Drug court utilization of medications for opioid use disorder in high opioid mortality communities

Introduction: A 2012 national survey found low utilization of medication for opioid use disorder (MOUD) in US drug courts. This study provides an update on MOUD policies and practices among drug courts in communities that the opioid epidemic has substantially impacted. Methods: The study surveyed adult drug courts (N = 169, 80 % response rate) in US counties with high opioid mortality rates or numbers of opioid-related deaths about their policies and practices relating to MOUD and the overdose-reversal medication, naloxone. Results: Nearly three quarters of the programs (73 %) reported providing access to all FDA-approved MOUD medications, >90 % offer agonist medications (buprenorphine and/or methadone), 80 % provide naloxone training, and 62 % distribute naloxone overdose-reversal kits to their clients. Most programs rely principally on medical judgment for medication decisions (75 %), have received staff training on MOUD (65 %), and have arranged for clients to continue receiving agonist medications while serving jail sanctions for program violations (63 %). Nevertheless, only about one quarter to one half of clients with OUDs receive the medications in most programs, and respondents offered few explanations for this disconnect between policy and practice. In addition, 24 % of the programs continue to overrule medication decisions and 36 % of the jails in these communities do not offer agonist medication for drug court clients serving custodial sanctions. Conclusions: Programs have achieved substantial progress in the past decade in improving drug court policies concerning MOUD in communities enduring the worst brunt of the opioid epidemic; however, programs require further guidance to help them understand and rectify service barriers and put intended MOUD policies into effective operation. The authors provide recommendations to enhance MOUD utilization in drug courts and the broader criminal justice system.