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The Oregon depo-Provera Prograxm: A Five-Year Follow-Up

Abstract

In 1999, the Oregon State Legislature, concerned about the risk certain sexual offenders might pose to their communities upon release from prison, enacted House Bill 2500. This bill required selected offenders to be evaluated prior to their release to determine whether medical treatment with medroxyprogesterone acetate (MPA), also known by its trade name of depo-Provera, was indicated to reduce their risk. The present study reviewed the first 275 men to be evaluated under this program from the years 2000 through 2004. Data were collected on diagnoses and outcome on three groups: men judged to need MPA who eventually went on to actually receive it; men recommended to receive MPA who, for a variety of reasons, did not receive the medication; and men deemed not to need MPA. Outcome measures included recidivism data, including reoffenses, parole violations, and reincarcerations, and whether these were sexual in nature. Data were also collected on employment and whether supervising officers believed the men in each group were doing well. Significant differences emerged among these three groups, with men actually receiving depo-Provera committing no new sexual offenses and also committing fewer overall offenses and violations compared to the other two groups. In addition, almost one third of men judged to need medication but who did not receive it committed a new offense and almost 60% of these were sexual in nature. While generalizations from these types of retrospective and partially subjective findings are inherently limited, the present study lends credence to the belief that, in selected offenders, anti-androgenic medication can be a valuable, if time-limited, addition to a cognitive and behavioral treatment program. Suggestions for more practical and far-reaching implementation of this adjunctive approach are offered.

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Correspondence to Barry M. Maletzky.

Appendix

Appendix

The depo-Provera scale

The depo-Provera Scale attempts to measure appropriateness for the use of depo-Provera. It relies on factors based on a records review, at times supplemented by the sexual offender's history. No factors are based solely on the offender's history, however.

The factors comprising the Scale are taken from research and experience indicating the need for depo-Provera. They have also been culled from results of patients receiving this medication. Notably absent from the Scale are nonsexual parameters such as vocational and relationship histories, history of nonsexual violations, and a history of antisocial behaviors. Also missing are dynamic change factors inasmuch as most of the men being evaluated for depo-Provera have not yet participated in treatment programs. Those items which must derive from only the offender's account of his history are also not included, such as the level of disclosure or denial and amenability to treatment.

For purposes of quantification, each factor counts either as a 1 or a 2. The more heavily weighted factors, including the presence of deviant sexual arousal, the existence of male victims, a history of sexual offender treatment failure, and the presence of CNS dysfunction, have all been found, from research and experience, to especially identify an offender as appropriate for depo-Provera. An attempt is being made to quantify this Scale in order to determine retrospectively if it identifies those offenders, also selected by experts, as appropriate for depo-Provera.

Scoring

Any offender with three or more factors, with two or more starred factors, or with a score exceeding 6, should be seriously considered for depo-Provera.

Table 6  

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Maletzky, B., Tolan, A. & McFarland, B. The Oregon depo-Provera Prograxm: A Five-Year Follow-Up. Sex Abuse 18, 303–316 (2006). https://doi.org/10.1007/s11194-006-9021-4

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Keywords

  • Anti-androgens
  • Depo-Provera
  • Medroyxprogesterone acetate
  • Paraphilias
  • Recidivism
  • Sexual offending