Pivovarova Ekaterina, Taxman Faye S, Boland Alexandra K, Smelson David A, Lemon Stephenie C, Friedmann Peter D
Department of Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Schar School of Policy and Government, George Mason University, Fairfax, VA, USA.
J Subst Use Addict Treat. 2023 Apr;147:208950. doi: 10.1016/j.josat.2022.208950. Epub 2023 Jan 13.
Access to medications for opioid use disorder (MOUD) is limited for individuals in drug courts - programs that leverage sanctions for mandatory substance use treatment. Drug courts rely on community agencies to provide MOUD. However, relationships with MOUD agencies, which impact access to treatment, are understudied. We examined barriers and facilitators from drug court staffs' perspectives to understand how to enhance collaborations with MOUD providers.
Drug court staff (n = 21) from seven courts participated in semi-structured interviews about their experience in collaborating with MOUD providers. Interviews were informed by the Consolidated Framework for Implementation Research. Inductive (theory-based) and deductive (ground-up) approaches were used for analyses.
Facilitator and barrier themes centered around the needs and resources of drug court participants, external policies such MOUD access in jails, networking with external agencies, and beliefs about MOUD providers. Drug court staff preferred working with agencies that offered MOUD alongside comprehensive services. Drug courts benefited when jails offered MOUD in-house and facilitated community referrals. Existing relationships with providers and responsive communication eased referrals and served to educate the courts about MOUD. Barriers included logistical limitations (limited hours, few methadone providers) and inadequate communication patterns between providers and drug court staff. A lack of confidence in providers' prescribing practices and concerns around perceived overmedication of participants impacted referrals, interagency collaboration, and further burdened the participants.
Collaboration between drug courts and MOUD providers was driven by patient needs, external policies, communication patterns, and perceptions. Interventions to increase access MOUD for drug court participants will need to incorporate collaboration strategies while considering the unique features of drug courts.
对于药物法庭中的个人而言，获得阿片类药物使用障碍（MOUD）治疗药物的机会有限。药物法庭是利用制裁措施来强制进行药物使用治疗的项目。药物法庭依赖社区机构来提供MOUD。然而，与MOUD机构的关系（这会影响治疗机会）却鲜有研究。我们从药物法庭工作人员的角度审视了障碍和促进因素，以了解如何加强与MOUD提供者的合作。
来自七个法庭的21名药物法庭工作人员参与了关于他们与MOUD提供者合作经验的半结构化访谈。访谈参考了实施研究综合框架。采用归纳（基于理论）和演绎（自下而上）方法进行分析。
促进因素和障碍主题围绕药物法庭参与者的需求和资源、外部政策（如监狱中的MOUD获取）、与外部机构的网络联系以及对MOUD提供者的看法。药物法庭工作人员更倾向于与提供MOUD及综合服务的机构合作。当监狱内部提供MOUD并促进社区转诊时，药物法庭会从中受益。与提供者现有的关系以及及时的沟通简化了转诊流程，并有助于让法庭了解MOUD。障碍包括后勤限制（工作时间有限、美沙酮提供者少）以及提供者与药物法庭工作人员之间沟通模式不足。对提供者处方做法缺乏信心以及对参与者用药过量的担忧影响了转诊、机构间合作，并给参与者带来了进一步负担。
药物法庭与MOUD提供者之间的合作受患者需求、外部政策、沟通模式和看法驱动。为增加药物法庭参与者获得MOUD的机会而采取的干预措施需要纳入合作策略，同时考虑药物法庭的独特特征。
