Methadone maintenance treatment decreases reoffending

A recent study in how methadone can be a useful tool in preventing re-offending and prisoner death rates has been released by the National Drug and Alcohol Research Centre at the University of New South Wales. The 10 year long study involved 375 male heroin using prisoners from New South Wales prisons. The study found that those on methadone were 20% less likely to re-offend compared to those not on methadone substitution. The study also looked at mortality rates and found that during the course of the study those on methadone were 40% less likely to die compared to those who were not on methadone substitution.


The study does mention however that if prisoner have methadone treatment within the prison but upon release stops have methadone substitution then his re-offending and mortality rate is the same as those who did not undergo methadone treatment. At this point critics may suggest that there is no point in providing people in prison methadone substitution but the authors of the study and indeed several other studies dispute this.


One paper highlights this fact, in the study done by Kinlock 200 prisoners were used and checked on after one month. The study found that offering methadone treatment in prison “was associated with greater treatment entry in the community”. Apart from this there is also the fact that methadone substitution can be used as an effective tool in combating HIV infections within the prison environment with one study saying it was a very “cost effective” way of reducing HIV infections within prisons.


Deaths are also dramatically reduced for those on methadone substitution treatments one study found that 17 out of the 382 ex-prisoners in the study that were not on methadone substitution died whilst none of the ex-prisoners on methadone substitution died. The study also seems to point to counselling by itself not being as effective as methadone substitution considering 4 of those 17 participants who died were depending solely counselling.


All this seems to point towards methadone substitution being an effective tool in prisons in the fight against the spread of diseases, reoffending and deaths. So why is it that three states in Australia still choose to ignore these findings? Queensland, Tasmania and the Northern Territory do not offer prisoners methadone substitution unless they are either pregnant or were on methadone substitution before being put in prison.


This means that up to 20% of prisoners in Tasmania that could benefit from substitution treatment are denied it. In Queensland it is no better were just 17 prisoners were on substitution treatment. 17 prisoners on methadone treatment in Queensland is quite alarming considering the fact that at least 44% of injecting drug users have gone to prison. Despite this only 17 prisoners are on methadone substitution treatment in jail which is just bewildering.


Countless studies have shown that methadone substitution is cost effective in prisons. One study which looked at the prison methadone program in New South Wales (the biggest prison based methadone programs in Australia) concluded that “prison methadone compares favourably to community based methadone on the basis of cost alone.” The cost per person of methadone treatment in a New South Wales prisons is $3234 a year this includes the cost of administration, nursing, doctors etc whilst the cost of locking up someone in New South Wales is $176 a day which means $64,240 a year. If an inmate stays out of jail for 20 days more a year then methadone substitution can be viewed as being cost effective.  There is no conclusive evidence about how many days on average ex-inmates on methadone substitution treatments stay out of prison. Recent studies such as the one in Australia show that those on methadone are 20% less likely to reoffend. Other sources credit the New South Wales methadone treatment program in jails as reducing recidivism by up to 70%.


One study which tried to work out how many weeks/days less an ex inmate would spend if on methadone substitution was by Keen, Rowse, Mathers, Campbell and Seivewright their study was quite limited though as it was based on only 57 participants. In their study time spent in prison before methadone treatment and time spent in prison after methadone treatment were compared. On average participants before methadone substitution therapy where spending 2.5 weeks in prison, this was drastically reduced to 0.5 weeks once they went on methadone substitution treatment. That is an astonishing 82% less time in prison per year and does seem to indicate that methadone treatment can be a cost effective way of keeping people out of jail.


Even disregarding the reduced prison time methadone still makes cost effective sense due to the fact that it is a proven method of reducing infections such as HIV which spreads throughout prisons. Countless studies have been done mentioning the fact that there is a link between methadone substitution and a decreased use of needles. As Dolan from the National Drug and Alcohol Research Centre says “injecting drug users who received methadone maintenance treatment during imprisonment reported significantly fewer injections per week”.


The study released saying that those on methadone substitution have a lower mortality and a lower risk of re-offending should vindicate more money being put into providing these treatments, in particular in states such as Queensland where methadone substitution is severely limited in prisons.  Places like New South Wales who have a more impressive prison based substitution treatments need to also increase its methadone substitution facilities. As Dr Alex Wodak from the alcohol and drug service at St Vincent Hospital says New South Wales methadone treatment in jail was “grossly deficient”.


Methadone substitution in jails will not only help the individual but it will also help society and the study released by the National Drug and Alcohol Research Centre is just another addition to the countless studies, expert opinions and statistics which point to methadone being a very cost effective and useful tool in the prevention of reoffending, mortality rates and reduction in infections.