Sarah Larney, Bradley Mathers and Kate Dolan Illicit drug treatment ...

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6. CONCLUSIONSThis report has reviewed four interventions for drug-dependent prisoners: detoxification;drug-free units; therapeutic communities; and opioid substitution treatment. None ofthese treatment options have been thoroughly studied in the prison context, although theevidence base is increasing in the cases of therapeutic communities and opioidsubstitution treatment. On current evidence, methadone maintenance treatment is themost effective treatment for reducing drug use and criminal recidivism. It may also assistin reducing HIV and other blood borne virus transmission. However, this treatment issuitable only for opioid-dependent populations; users of psychostimulants and othernon-opioid drugs remain poorly served by current treatment approaches, both in thecommunity and in prison.This literature review has identified a number of areas requiring further research:Detoxification:• Buprenorphine is widely considered the most efficacious agent for opioiddetoxification; however, in prison settings, administration of this medication canbe problematic. An exploratory study to develop and evaluate innovativetreatment protocols that minimise problems is warranted.• Clinical trials to evaluate the effectiveness of pharmacological agents forpsychostimulant detoxification are underway. These studies should be expandedto include prison populations.Drug-free units:• There has been very little methodologically rigorous research into drug-free units.Specific topics requiring closer examination include defining drug-free units andhow they differ from other non-pharmacological treatment options such astherapeutic communities; and identification of program elements that contributeto decreased drug use.Therapeutic communities:• Surprisingly few studies have focused on reduced drug use or improved inmatehealth following therapeutic community treatment. Studies focusing on these25
outcomes should be conducted. Other treatment outcomes that could also beconsidered include reduced incidence of blood borne viral infections andmortality.• Identifying program elements that increase positive outcomes should be apriority for researchers, as should improving outcomes for prisoners fromculturally and ethnically diverse backgrounds.Opioid substitution treatment:• Further randomised controlled trials of methadone maintenance treatmentshould be conducted. In particular, further evidence should be collected onMMT in prisons in non-Western countries and low- and middle-incomecountries.• Randomised controlled trials of buprenorphine maintenance treatment should beconducted to provide evidence of the effectiveness or otherwise of this treatmentin prison settings.Findings from research projects such as those listed above will help to build the evidencebase for providing effective drug treatment in prison.26
Page 1: Sarah Larney, Bradley Mathers and K
Page 5: AcknowledgementsAn earlier draft of
Page 9 and 10: 1. INTRODUCTIONThe relationship bet
Page 11 and 12: 2. DETOXIFICATIONDetoxification is
Page 13 and 14: To date, there have been no publish
Page 15 and 16: 3. DRUG-FREE WINGSVoluntary drug-fr
Page 17 and 18: 4. THERAPEUTIC COMMUNITIESThe thera
Page 19 and 20: completion, which in turn was assoc
Page 21 and 22: of similar cost-effectiveness to MM
Page 23 and 24: prison in New York revealed that th
Page 25: 5.2.4 Levo-alpha-acetylmethadol mai
Page 29 and 30: Dolan, K., Wodak, A., Hall, W., Gau
Page 31: Ward, J., Mattick, R., & Hall, W. (

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