Criminal problem-solving and civil dependency court policies regarding medications for opioid use disorder

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.

Keywords:

• Policy
• buprenorphine
• methadone
• naltrexone
• court
• criminal justice
• survey
• treatment
• medication
• opioid use disorder

Disclosure statement

In 2017, Dr. Andraka-Christou received a research grant from Alkermes, Inc. to develop online education about substance use disorder for college students and a mobile health tracking application for college students.

Author contributions

Dr. Andraka-Christou conceptualized the project, obtained funding for the research, led development of the survey instrument, recruited participants, and led manuscript drafting. Dr. Atkins and Dr. Clark performed analysis of the data and assisted with manuscript drafting and editing. Dr. del Pozo assisted with data interpretation, manuscript drafting, and editing.

Data availability statement

Deidentified survey data, with small cell sizes redacted, are available from the corresponding author by request.

Additional information

Funding

This work was supported by the Florida Office of the State Courts Administrator. The funder did not have any role in the design, data collection, or analysis of the study, except that the funder provided the researchers with the email addresses of all criminal problem-solving court and dependency court staff in Florida.