Trying to break the cycle of heroin addiction, prison

Inmates: As part of a study, 60 will receive methadone leading up to release.

July 23, 2005|By Alec MacGillis | Alec MacGillis,SUN STAFF

Over and over again, Dennis Wise re-enacted the destructive routine that Baltimore knows all too well. He sold drugs and shoplifted to support his 10-year heroin habit; he went to jail or prison after getting caught; he went without drugs while inside - and then went right back on them as soon as he got out.

But then, while he was serving a 12-month prison term two years ago, something different happened. He was offered the chance to go on methadone, the syruplike heroin replacement medication, five months before his release. When he got out of prison last year, he stayed on methadone. He's now proud to be holding down a job and caring for his family in Northeast Baltimore.

"I had a start this time. I had a clear mind," said Wise, 41, during a recent visit to the Man Alive clinic on Maryland Avenue, where he goes three times a week for methadone and counseling. "It got me on a different track."

Wise benefited from an approach being tried in Baltimore to break the cycle of arrest, release and relapse that has stymied the city's and state's best efforts to reduce crime and fight drugs. As part of a five-year federally funded study, a total of about 60 inmates at the Metropolitan Transition Center, the state prison on Forrest Street, will be given methadone in the months leading up to release.

Researchers from the Friends Research Institute, a Baltimore organization that administers health-related studies, are trying to determine whether these inmates will be more likely to seek methadone and counseling after their release, and to get jobs and stay out of trouble, than other inmates with heroin problems.

The researchers are following up with the inmates up to a year after their release, and they expect to have results by 2008. At that point, the state may decide to expand methadone distribution to all its prisons, depending on the study's findings.

Unique approach

The $500,000 study represents a sharp departure from the way most prisons have handled drug treatment for the many inmates who come into prison with histories of drug use and drug-related crime. While methadone has long been a fixture of heroin treatment, it is rarely used behind bars. Some jails use it to help detoxify incoming inmates, and the Rikers Island jail in New York offers it on a longer-term basis to addicts at the jail.

But there are no reports of methadone's use at prisons, where inmates serve longer sentences than they do at jails, and where treatment is typically limited to group counseling sessions. Most corrections officials have reasoned that prison inmates, who are typically in for at least a year, will by necessity break their addiction while inside because even the drugs that do manage to get inside prison are often not adequate to sustain a serious habit.

The state corrections department, which supports the study, acknowledged that the approach could strike some as odd: Why give inmates who have spent months or years without heroin a daily opiate dose, even in the well-regulated form of methadone maintenance?

"These are theoretically people incarcerated long enough that it's not just a question of [using methadone for] going through detoxification or withdrawal," said Richard B. Rosenblatt, assistant secretary for treatment. "Theoretically, we're starting them up again."

The researchers in charge of the study point out, however, that some inmates manage to get drugs while in prison. More important, even those who go without inside tend to go back on drugs when they get out, increasing their chances of infection with HIV or hepatitis C through shared needles.

Relapse after release is so common because abstinence brought on by a lack of supply often isn't enough to break an addiction, said Dr. Robert Schwartz, a Baltimore psychiatrist specializing in substance abuse and one of the lead investigators on the study.

"When they're sitting in jail, they may be going cold turkey, but all they're thinking about is getting out and using," he said. Offering methadone before release "potentially is an opportunity to make a huge difference."

Wise, the recovering addict, puts it another way: "When you're locked away, you didn't stop because you wanted to. You stopped because you have to; it's taken away from you," he said. "Very few stay clean when they get back out. They may stay clean for a minute, but that's it. Their mind is still the same. It's a disease. It's a big disease."

The numbers back up claims that the current approach hasn't been working. A survey by the Center for Substance Abuse Research at the University of Maryland found that more than a third of men arrested in Baltimore, and nearly half of women arrested, have used heroin in the month before their arrest, among the highest rates in the country. Other studies have found that a majority of addicted inmates relapse onto heroin within a month of their release.

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