Viewing Then Doing?: Problem-Solving Court Coordinators’ Perceptions of Medications for Opioid Use Disorders from a Nationally Representative Survey in the United States

Abstract

Background. Overdose deaths in the United States (U.S.) surpassed 100,000 in 2021. Problem-solving courts (PSCs), which originally began as drug courts, divert people with nonviolent felonies and underlying social issues (e.g. opioid use disorders (OUDs)) from the carceral system to a community-based treatment court program. PSCs are operated by a collaborative court staff team including a judge that supervises PSC clients, local court coordinators that manage PSC operations, among other staff. Based on staff recommendations, medications for opioid use disorders (MOUDs) can be integrated into court clients’ treatment plans. MOUDs are an evidence-based treatment option. However, MOUDs remain widely underutilized within criminal justice settings partially due to negative perceptions of MOUDs held by staff. Objective. PSCs are an understudied justice setting where MOUD usage would be beneficial. This study sought to understand how court coordinators’ perceptions and attitudes about MOUDs influenced their uptake and utilization in PSCs. Methods. A nationally representative survey of 849 local and 42 state PSC coordinators in the U.S. was conducted to understand how coordinators’ perceptions influenced MOUD utilization. Results. Generally, court coordinators hold positive views of MOUDs, especially naltrexone. While state and local coordinators’ views do not differ greatly, their stronger attitudes align with different aspects of and issues in PSCs such as medication diversion (i.e. misuse). Conclusions. This study has implications for PSCs and their staff, treatment providers, and other community supervision staff (e.g. probation/parole officers, court staff) who can promote and encourage the use of MOUDs by clients.

Keywords:

• Perceptions
• MOUDs
• problem-solving courts
• coordinators
• substance use

Acknowledgments

Dr. Gordon collaborated with Drs. Faye Taxman and James Witte of George Mason University to conduct the Medication-Assisted Treatment (MAT) Utilization Survey of Problem-Solving Courts (PSCs). We would also like to thank our survey administrators, research assistants, and research participants, all of whom collectively helped make this study possible.

Disclosure statement

The authors would like to disclose drug donations from Alkermes (Vivitrol) and Braeburn (CAM2038) given to Friends Research Institute for other studies.

Notes

1 During the course of this study, the field began using the term medication-assisted treatment (MAT) to a lesser extent since the term medications for opioid use disorders (MOUDs) is more favored due to the emphasis on treatment for opioid use disorder specifically. This paper will only focus on coordinators’ perceptions of medications that target opioid use disorders, although coordinators were asked about medications for alcohol use disorder too.

2 There was a significant amount of non-response to demographic questions asked of respondents so demographic percentages may not rise to the level of majority (i.e., > 50%) as the percentages presented are of that of the entire sample (n = 849, n = 42); however, the demographic percentages presented are what a majority of respondents selected.

3 The state coordinator was not asked about tenure in their position.

Additional information

Funding

This work was supported by the National Institutes of Health under a National Institute on Drug Abuse grant [R01DA043476]. The grant was awarded to Dr. Michael Gordon of Friends Research Institute.