Fostering MOUD use in justice populations: Assessing the comparative effectiveness of two favored implementation strategies to increase MOUD use

Abstract

Coaching is a favored strategy for the implementation of medications for opioid use disorder (MOUD), yet research has not adequately tested or assessed coaching dosages and mediums for overall effectiveness, nor have coaching doses been widely studied within criminal justice settings (CJS). Scaling up the use of MOUD, particularly in CJS, presents a challenge given the stigmatization of substance use disorder, funding for MOUD, availability and capacity of community-based treatment providers, leadership support, and the historical preference for behavioral therapy–based treatment practices. The University of Wisconsin's Center for Health Enhancement and Systems Studies (CHESS) and George Mason University's Center for Advancing Correctional Excellence! (ACE!) are conducting a randomized controlled trial to determine the optimal combination and dosages for two different coaching strategies to disseminate MOUD in justice-involved populations; those strategies are the NIATx model for process improvement and Extension for Community Healthcare Outcomes (ECHO) model. NIATx coaches provide technical assistance in MOUD implementation and organizational change to help justice and treatment organizations to implement and disseminate MOUD for justice clients. The ECHO platform focuses primarily on the clinical provider by connecting the provider with expert MOUD prescribers to promote high-quality MOUD practices. The trial will have four study arms that compare high-dose and low-dose coaching, with and without ECHO. This will be the first trial that assesses the comparative effectiveness of two types of coaching methods at varying dosages for justice-involved individuals. The trial will be conducted with 48 jails and community-based treatment provider sites that handle justice-involved persons with opioid use disorder (OUD).