Problematic Policies Regarding Medications for Opioid Use Disorder among Florida Courts

Introduction: Judges may harbor misconceptions about medications for opioid use disorder (MOUDs); but few studies have examined court MOUD policies, especially regarding naltrexone. Therefore, in this study, we examined the frequency of MOUD-related policies among a convenience sample of Florida judges in problem-solving courts and dependency courts.

Methods: We created an online survey asking about policies for MOUDs (i.e., methadone, buprenorphine, naltrexone). For each MOUD, respondents were asked whether: a) clients may start MOUD in the court program, b) clients may continue previously begun MOUD, and c) clients may complete the court program/graduate while utilizing MOUD. Each item was formatted as a four-point rating scale (never to always) with options for “I don’t know” and “I choose not to answer.” After piloting, the survey was distributed to all criminal problem-solving and dependency judges/court staff in Florida. Our final sample for this analysis included only judges to limit the sample to one respondent per court (i.e. 1 judge=1 court). We tested whether courts were more likely to have certain policies for MOUD and whether certain MOUDs were more likely allowed using Friedman tests for related samples.

Results: 58 judges responded, primarily from adult drug courts. A) Starting MOUD: 0%-2% of courts never permitted, 54%-56% sometimes or usually permitted, and 14%-17% always permitted starting the MOUD. B) Completing the court program with MOUD: 5%-7% of courts never permitted, 43%-52% sometimes or usually permitted, and 6%-12% always permitted program completion with the MOUD. C) Continuing previously begun MOUD: 0%-3% of courts never permitted, 47%-53% sometimes or usually permitted, and 16%-22% always permitted the previously begun MOUD. Courts were more likely to allow clients to continue MOUDs begun prior to the court program that to begin MOUD while in the court program or to complete the court program with MOUD. Courts were more likely to permit clients to complete court programs using naltrexone than methadone or buprenorphine and more likely to permit continuing previously begun naltrexone than methadone.

Conclusions: Relatively high frequencies of “sometimes” or “usually” responses for beginning or continuing previously begun MOUD suggests courts are making such decisions on a case-by-case basis. Further research is needed regarding decision-making factors. discrepancies in policies by medication suggest bias toward naltrexone and against methadone. Since for all MOUDs, courts are less likely to allow clients to complete the program utilizing MOUD than to begin MOUD/continue previously begun MOUD, courts may be requiring clients to discontinue MOUD as a condition of graduation. If true, such policies could place court participants at risk of increased morbidity or mortality. Greater likelihood of courts permitting previously begun MOUD could also reflect judicial knowledge of a federal 1st circuit case (Smith v. Aroostook, 2019), in which it was affirmed that jails preventing continuation of previously begun MOUD could violate the Americans with Disabilities Act.