 fatal overdoses, none occurring during Methadone Treatment, and 109 hospitalizations unrelated to the study. Conclusions Given the high morbidity and mortality found in this population of arrestees and costs to society associated with their health care utilization and continued crime and arrests, research aimed at finding more effective interventions should be continued. Clinical trial registration ClinicalTrials.gov: NCT 02334215.

  • Impact of Methadone Treatment initiated in jail on subsequent arrest.
    Journal of substance abuse treatment, 2020
    Co-Authors: Sharon M. Kelly, Robert P Schwartz, Kevin E. O'grady, Shannon Gwin Mitchell, Anjalee Sharma, Tiffany Duren, Jerome H Jaffe
    Abstract:

    Abstract Background There are limited data from randomized trials about the impact of starting Methadone Treatment in jail on subsequent arrest after release for adults with opioid use disorder (OUD). Methods Official arrest records were obtained for 212 participants with OUD who were enrolled in a three-group randomized controlled trial of initiating Methadone Treatment in jail either with or without patient navigation vs. enhanced Treatment-as-usual in Baltimore, Maryland. Participants treated for opioid withdrawal in jail were assigned to: 1) interim Methadone (IM) with patient navigation (PN; IM + PN); 2) IM without PN (IM); or 3) enhanced Treatment-as-usual (ETAU). Participants in both IM groups were able to continue Treatment at a community-based Methadone Treatment program with counseling upon release, while ETAU participants received overdose information and a city-wide Treatment assessment/referral number. Likelihood of arrest, time to first subsequent arrest, and severity of arrest charges in the 12 months following release were examined for: 1) combined IM + PN and IM groups compared to ETAU; and 2) IM + PN compared to IM. Results Within 12 months of release from the index incarceration, 50.5% of the sample had been arrested. The majority of arrest charges (71%) were for low-level, nonviolent crimes. On an intention-to-treat basis, there were no significant differences between the combined IM + PN and IM groups vs. ETAU or IM + PN vs. IM in the likelihood of arrest, time to first subsequent arrest, or severity of arrest charges. Conclusion Initiating IM with or without PN during pretrial detention did not have a significant effect on subsequent arrest during a 12-month post-release follow-up compared to not starting Methadone maintenance during detention, despite the high rate of Methadone Treatment entry in the community following release. This finding may be attributable to the considerable attrition from Treatment in the community or other systematic factors. Additional interventions may be needed to reduce the likelihood of subsequent arrest.

  • Methadone Treatment of arrestees: A randomized clinical trial.
    Drug and alcohol dependence, 2019
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Anjalee Sharma, Jerome H Jaffe
    Abstract:

    Abstract Background Opioid use disorder is common among detainees in US jails, yet Methadone Treatment is rarely initiated. Methods This is a three-group randomized controlled trial in which 225 detainees in Baltimore treated for opioid withdrawal were assigned to: (1) interim Methadone (IM) with patient navigation (IM + PN); (2) IM; or (3) enhanced Treatment-as-usual (ETAU). Participants in both IM groups were able to enter standard Methadone Treatment upon release, while ETAU participants received an assessment/referral number. Follow-up assessments at 1, 3, 6, and 12 months post-release determined Treatment enrollment, urine drug testing results, self-reported days of drug use, criminal activity, and overdose events. Generalized linear mixed modelling examined two planned contrasts: (1) IM groups combined vs. ETAU; and (2) IM + PN vs. IM. Results On an intention-to-treat basis, compared to ETAU, significantly more participants in the combined IM groups were in Treatment 30 days post-release, while the IM + PN vs. IM groups did not significantly differ. By month 12, there were no significant differences in the estimated marginal means of enrollment in any kind of drug Treatment (0.40 and 0.27 for IM + PN and IM groups, respectively, compared to 0.29 for ETAU). There were no significant differences for either contrast in opioid-positive tests, although all groups reported a sharp decrease in heroin use from baseline to follow-up. There were five fatal overdoses, but none occurred during Methadone Treatment. Conclusion Initiating Methadone Treatment in jail was effective in promoting entry into community-based drug abuse Treatment but subsequent Treatment discontinuation attenuated any potential impact of such Treatment.

  • Initiating Methadone in jail and in the community: Patient differences and implications of Methadone Treatment for reducing arrests.
    Journal of substance abuse treatment, 2018
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Jerome H Jaffe
    Abstract:

    Abstract The extent to which patient characteristics differ between individuals entering Methadone Treatment through community programs and jail-based programs is not known. Such differences could impact the likelihood of relapse and recidivism in these two populations and inform efforts at targeting interventions. We compared Treatment-entry characteristics of participants enrolling in Methadone Treatment in two studies conducted in Baltimore, one conducted in community programs (N = 295) and the other in a jail-based program (N = 225). Controlling for age, race, and gender, individuals starting Methadone Treatment in jail compared to the community, had more severe drug use and criminal justice profiles. These different characteristics suggest that patients initiating Methadone in a jail-based program could have greater likelihood of future arrest compared to patients entering community-based Treatment. Clinical trials registration Clinicaltrials.gov NCT 02334215 and NCT 01442493.

  • Patient-centered Methadone Treatment: a randomized clinical trial
    Addiction (Abingdon England), 2016
    Co-Authors: Robert P Schwartz, Devang Gandhi, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Yngvild Olsen, Jerome H Jaffe
    Abstract:

    Background and Aims Methadone patients who discontinue Treatment are at high risk of relapse, yet a substantial proportion discontinue Treatment within the first year. We investigated whether a patient-centered approach to Methadone Treatment improved participant outcomes at 12 months following admission, compared with Methadone Treatment-as-usual. Design Two-arm open-label randomized trial. Setting Two Methadone Treatment programs (MTPs) in Baltimore, MD, USA. Participants Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males. Intervention Newly admitted MTP patients were assigned randomly to either patient-centered Methadone Treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or Treatment-as-usual (TAU; n = 151). Measurements The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in Treatment. Findings There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05). Conclusions Patient-centered Methadone Treatment (with optional counseling and the counselor not serving as the Treatment program disciplinarian) does not appear to be more effective than Methadone Treatment-as-usual.

Sharon M. Kelly - One of the best experts on this subject based on the ideXlab platform.

  • Randomized trial of Methadone Treatment of arrestees: 24-month post-release outcomes.
    Drug and alcohol dependence, 2020
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Anjalee Sharma, Tiffany Duren, Jerome H Jaffe
    Abstract:

    Abstract Background We report on the 24-month post-release outcomes of arrestees with opioid use disorder (OUD) enrolled in a randomized trial comparing three Treatment approaches initiated in jail. Methods Adults (N = 225) receiving medically supervised withdrawal from opioids in the Baltimore Detention Center within a few days of arrest were randomly assigned to: (1) interim Methadone Treatment plus patient navigation (IM + PN) started in the Detention Center; (2) IM; or (3) Enhanced Treatment-as-Usual (ETAU) consisting of detoxification with Methadone and referral to Treatment in the community. Participants in both Methadone conditions could transfer to standard Methadone Treatment following release. Participants were interviewed at baseline, and 1, 3, 6, 12, and 24 months post-release. Urine was drug tested at follow-up and official arrest records were obtained. Results On an intention-to-treat basis, there were no significant differences among the three conditions over the 24-month post-release period in terms of opioid- or cocaine-positive urine test results or self-reported opioid or cocaine use, meeting opioid or cocaine use disorder criteria, self-reported criminal behavior, or the number of official arrests. There were 9 fatal overdoses, none occurring during Methadone Treatment, and 109 hospitalizations unrelated to the study. Conclusions Given the high morbidity and mortality found in this population of arrestees and costs to society associated with their health care utilization and continued crime and arrests, research aimed at finding more effective interventions should be continued. Clinical trial registration ClinicalTrials.gov: NCT 02334215.

  • Impact of Methadone Treatment initiated in jail on subsequent arrest.
    Journal of substance abuse treatment, 2020
    Co-Authors: Sharon M. Kelly, Robert P Schwartz, Kevin E. O'grady, Shannon Gwin Mitchell, Anjalee Sharma, Tiffany Duren, Jerome H Jaffe
    Abstract:

    Abstract Background There are limited data from randomized trials about the impact of starting Methadone Treatment in jail on subsequent arrest after release for adults with opioid use disorder (OUD). Methods Official arrest records were obtained for 212 participants with OUD who were enrolled in a three-group randomized controlled trial of initiating Methadone Treatment in jail either with or without patient navigation vs. enhanced Treatment-as-usual in Baltimore, Maryland. Participants treated for opioid withdrawal in jail were assigned to: 1) interim Methadone (IM) with patient navigation (PN; IM + PN); 2) IM without PN (IM); or 3) enhanced Treatment-as-usual (ETAU). Participants in both IM groups were able to continue Treatment at a community-based Methadone Treatment program with counseling upon release, while ETAU participants received overdose information and a city-wide Treatment assessment/referral number. Likelihood of arrest, time to first subsequent arrest, and severity of arrest charges in the 12 months following release were examined for: 1) combined IM + PN and IM groups compared to ETAU; and 2) IM + PN compared to IM. Results Within 12 months of release from the index incarceration, 50.5% of the sample had been arrested. The majority of arrest charges (71%) were for low-level, nonviolent crimes. On an intention-to-treat basis, there were no significant differences between the combined IM + PN and IM groups vs. ETAU or IM + PN vs. IM in the likelihood of arrest, time to first subsequent arrest, or severity of arrest charges. Conclusion Initiating IM with or without PN during pretrial detention did not have a significant effect on subsequent arrest during a 12-month post-release follow-up compared to not starting Methadone maintenance during detention, despite the high rate of Methadone Treatment entry in the community following release. This finding may be attributable to the considerable attrition from Treatment in the community or other systematic factors. Additional interventions may be needed to reduce the likelihood of subsequent arrest.

  • Methadone Treatment of arrestees: A randomized clinical trial.
    Drug and alcohol dependence, 2019
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Anjalee Sharma, Jerome H Jaffe
    Abstract:

    Abstract Background Opioid use disorder is common among detainees in US jails, yet Methadone Treatment is rarely initiated. Methods This is a three-group randomized controlled trial in which 225 detainees in Baltimore treated for opioid withdrawal were assigned to: (1) interim Methadone (IM) with patient navigation (IM + PN); (2) IM; or (3) enhanced Treatment-as-usual (ETAU). Participants in both IM groups were able to enter standard Methadone Treatment upon release, while ETAU participants received an assessment/referral number. Follow-up assessments at 1, 3, 6, and 12 months post-release determined Treatment enrollment, urine drug testing results, self-reported days of drug use, criminal activity, and overdose events. Generalized linear mixed modelling examined two planned contrasts: (1) IM groups combined vs. ETAU; and (2) IM + PN vs. IM. Results On an intention-to-treat basis, compared to ETAU, significantly more participants in the combined IM groups were in Treatment 30 days post-release, while the IM + PN vs. IM groups did not significantly differ. By month 12, there were no significant differences in the estimated marginal means of enrollment in any kind of drug Treatment (0.40 and 0.27 for IM + PN and IM groups, respectively, compared to 0.29 for ETAU). There were no significant differences for either contrast in opioid-positive tests, although all groups reported a sharp decrease in heroin use from baseline to follow-up. There were five fatal overdoses, but none occurred during Methadone Treatment. Conclusion Initiating Methadone Treatment in jail was effective in promoting entry into community-based drug abuse Treatment but subsequent Treatment discontinuation attenuated any potential impact of such Treatment.

  • Initiating Methadone in jail and in the community: Patient differences and implications of Methadone Treatment for reducing arrests.
    Journal of substance abuse treatment, 2018
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Jerome H Jaffe
    Abstract:

    Abstract The extent to which patient characteristics differ between individuals entering Methadone Treatment through community programs and jail-based programs is not known. Such differences could impact the likelihood of relapse and recidivism in these two populations and inform efforts at targeting interventions. We compared Treatment-entry characteristics of participants enrolling in Methadone Treatment in two studies conducted in Baltimore, one conducted in community programs (N = 295) and the other in a jail-based program (N = 225). Controlling for age, race, and gender, individuals starting Methadone Treatment in jail compared to the community, had more severe drug use and criminal justice profiles. These different characteristics suggest that patients initiating Methadone in a jail-based program could have greater likelihood of future arrest compared to patients entering community-based Treatment. Clinical trials registration Clinicaltrials.gov NCT 02334215 and NCT 01442493.

  • Patient-centered Methadone Treatment: a randomized clinical trial
    Addiction (Abingdon England), 2016
    Co-Authors: Robert P Schwartz, Devang Gandhi, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Yngvild Olsen, Jerome H Jaffe
    Abstract:

    Background and Aims Methadone patients who discontinue Treatment are at high risk of relapse, yet a substantial proportion discontinue Treatment within the first year. We investigated whether a patient-centered approach to Methadone Treatment improved participant outcomes at 12 months following admission, compared with Methadone Treatment-as-usual. Design Two-arm open-label randomized trial. Setting Two Methadone Treatment programs (MTPs) in Baltimore, MD, USA. Participants Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males. Intervention Newly admitted MTP patients were assigned randomly to either patient-centered Methadone Treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or Treatment-as-usual (TAU; n = 151). Measurements The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in Treatment. Findings There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05). Conclusions Patient-centered Methadone Treatment (with optional counseling and the counselor not serving as the Treatment program disciplinarian) does not appear to be more effective than Methadone Treatment-as-usual.

Jerome H Jaffe - One of the best experts on this subject based on the ideXlab platform.

  • Randomized trial of Methadone Treatment of arrestees: 24-month post-release outcomes.
    Drug and alcohol dependence, 2020
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Anjalee Sharma, Tiffany Duren, Jerome H Jaffe
    Abstract:

    Abstract Background We report on the 24-month post-release outcomes of arrestees with opioid use disorder (OUD) enrolled in a randomized trial comparing three Treatment approaches initiated in jail. Methods Adults (N = 225) receiving medically supervised withdrawal from opioids in the Baltimore Detention Center within a few days of arrest were randomly assigned to: (1) interim Methadone Treatment plus patient navigation (IM + PN) started in the Detention Center; (2) IM; or (3) Enhanced Treatment-as-Usual (ETAU) consisting of detoxification with Methadone and referral to Treatment in the community. Participants in both Methadone conditions could transfer to standard Methadone Treatment following release. Participants were interviewed at baseline, and 1, 3, 6, 12, and 24 months post-release. Urine was drug tested at follow-up and official arrest records were obtained. Results On an intention-to-treat basis, there were no significant differences among the three conditions over the 24-month post-release period in terms of opioid- or cocaine-positive urine test results or self-reported opioid or cocaine use, meeting opioid or cocaine use disorder criteria, self-reported criminal behavior, or the number of official arrests. There were 9 fatal overdoses, none occurring during Methadone Treatment, and 109 hospitalizations unrelated to the study. Conclusions Given the high morbidity and mortality found in this population of arrestees and costs to society associated with their health care utilization and continued crime and arrests, research aimed at finding more effective interventions should be continued. Clinical trial registration ClinicalTrials.gov: NCT 02334215.

  • Impact of Methadone Treatment initiated in jail on subsequent arrest.
    Journal of substance abuse treatment, 2020
    Co-Authors: Sharon M. Kelly, Robert P Schwartz, Kevin E. O'grady, Shannon Gwin Mitchell, Anjalee Sharma, Tiffany Duren, Jerome H Jaffe
    Abstract:

    Abstract Background There are limited data from randomized trials about the impact of starting Methadone Treatment in jail on subsequent arrest after release for adults with opioid use disorder (OUD). Methods Official arrest records were obtained for 212 participants with OUD who were enrolled in a three-group randomized controlled trial of initiating Methadone Treatment in jail either with or without patient navigation vs. enhanced Treatment-as-usual in Baltimore, Maryland. Participants treated for opioid withdrawal in jail were assigned to: 1) interim Methadone (IM) with patient navigation (PN; IM + PN); 2) IM without PN (IM); or 3) enhanced Treatment-as-usual (ETAU). Participants in both IM groups were able to continue Treatment at a community-based Methadone Treatment program with counseling upon release, while ETAU participants received overdose information and a city-wide Treatment assessment/referral number. Likelihood of arrest, time to first subsequent arrest, and severity of arrest charges in the 12 months following release were examined for: 1) combined IM + PN and IM groups compared to ETAU; and 2) IM + PN compared to IM. Results Within 12 months of release from the index incarceration, 50.5% of the sample had been arrested. The majority of arrest charges (71%) were for low-level, nonviolent crimes. On an intention-to-treat basis, there were no significant differences between the combined IM + PN and IM groups vs. ETAU or IM + PN vs. IM in the likelihood of arrest, time to first subsequent arrest, or severity of arrest charges. Conclusion Initiating IM with or without PN during pretrial detention did not have a significant effect on subsequent arrest during a 12-month post-release follow-up compared to not starting Methadone maintenance during detention, despite the high rate of Methadone Treatment entry in the community following release. This finding may be attributable to the considerable attrition from Treatment in the community or other systematic factors. Additional interventions may be needed to reduce the likelihood of subsequent arrest.

  • Methadone Treatment of arrestees: A randomized clinical trial.
    Drug and alcohol dependence, 2019
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Anjalee Sharma, Jerome H Jaffe
    Abstract:

    Abstract Background Opioid use disorder is common among detainees in US jails, yet Methadone Treatment is rarely initiated. Methods This is a three-group randomized controlled trial in which 225 detainees in Baltimore treated for opioid withdrawal were assigned to: (1) interim Methadone (IM) with patient navigation (IM + PN); (2) IM; or (3) enhanced Treatment-as-usual (ETAU). Participants in both IM groups were able to enter standard Methadone Treatment upon release, while ETAU participants received an assessment/referral number. Follow-up assessments at 1, 3, 6, and 12 months post-release determined Treatment enrollment, urine drug testing results, self-reported days of drug use, criminal activity, and overdose events. Generalized linear mixed modelling examined two planned contrasts: (1) IM groups combined vs. ETAU; and (2) IM + PN vs. IM. Results On an intention-to-treat basis, compared to ETAU, significantly more participants in the combined IM groups were in Treatment 30 days post-release, while the IM + PN vs. IM groups did not significantly differ. By month 12, there were no significant differences in the estimated marginal means of enrollment in any kind of drug Treatment (0.40 and 0.27 for IM + PN and IM groups, respectively, compared to 0.29 for ETAU). There were no significant differences for either contrast in opioid-positive tests, although all groups reported a sharp decrease in heroin use from baseline to follow-up. There were five fatal overdoses, but none occurred during Methadone Treatment. Conclusion Initiating Methadone Treatment in jail was effective in promoting entry into community-based drug abuse Treatment but subsequent Treatment discontinuation attenuated any potential impact of such Treatment.

  • Initiating Methadone in jail and in the community: Patient differences and implications of Methadone Treatment for reducing arrests.
    Journal of substance abuse treatment, 2018
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Jerome H Jaffe
    Abstract:

    Abstract The extent to which patient characteristics differ between individuals entering Methadone Treatment through community programs and jail-based programs is not known. Such differences could impact the likelihood of relapse and recidivism in these two populations and inform efforts at targeting interventions. We compared Treatment-entry characteristics of participants enrolling in Methadone Treatment in two studies conducted in Baltimore, one conducted in community programs (N = 295) and the other in a jail-based program (N = 225). Controlling for age, race, and gender, individuals starting Methadone Treatment in jail compared to the community, had more severe drug use and criminal justice profiles. These different characteristics suggest that patients initiating Methadone in a jail-based program could have greater likelihood of future arrest compared to patients entering community-based Treatment. Clinical trials registration Clinicaltrials.gov NCT 02334215 and NCT 01442493.

  • Patient-centered Methadone Treatment: a randomized clinical trial
    Addiction (Abingdon England), 2016
    Co-Authors: Robert P Schwartz, Devang Gandhi, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Yngvild Olsen, Jerome H Jaffe
    Abstract:

    Background and Aims Methadone patients who discontinue Treatment are at high risk of relapse, yet a substantial proportion discontinue Treatment within the first year. We investigated whether a patient-centered approach to Methadone Treatment improved participant outcomes at 12 months following admission, compared with Methadone Treatment-as-usual. Design Two-arm open-label randomized trial. Setting Two Methadone Treatment programs (MTPs) in Baltimore, MD, USA. Participants Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males. Intervention Newly admitted MTP patients were assigned randomly to either patient-centered Methadone Treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or Treatment-as-usual (TAU; n = 151). Measurements The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in Treatment. Findings There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05). Conclusions Patient-centered Methadone Treatment (with optional counseling and the counselor not serving as the Treatment program disciplinarian) does not appear to be more effective than Methadone Treatment-as-usual.

James W. Luckey - One of the best experts on this subject based on the ideXlab platform.

  • Implementation of the Methadone Treatment Quality Assurance System Findings from the Feasibility Study
    Evaluation & the health professions, 2000
    Co-Authors: Lori J. Ducharme, James W. Luckey
    Abstract:

    This article describes the development and large-scale testing of the Methadone Treatment Quality Assurance System (MTQAS). MTQAS originated as a NIDA (National Institute on Drug Abuse) funded study to assess the feasibility and utility of implementing a performance-based feedback reporting system for narcotic addiction Treatment programs. After several years of research to identify a set of valid, reliable, and clinically useful indicators of program performance using patients' in-Treatment outcomes, MTQAS was tested in a feasibility study with more than 70 Methadone Treatment clinics in seven states. For each of nine quarters, participating clinics received a report summarizing their patient outcomes; reports also included summary data permitting comparisons across states, across clinics within a state, and within a clinic over time. In addition, MTQAS included a case-mix adjustment strategy that permitted fair comparisons of performance among programs with systematically different patient caseloads. The structure and operation of MTQAS, selected analyses of the data, and lessons for future performance measurement systems are discussed.

  • Methadone Treatment Quality Assurance System (MTQAS)
    Journal of Maintenance in the Addictions, 1997
    Co-Authors: Dorynne Czechowicz, Robert L. Hubbard, Mph Charles D. Phillips, Douglas L. Fountain Mpa, James R. Cooper, Stephen P. Molinari, James W. Luckey, Laura A. Graham Mpa
    Abstract:

    (1998). Methadone Treatment Quality Assurance System (MTQAS) Journal of Maintenance in the Addictions: Vol. 1, No. 2, pp. 5-7.

Shannon Gwin Mitchell - One of the best experts on this subject based on the ideXlab platform.

  • Randomized trial of Methadone Treatment of arrestees: 24-month post-release outcomes.
    Drug and alcohol dependence, 2020
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Anjalee Sharma, Tiffany Duren, Jerome H Jaffe
    Abstract:

    Abstract Background We report on the 24-month post-release outcomes of arrestees with opioid use disorder (OUD) enrolled in a randomized trial comparing three Treatment approaches initiated in jail. Methods Adults (N = 225) receiving medically supervised withdrawal from opioids in the Baltimore Detention Center within a few days of arrest were randomly assigned to: (1) interim Methadone Treatment plus patient navigation (IM + PN) started in the Detention Center; (2) IM; or (3) Enhanced Treatment-as-Usual (ETAU) consisting of detoxification with Methadone and referral to Treatment in the community. Participants in both Methadone conditions could transfer to standard Methadone Treatment following release. Participants were interviewed at baseline, and 1, 3, 6, 12, and 24 months post-release. Urine was drug tested at follow-up and official arrest records were obtained. Results On an intention-to-treat basis, there were no significant differences among the three conditions over the 24-month post-release period in terms of opioid- or cocaine-positive urine test results or self-reported opioid or cocaine use, meeting opioid or cocaine use disorder criteria, self-reported criminal behavior, or the number of official arrests. There were 9 fatal overdoses, none occurring during Methadone Treatment, and 109 hospitalizations unrelated to the study. Conclusions Given the high morbidity and mortality found in this population of arrestees and costs to society associated with their health care utilization and continued crime and arrests, research aimed at finding more effective interventions should be continued. Clinical trial registration ClinicalTrials.gov: NCT 02334215.

  • Impact of Methadone Treatment initiated in jail on subsequent arrest.
    Journal of substance abuse treatment, 2020
    Co-Authors: Sharon M. Kelly, Robert P Schwartz, Kevin E. O'grady, Shannon Gwin Mitchell, Anjalee Sharma, Tiffany Duren, Jerome H Jaffe
    Abstract:

    Abstract Background There are limited data from randomized trials about the impact of starting Methadone Treatment in jail on subsequent arrest after release for adults with opioid use disorder (OUD). Methods Official arrest records were obtained for 212 participants with OUD who were enrolled in a three-group randomized controlled trial of initiating Methadone Treatment in jail either with or without patient navigation vs. enhanced Treatment-as-usual in Baltimore, Maryland. Participants treated for opioid withdrawal in jail were assigned to: 1) interim Methadone (IM) with patient navigation (PN; IM + PN); 2) IM without PN (IM); or 3) enhanced Treatment-as-usual (ETAU). Participants in both IM groups were able to continue Treatment at a community-based Methadone Treatment program with counseling upon release, while ETAU participants received overdose information and a city-wide Treatment assessment/referral number. Likelihood of arrest, time to first subsequent arrest, and severity of arrest charges in the 12 months following release were examined for: 1) combined IM + PN and IM groups compared to ETAU; and 2) IM + PN compared to IM. Results Within 12 months of release from the index incarceration, 50.5% of the sample had been arrested. The majority of arrest charges (71%) were for low-level, nonviolent crimes. On an intention-to-treat basis, there were no significant differences between the combined IM + PN and IM groups vs. ETAU or IM + PN vs. IM in the likelihood of arrest, time to first subsequent arrest, or severity of arrest charges. Conclusion Initiating IM with or without PN during pretrial detention did not have a significant effect on subsequent arrest during a 12-month post-release follow-up compared to not starting Methadone maintenance during detention, despite the high rate of Methadone Treatment entry in the community following release. This finding may be attributable to the considerable attrition from Treatment in the community or other systematic factors. Additional interventions may be needed to reduce the likelihood of subsequent arrest.

  • Methadone Treatment of arrestees: A randomized clinical trial.
    Drug and alcohol dependence, 2019
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Anjalee Sharma, Jerome H Jaffe
    Abstract:

    Abstract Background Opioid use disorder is common among detainees in US jails, yet Methadone Treatment is rarely initiated. Methods This is a three-group randomized controlled trial in which 225 detainees in Baltimore treated for opioid withdrawal were assigned to: (1) interim Methadone (IM) with patient navigation (IM + PN); (2) IM; or (3) enhanced Treatment-as-usual (ETAU). Participants in both IM groups were able to enter standard Methadone Treatment upon release, while ETAU participants received an assessment/referral number. Follow-up assessments at 1, 3, 6, and 12 months post-release determined Treatment enrollment, urine drug testing results, self-reported days of drug use, criminal activity, and overdose events. Generalized linear mixed modelling examined two planned contrasts: (1) IM groups combined vs. ETAU; and (2) IM + PN vs. IM. Results On an intention-to-treat basis, compared to ETAU, significantly more participants in the combined IM groups were in Treatment 30 days post-release, while the IM + PN vs. IM groups did not significantly differ. By month 12, there were no significant differences in the estimated marginal means of enrollment in any kind of drug Treatment (0.40 and 0.27 for IM + PN and IM groups, respectively, compared to 0.29 for ETAU). There were no significant differences for either contrast in opioid-positive tests, although all groups reported a sharp decrease in heroin use from baseline to follow-up. There were five fatal overdoses, but none occurred during Methadone Treatment. Conclusion Initiating Methadone Treatment in jail was effective in promoting entry into community-based drug abuse Treatment but subsequent Treatment discontinuation attenuated any potential impact of such Treatment.

  • Initiating Methadone in jail and in the community: Patient differences and implications of Methadone Treatment for reducing arrests.
    Journal of substance abuse treatment, 2018
    Co-Authors: Robert P Schwartz, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Jerome H Jaffe
    Abstract:

    Abstract The extent to which patient characteristics differ between individuals entering Methadone Treatment through community programs and jail-based programs is not known. Such differences could impact the likelihood of relapse and recidivism in these two populations and inform efforts at targeting interventions. We compared Treatment-entry characteristics of participants enrolling in Methadone Treatment in two studies conducted in Baltimore, one conducted in community programs (N = 295) and the other in a jail-based program (N = 225). Controlling for age, race, and gender, individuals starting Methadone Treatment in jail compared to the community, had more severe drug use and criminal justice profiles. These different characteristics suggest that patients initiating Methadone in a jail-based program could have greater likelihood of future arrest compared to patients entering community-based Treatment. Clinical trials registration Clinicaltrials.gov NCT 02334215 and NCT 01442493.

  • Patient-centered Methadone Treatment: a randomized clinical trial
    Addiction (Abingdon England), 2016
    Co-Authors: Robert P Schwartz, Devang Gandhi, Sharon M. Kelly, Kevin E. O'grady, Shannon Gwin Mitchell, Jan Gryczynski, Yngvild Olsen, Jerome H Jaffe
    Abstract:

    Background and Aims Methadone patients who discontinue Treatment are at high risk of relapse, yet a substantial proportion discontinue Treatment within the first year. We investigated whether a patient-centered approach to Methadone Treatment improved participant outcomes at 12 months following admission, compared with Methadone Treatment-as-usual. Design Two-arm open-label randomized trial. Setting Two Methadone Treatment programs (MTPs) in Baltimore, MD, USA. Participants Three hundred newly admitted MTP patients were enrolled between 13 September 2011 and 26 March 2014. Their mean age was 42.7 years [standard deviation (SD) = 10.1] and 59% were males. Intervention Newly admitted MTP patients were assigned randomly to either patient-centered Methadone Treatment (PCM; n = 149), which modified the MTP's rules (e.g. counseling attendance was optional), and counselor roles (e.g. counselors were not responsible for enforcing clinic rules) or Treatment-as-usual (TAU; n = 151). Measurements The primary outcome was opioid-positive urine test at 12-month follow-up. Other 12-month outcomes included days of heroin and cocaine use, cocaine-positive urine tests, meeting DSM-IV opioid and cocaine dependence diagnostic criteria, HIV risk behavior and quality of life and retention in Treatment. Findings There was no significant difference between PCM and TAU conditions in opioid-positive urine screens at 12 months [adjusted odds ratio = 0.98; 95% confidence interval (CI) = 0.61, 1.56]. There were also no significant differences in any of the secondary outcome measures (all Ps > 0.05) except Quality of Life Global Score (P = 0.04; 95% CI = 0.01, 0.45). There were no significant differences between conditions in the number of individual or group counseling sessions attended. (Ps > 0.05). Conclusions Patient-centered Methadone Treatment (with optional counseling and the counselor not serving as the Treatment program disciplinarian) does not appear to be more effective than Methadone Treatment-as-usual.