1. Social Research Design: Draft Proposal Methadone in Australian Prisons By Kristy Ohlsen

2. Background  Methadone Maintenance Treatment (MMT) is used in New South Wales prisons to try to reduce recidivism and minimize hepatitis and HIV through needle sharing whilst incarcerated. Methadone is a synthetic Opioid agonist used as a maintenance tool for drug dependent individuals. It also reduces withdrawal symptoms and euphoric effects of any future drug use are minimalized as well as any need or want to use or inject Opioids.  Methadone, when first released as a program in prison, was only available to inmates who had an extensive history of drug use and also continually became incarcerated. It was a pre-release program specifically targeted to inmates who are injecting drug users (IDUs). At present, the Methadone Program is available to drug users who do not have an extensive history of drug use or a historical record of previous prison sentences.  The Methadone Maintenance Treatment can be seen as a social problem as the community may possibly view this as being problematic and enabling drug users. This is without knowing any background information of the positives of what Methadone can give. The public can be misinformed of information due to hype and media attention. By researching the Methadone Maintenance program, cost will also be explored to give a broader outlook and insight as to how much it costs to distribute this treatment program in Australian prisons. This cost is on top of medications that are already distributed daily at no cost to the inmates. This can be seen as one of the disadvantages and concerns to the taxpayer when looking at the overall figures.

3. Literature Review  The Methadone Treatment Program in NSW prisons commenced in 1986 with a primary reason to reduce recidivism. Despite efforts to cease heroin being smuggled into prisons it still became an issue. The program had become quite expansive in 1992 with a new objective to reduce HIV and hepatitis. In 2003, the program had on average 900 inmates across 23 prisons and was the largest Methadone Program in Australia. Two studies, randomised controlled trial and a subsequent follow-up study have explored the effectiveness of the prison Methadone Program (Dolan et al.2006).  The Methadone Treatment Program has been a continuing controversy within the Department of Corrective Services about the program. The Rationale behind the treatment has not been well received by Corrective Services staff or understood. Those that object to the Methadone Program see it as replacing one drug with another rather than breakaway without a substitute in place. The inmates who have been on the program have shown vast improvement in avoiding opioids altogether when released. The primary concern for Correctional Officers is diversion of this medication, whether voluntarily or through standover tactics. The research on the Methadone Programs effectiveness in NSW prisons is impaired by restrictions in place for security measures, lack of understanding of its rationale (Hall, Mattick &Ward, 1993).  In 2009, there were 3328 inmates receiving methadone in Australian Correctional facilities. All jurisdictions allow inmates to be able to continue treatment immediately after release with the exception of Queensland who only permit Females to continue on with the treatment. By maintaining opioid tolerance prior to release it may assist in reducing deaths by drug overdose and has shown a significant change in injecting-related HIV risk behaviours (Burns et al. 2011).  Methadone treatment had been discredited in all states except Queensland. The growing heroin problem was not being treated by other methods or through the legal system. The NSW Department of Health continued to hold strong negative views about methadone treatment, with media attention swirling around the issue it was then that research began to arise with drugs and crime. This link provoked the NSW Bureau of Crime Statistics, 1984, which showed an alarming rate of violent and non-violent drug linked crime (McArthur, 1999).

4. Research Question  Should the Methadone Treatment Program be used to treat drug-addicted inmates in Australian Prisons?  Nominal definition: Methadone, A powerful synthetic analgesic drug, which is similar in effects to Morphine but less sedative. It is used as a substitute drug to treat morphine and heroin addiction.  Operational Definition: Distributed orally in small doses until the correct dosage is reached to the correct dosage level for that particular inmate.  Nominal Definition: Drug addicted, an overwhelming desire to continue taking a drug due to its effects on mental status.  Operational Definition: Duty of care to inmates in prison by Correctional staff, receiving appropriate medical needs while housed in a Correctional facility for duration of incarceration.  Nominal Definition: Prison, A place of confinement for lawbreakers and an institution for confinement of persons convicted of serious crimes.

5. Methodology  The data used for the research will be by way of survey and posted or emailed, depending on participants choice, to all participants involved.  Non-probability sampling will be used.  500 active Justice Health nurses across Australia will be chosen to participate over a 6 month period. By using Justice Health staff these participants have first hand dealings with distributing methadone and monitoring inmates behaviours daily for any changes in behaviours.  The survey will be thoroughly explained via email beforehand discussing what the survey is exploring.  Participants must be over the age of 18.  Responses to survey question will be as follows: Strongly agree Agree Strongly disagree Disagree Unsure

6. Ethical considerations  Confidentiality, all names will be removed from survey answers upon return and before publication.  Informed consent  Beneficence, no physical, emotional, psychological or legal harm to participants.  Participants are not under any duress to complete the survey.  The research proposal will be submitted to the ethics committee for review.  All participants will receive a copy of the findings of the survey.  All inmates on the Methadone Maintenance Treatment Program will have identities withheld; only overall numbers will be used to examine costs and effectiveness.