Beliefs about medications for opioid use disorder among Florida criminal problem-solving court & dependency court staff

Abstract

ABSTRACT Background Criminal problem-solving and dependency (child/dependent) court staff refer clients with opioid use disorder (OUD) to treatment and set treatment policies. Negative beliefs regarding the safety and efficacy of medications for opioid use disorder (MOUD) have previously been reported in court staff. MOUD is superior to other OUD interventions, is severely underutilized, and is highly effective even in the absence of behavioral treatment. Objective We examined Florida court staff MOUD beliefs, exploring associations with court type and staff role. We also explored beliefs about the relationship of MOUD to child reunification, counseling, polysubstance use, and titration requirements. Methods We modified a previously developed cross-sectional survey. We fielded the online survey among all Florida criminal problem-solving and dependency court staff. Likert scale questions were asked about beliefs regarding methadone, buprenorphine, and extended-release naltrexone. We analyzed responses using descriptive statistics and logistic regression. Results 154 individuals (26% of the population) responded. Only 1/3 believed MOUD was more effective for OUD than nonpharmacological treatment. 31% believed methadone treatment makes it difficult for parents to regain child custody. Criminal problem-solving court staff were more likely to report certain positive beliefs about naltrexone. Fewer than 10% felt any MOUD should be permitted without counseling. Over 60% felt prescribers should have tapering plans for each MOUD patient. Beliefs were generally more positive for naltrexone than buprenorphine, and more positive for buprenorphine than methadone. Conclusions Court staff need education about MOUD efficacy. Policymakers should prohibit courts from banning MOUD and from preventing child reunification for parents utilizing MOUD.