An Experimental Survey of Key Factors Involved in Problem-Solving Court Staff Decisions About Medications For Opioid...

Medications for opioid use disorder (MOUD) are underused by problem-solving court (PSC) clients, despite their treatment efficacy. Prior qualitative work suggests PSC staff make case-by-case decisions about whether clients can use MOUD, with decisions influenced by the type of MOUD desired and the presence of PSC-MOUD provider partnerships. This study tests these qualitative findings using an experimental survey.

A national convenience sample of 53 PSC staff was randomly assigned 8 of 32 hypothetical vignettes with varying court client factors in a factorial online survey experiment. For each vignette, staff were asked whether their court would allow MOUD. Decision factors tested included client race, client gender, type of MOUD, history of client MOUD misuse, and whether the MOUD would come from an MOUD provider who partners with the court. Client race and gender were made to vary across surveys, while the remaining factors varied within surveys. Hierarchical ordinal modeling tested the effects of factors on decisions.

PSC staff were significantly less likely (P < .05) to allow MOUD if hypothetical clients (a) were prescribed methadone rather than buprenorphine, (b) desired medication from a non-partnering treatment provider versus a partner, or (c) had a history of MOUD misuse versus no history.

Findings affirm prior qualitative work indicating the PSC's relationship to the MOUD provider and MOUD type affect case-by-case PSC staff decisions about MOUD. Interventions to promote development of court-MOUD provider partnerships could help increase MOUD utilization among PSC clients. Partnerships with methadone providers might help address methadone misconceptions.