When transitioning from prison to the community, formerly incarcerated individuals face numerous challenges, including lack of employment, housing, and health care. This transition is more precarious for those with HIV or opioid use disorder, who, due to these diseases, have an increased risk of medical complications and even death.

In a new Yale-led study, published in the International Journal of Drug Policy, researchers showed that treatment with methadone in patients with HIV and opioid use disorder before they are released from prison resulted in substantially better HIV outcomes during the year following release. The findings, the researchers say, support routinely integrating methadone treatment into prison health care systems to reduce HIV transmission and improve public health.

“We knew that there is a synergistic effect between addiction and HIV,” said Frederick Altice, MD, professor of medicine (infectious diseases) at Yale School of Medicine and of epidemiology (microbial diseases) at the Yale School of Public Health, discussing the impetus for the study. “We hypothesized that if we could directly address that synergy by optimizing the treatment for the substance use disorder, we could have an impact on HIV treatment and prevention.”

For the study, 296 incarcerated individuals with HIV and opioid use disorder from Malaysia’s largest prison were randomized to receive either pre-release methadone, a risk-reduction behavioral intervention, neither, or both. Participants who had been prescribed methadone were significantly more likely to engage in HIV care by 30 days after release into the community, and this engagement increased more than 2.5-fold by one year after release.

The study is one of the first to show quantitatively through a randomized control trial the impact of methadone not only on treatment for opioid use disorder, which is well established, but also on the treatment of HIV, according to Allison Mobley, MD, first author of the study, who conducted this research in Malaysia with the support of the Yale Global Health Equity Scholars program.

Mobley added that the implementation of methadone treatment in prisons does more than support the health of marginalized populations. “It would be a significant step toward dismantling the cycle of recidivism and health disparity that affects these individuals,” she said.

Altice views the study, made possible through a longstanding collaboration with researchers in Malaysia, as a call to action for policymakers and prison administrators in the U.S. and around the world.

“Integrating methadone treatment into prison health care systems and making it accessible for those who need it is a critical step toward achieving global HIV targets and enhancing public health goals,” he said.

Other Yale authors of the study include Sheela Shenoi, Daniel Bromberg, and Ahsan Ahmad.

The research reported in this news article was supported by the National Institutes on Drug Abuse (awards R01DA025943, R01DA041271, F31DA054861, and F30DA039716), the Fogarty International Center (awards D43TW011324 and D43TW010540), and the National Institute of Mental Health (award F30MH105153). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Doris Duke Charitable Foundation International Clinical Research Fellowship also supported this work.

Yale School of Medicine’s Department of Internal Medicine Section of Infectious Diseases engages in comprehensive and innovative patient care, research, and educational activities for a broad range of infectious diseases. Learn more at Infectious Diseases.