Medications for Opioid Use Disorder and Problem-Solving Courts

"This study found that of MAT [Medication-Assisted Treatment] usage was associated with the availability of funding for MAT in PSCs [Problem Solving Courts] and the availability of providers and/or facilities that provide MAT. Coordinators’ willingness to authorize MAT was also associated with knowledge and interest in medications. When coordinators have perceptions that MAT is merely a substitute for illicit drugs, then the court is less likely to authorize MAT (Andraka-Christou & Atkins, 2020; Fendrich & LeBel, 2019; Matusow et al., 2013; Richard et al., 2020). Medicaid expansion impacts the number of patients that receive medications and the number of qualified providers and clinics (Maclean & Saloner 2019; Abraham et al., 2021). This study found that increasing the uptake of MAT could be affected by Medicaid expansion, the regulations that expand where MAT is offered, and who can provide MAT. State mandated eligibility criteria to participate in PSC were negatively associated with increased participant utilization of MAT. It also identified that a barrier to utilization of MAT was the attitude of coordinators regarding the perception that MAT is just substituting one drug for another.

"This national survey of PSCs was challenging to conduct and revealed that the courts lack infrastructure to understand the participants’ needs and service provision. The challenges we encountered included defining a PSC and obtaining a valid list of PSCs and their coordinators. Such a list is not maintained at the national level, and many states do not have this information or were not willing to share the information. Further, the hierarchical nature of PSCs, where a state coordinator provides approval for study participation, is a further barrier. In the end, 13 state coordinators did not provide permission to sample specific courts but allowed for the survey to be administered to all courts in their state; six state coordinators did not provide a list of their courts—this resulted in the study design needing to be modified based on the state coordinator. In 28 states, the study team dispensed the online survey link to only a few courts and in 13 states the state coordinator sent the link to all courts in the state. This resulted in obtaining responses from 849 courts which we found to be similar to the original 402 surveys from target courts. We assessed whether the additional courts had an impact on our two dependent outcomes—adopt MAT and use MAT for participants in the courts—and it did not."