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Smith LR, Faragó F, Blue T, Witte JC, Gordon MS, Taxman FS. Viewing Then Doing?: Problem-Solving Court Coordinators' Perceptions of Medications for Opioid Use Disorders from a Nationally Representative Survey in the United States. Subst Use Misuse 2023; 58:1780-1788. [PMID: 37595101 PMCID: PMC10538407 DOI: 10.1080/10826084.2023.2247076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
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.
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Affiliation(s)
- Lindsay R. Smith
- Department of Criminology, Law and Society, George Mason University
| | - Fanni Faragó
- Department of Sociology & Anthropology, George Mason University
| | | | - James C. Witte
- Department of Sociology & Anthropology, George Mason University
| | | | - Faye S. Taxman
- Schar School of Policy and Government, George Mason University
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Andraka-Christou B, Asi YM, Totaram R, Matusow H. Problem-Solving Court Staff Preferences for Educational Videos about Medications for Opioid Use Disorder. Subst Use Misuse 2023; 58:1550-1559. [PMID: 37462200 DOI: 10.1080/10826084.2023.2236201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
Problem-solving courts use an interdisciplinary approach with treatment mandates, hearings, and monitoring to rehabilitate individuals arrested for drug-related crimes or lost custody of children due to drug use. Medications for opioid use disorder (MOUD) are the standard of care for treating opioid use disorder (OUD), but few problem-solving court clients with OUD are referred to MOUD. Previous studies found court staff often harbor misconceptions about MOUD and could benefit from MOUD education. Tailoring education to the intended audience is an educational best practice. We sought to identify content and style preferences for two MOUD education videos: 1) an introduction to MOUD and, 2) MOUD myths/misconceptions. We recruited 40 Florida problem-solving court staff. Using semi-structured interviews, invited document/script edits, and qualitative surveys, we collected data at each of four video development stages. We used template analysis for qualitative data. Court staff desired the following content: OUD as a chronic brain condition and MOUD as an effective response; MOUD risks and benefits; how MOUD is accessed; and the appropriate role of court staff with MOUD decisions. Style preferences were: no juvenile/cutesy animation; relatable characters/environments; simple concept illustration; individualizing the learning experience; and combinations of scientific animated videos and successful stakeholder interviews. Our findings reinforce the importance of tailoring MOUD education to the audience. Court staff's wish for education about their appropriate role with MOUD reflects their unique position making treatment referrals. Court staff's desire for stakeholder recordings of success stories mirrors the importance of opinion leaders in other dissemination studies.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, Orlando, FL, USA
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL, USA
| | - Yara M Asi
- School of Global Health Management & Informatics, University of Central Florida, Orlando, FL, USA
| | - Rachel Totaram
- School of Global Health Management & Informatics, University of Central Florida, Orlando, FL, USA
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Farago F, Blue TR, Smith LR, Witte JC, Gordon M, Taxman FS. Medication-Assisted Treatment in Problem-solving Courts: A National Survey of State and Local Court Coordinators. JOURNAL OF DRUG ISSUES 2023; 53:296-320. [PMID: 38179102 PMCID: PMC10766435 DOI: 10.1177/00220426221109948] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Problem-solving courts (PSCs) are a critical part of a societal effort to mitigate the opioid epidemic's devastating consequences. This paper reports on a national survey of PSCs (N = 42 state-wide court coordinators; N = 849 local court coordinators) and examines the structural factors that could explain the likelihood of a local PSC authorizing medication-assisted treatment (MAT) and MAT utilization. Results of the analyses indicate that MAT availability at the county level was a significant predictor of the likelihood of local courts authorizing MAT. The court's location in a Medicaid expansion state was also a significant predictor of local courts allowing buprenorphine and methadone, but not naltrexone. Problem-solving courts are in the early stages of supporting the use of medications, even when funding is available through Medicaid expansion policies. Adoption and use of treatment innovations like MAT are affected by coordinators' perceptions of MAT as well as structural factors such as the availability of the medications in the community and funding resources. The study has important implications for researchers, policymakers, and practitioners.
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Affiliation(s)
- Fanni Farago
- Department of Sociology and Anthropology, George Mason
University, Fairfax, VA, USA
| | | | - Lindsay Renee Smith
- Schar School of Policy and Government, Center for Advancing
Correctional Excellence, George Mason University, Fairfax, VA, USA
| | - James C. Witte
- Department of Sociology and Anthropology, George Mason
University, Fairfax, VA, USA
| | | | - Faye S. Taxman
- Schar School of Policy and Government, Center for Advancing
Correctional Excellence, George Mason University, Fairfax, VA, USA
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Ahmed FZ, Andraka-Christou B, Clark MH, Totaram R, Atkins DN, Del Pozo B. Barriers to medications for opioid use disorder in the court system: provider availability, provider "trustworthiness," and cost. HEALTH & JUSTICE 2022; 10:24. [PMID: 35895179 PMCID: PMC9327334 DOI: 10.1186/s40352-022-00188-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medications for opioid use disorder (MOUD) significantly decrease mortality but courts rarely refer participants with opioid use disorder to MOUD providers. Previous qualitative work suggests routine court referrals to MOUD providers are more likely if court team members perceive providers as "trustworthy." Court team members may also be less likely to refer participants to MOUD if they consider MOUD unaffordable, particularly in Florida, which has not expanded Medicaid. Our aims were to explore court team members' 1) perceptions of availability of local trustworthy MOUD providers, 2) characteristics associated with perceptions of availability of local trustworthy MOUD providers, including beliefs about MOUD efficacy, and 3) perceptions of MOUD affordability. METHODS An online survey was distributed to all criminal problem-solving court and dependency court team members in Florida in 2019 and 2020. Likert scale questions assessed respondent agreement with statements about the availability of any MOUD providers, the availability of trustworthy MOUD providers, and the affordability of MOUD for court participants. An open-ended question explored MOUD barriers. Spearman's rho, Friedman, Kruskal Wallis, and Mann-Whitney U tests were used for analyzing quantitative data and iterative categorization for qualitative data. RESULTS One hundred fifty-one respondents completed quantitative questions (26% response rate), and 42 completed the qualitative question. Respondents were more likely to agree that local MOUD providers are more available than trustworthy MOUD providers. Perceptions of trustworthy provider availability differed significantly by MOUD type and were associated with MOUD efficacy beliefs. Qualitative results suggest that MOUD providers offering counseling and individualized treatment are more trustworthy. CONCLUSIONS Court team MOUD beliefs may influence their perceptions of providers, or negative experiences with providers may influence court team MOUD beliefs. Improving court team perceptions of local MOUD providers may be critical for facilitating court participant treatment access.
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Affiliation(s)
- Fatema Z Ahmed
- School of Global Health Management & Informatics, University of Central Florida, 528 W Livingston St, FL, 32801, Orlando, USA.
| | - Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, 528 W Livingston St, FL, 32801, Orlando, USA
- Department of Internal Medicine (Joint Secondary Appointment), University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - M H Clark
- Department of Learning Sciences & Educational Research, University of Central Florida, 12494 University Blvd, Orlando, FL, 32816, USA
| | - Rachel Totaram
- School of Global Health Management & Informatics, University of Central Florida, 528 W Livingston St, FL, 32801, Orlando, USA
| | - Danielle N Atkins
- School of Global Health Management & Informatics, University of Central Florida, 528 W Livingston St, FL, 32801, Orlando, USA
| | - Brandon Del Pozo
- Warren Alpert Medical School, Brown University, 222 Richmond St, Providence, RI, 02903, USA
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Andraka-Christou B, Randall-Kosich O, Golan M, Totaram R, Saloner B, Gordon AJ, Stein BD. A national survey of state laws regarding medications for opioid use disorder in problem-solving courts. HEALTH & JUSTICE 2022; 10:14. [PMID: 35357599 PMCID: PMC8969254 DOI: 10.1186/s40352-022-00178-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 03/09/2022] [Indexed: 05/03/2023]
Abstract
BACKGROUND Problem-solving courts have the potential to help reduce harms associated with the opioid crisis. However, problem-solving courts vary in their policies toward medications for opioid use disorder (MOUD), with some courts discouraging or even prohibiting MOUD use. State laws may influence court policies regarding MOUD; thus, we aimed to identify and describe state laws related to MOUD in problem-solving courts across the US from 2005 to 2019. METHODS We searched Westlaw legal software for regulations and statutes (collectively referred to as "state laws") in all US states and D.C. from 2005 to 2019 and included laws related to both MOUD and problem-solving courts in our analytic sample. We conducted a modified iterative categorization process to identify and analyze categories of laws related to MOUD access in problem-solving courts. RESULTS Since 2005, nine states had laws regarding MOUD in problem-solving courts. We identified two overarching categories of state laws: 1) laws that prohibit MOUD bans, and 2) laws potentially facilitating access to MOUD. Seven states had laws that prohibit MOUD bans, such as laws prohibiting exclusion of participants from programs due to MOUD use or limiting the type of MOUD, dose or treatment duration. Four states had laws that could facilitate access to MOUD, such as requiring courts to make MOUD available to participants. DISCUSSION Relatively few states have laws facilitating MOUD access and/or preventing MOUD bans in problem-solving courts. To help facilitate MOUD access for court participants across the US, model state legislation should be created. Additionally, future research should explore potential effects of state laws on MOUD access and health outcomes for court participants.
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Affiliation(s)
- Barbara Andraka-Christou
- School of Global Health Management & Informatics, University of Central Florida, 500 W Livingston Street, Orlando, FL 32801 USA
- Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, 500 W Livingston Street, Orlando, FL 32801 USA
| | | | | | - Rachel Totaram
- School of Global Health Management & Informatics, University of Central Florida, 500 W Livingston Street, Orlando, FL 32801 USA
| | - Brendan Saloner
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Adam J. Gordon
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT USA
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT USA
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Andraka-Christou B, Clark MH, Atkins DN, del Pozo B. Criminal problem-solving and civil dependency court policies regarding medications for opioid use disorder. Subst Abuse 2022; 43:425-432. [PMID: 34236297 PMCID: PMC9518695 DOI: 10.1080/08897077.2021.1944958] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Criminal problem-solving courts and civil dependency courts often have participants with substance use disorder (SUD), including opioid use disorder (OUD). These courts refer participants to treatment and set treatment-related requirements for court participants to avoid incarceration or to regain custody of children. Medications for opioid use disorder (MOUD) are the most effective treatment for OUD but are underutilized by court system participants. Little is known about variation in court policies for different MOUDs. Also, more information is needed about types of policies for each MOUD, including whether participants may begin MOUD, continue previously begun MOUD, or complete the court program with MOUD. Methods: An online survey was distributed to criminal problem-solving and civil dependency judges in Florida in 2019 and 2020, yielding data from 58 judges (a 24% response rate). We used nonparametric statistics to test hypotheses with ordinal data. A Friedman's test for related samples or Cochran's Q was used to make within-group comparisons between policies and MOUDs. Results: We found considerable policy variation, with more permissive policies for naltrexone than buprenorphine or methadone, and more permissive policies for continuing MOUD than for initiating MOUD or completing a court program with MOUD. For each medication, less than one quarter of judges indicated their court always permits MOUD, with most indicating that MOUD is permitted sometimes or usually. Conclusion: Because respondents rarely chose "never" or "always" for any MOUD policy, most courts appear to be making MOUD decisions on a case-by-case basis. A clearer understanding of this decision-making process is needed. Some court participants may be required to discontinue MOUD before completing a court program, even if they were permitted to start or continue MOUD treatment. Discontinuation of MOUD without medical justification is contrary to the standard of care for individuals with OUD and increases their risk of overdose.
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Affiliation(s)
- Barbara Andraka-Christou
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL, USA,Department of Internal Medicine (Joint Secondary Appointment), University of Central Florida, Orlando, FL, USA
| | - MH Clark
- Department of Learning Sciences and Educational Research, University of Central Florida, Orlando, FL, USA
| | - Danielle N. Atkins
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL, USA
| | - Brandon del Pozo
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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