Ahmad, Ahsan and Bromberg, Daniel J. and Shrestha, Roman and Salleh, N.A. Mohd and Bazazi, Alexander R. and Kamarulzaman, Adeeba and Shenoi, Sheela and Altice, Frederick L. (2024) Higher methadone dose at time of release from prison predicts linkage to maintenance treatment for people with HIV and opioid use disorder transitioning to the community in Malaysia. International Journal of Drug Policy, 126. p. 104369. ISSN 0955-3959, DOI https://doi.org/10.1016/j.drugpo.2024.104369.
Full text not available from this repository.Abstract
Background: Incarcerated people with HIV and opioid-dependence often experience poor post-release outcomes in the absence of methadone maintenance treatment (MMT). In a prospective trial, we assessed the impact of methadone dose achieved within prison on linkage to MMT after release. Methods: From 2010 to 2014, men with HIV (N = 212) and opioid dependence before incarceration were enrolled in MMT within 6 months of release from Malaysia's largest prison and followed for 12-months post-release. As a prospective trial, allocation to MMT was at random and later by preference design (predictive nonetheless). MMT dosing was individually targeted to minimally achieve 80 mg/day. Time-to-event analyses were conducted to model linkage to MMT after release. Findings: Of the 212 participants allocated to MMT, 98 (46 %) were prescribed higher dosages (>= 80 mg/day) before release. Linkage to MMT after release occurred in 77 (36 %) participants and significantly higher for those prescribed higher dosages (46% vs 28 %; p = 0.011). Factors associated with higher MMT dosages were being married, on antiretroviral therapy, longer incarceration periods, having higher levels of depression, and methadone preference compared to randomization. After controlling for other variables, being prescribed higher methadone dosage (aHR: 2.53, 95 %CI: 1.42-4.49) was the only independent predictor of linkage to methadone after release. Interpretation: Higher doses of methadone prescribed before release increased the likelihood of linkage to MMT after release. Methadone dosing should be introduced into international guidelines for treatment of opioid use disorder in prisons and further post-release benefits should be explored. Funding: National Institute of Drug Abuse (NIDA).
| Item Type: | Article |
|---|---|
| Funders: | United States Department of Health & Human Services National Institutes of Health (NIH) - USA NIH National Institute on Drug Abuse (NIDA) (R01 DA025943); (R01 DA041271); (F30 DA039716); (D43TW011324); (T32 GM007205); (K24 DA017072) |
| Uncontrolled Keywords: | Methadone; Optimal dosing; Prison; Retention; Opioid dependence |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine > Social & Preventive Medicine Centre of Excellence for Research in AIDS (CERiA) |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 21 Oct 2024 08:41 |
| Last Modified: | 21 Oct 2024 08:41 |
| URI: | http://eprints.um.edu.my/id/eprint/45438 |
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