Project Romeo: Opiate Replacement Therapy at Release from Incarceration

Started in 2007, ROMEO is a five-year NIDA-funded randomized controlled trial the purpose of which is to determine the effects of each study arm on reducing HIV risk behaviors, increasing drug treatment attendance, and ultiamtely reducing re-addiction and re-incarceration. The population of this study is prisoners with prior drug-related incarcerations and previous experience with methadone treatment. The setting is the Rhode Island Department of Corrections (RIDOC) prison in Cranston, RI. The three study arms include:

Arm 1 – initiation of methadone pre-release from incarceration with continued treatment in the inmates’ methadone program of choice and short-term payment of treatment costs

Arm 2 - referral to the participants’ methadone program of choice upon release from incarceration with provision of short-term financial assistance

Arm 3 - referral to the participants’ methadone program of choice upon release from incarceration without financial assistance.

Instituting opiate replacement therapy in prisons and jails has traditionally been hard to implement for logistical reasons and due to resistance by correctional staff. In addition to voicing concerns about safety/security, many correctional staff adopt a moral rather than medical approach to treatment, despite nearly 40 years of literature documenting reduced harms as result of methadone substitution therapy. In spite of the obstacles to initiating methadone maintenance therapy (MMT) in correctional facilities, the prison Director and Medical Director at the RIDOC have supported our project since its commencement. We began enrollment at the RIDOC’s minimum security prison in December 2007 and at the medium security prison in February 2007. To date we have enrolled 10 pilot participants and 31 study participants.

Preliminary results from ROMEO suggest that initiation of methadone treatment prior to release from incarceration increases the likelihood of entering community methadone treatment and decreases the amount of time between release and clinic initiation.

Ultimately, the goal of Project ROMEO is to explore a novel substance dependence treatment aimed at breaking the cycle of addiction, incarceration and re-addiction, alternately known as the “revolving door of the U.S. prison system,” that has become far too prevalent in the United States.