Medications for Opioid Use Disorder in the Criminal/Legal System: Knowledge, Beliefs, and Attitudes Among Rural Community-Based Stakeholders

Abstract

The aim of this study was to describe rural community stakeholders’ attitudes and perceptions of providing medication for opioid use disorder (MOUD) to individuals in the criminal/legal system. Data were utilized from a technical assistance initiative aimed at strengthening community-based OUD treatment within criminal/legal systems. A mixed-methods approach was applied. Survey responses were used to compare stakeholders’ who had and had not attended an MOUD training, and semistructured interviews were conducted with a convenience sample of rural criminal/legal and treatment stakeholders. MOUD training was associated with endorsing the effectiveness of methadone, oral naltrexone, and injectable naltrexone. Three primary themes emerged from the stakeholder interviews: 1) acceptance of MOUD uptake; 2) stigma of MOUD and diversion concerns; and 3) gaps in MOUD treatment. Most interviewees noted that there is a scarcity of treatment options in their community, and among the existing services, there are considerable barriers to care.

Differences in intent to refer buprenorphine among community correctional and treatment staff: A set of cross‐lagged models predicting efficacy beliefs and familiarity with buprenorphine for opioid use disorder

“…For corrections staff, there is a need to emphasize the efficacy of buprenorphine. Current training leads to a decrease in beliefs about buprenorphine efficacy, which has also been found in another study 13 . While further research is needed to confirm the role of efficacy beliefs towards MOUD referral among correction staff, previous studies have found that the most effective trainings are those that break down abstinence‐oriented barriers that may limit a correctional employee's beliefs about the efficacy of evidence based MOUD 2,34 .…”

“…However, we believe this was the most appropriate ordering of data given the measures available and the fact that referral intention is still measured 12 months after training exposure. This study and others have found that trainings may be correlated with changing attitudes about buprenorphine in correctional settings 13 but the precise mechanisms of these trainings that have the greatest impact remains unknown. Friedmann et al 2 conducted a targeted intervention for the MATICCE study participants and found that a standardized, targeted training was effective at increasing positive beliefs about MOUD and increasing referral intentions.…”

“…Current training leads to a decrease in beliefs about buprenorphine efficacy, which has also been found in another study. 13 While further research is needed to confirm the role of efficacy beliefs towards MOUD referral among correction staff, previous studies have found that the most effective trainings are those that break down abstinence-oriented barriers that may limit a correctional employee's beliefs about the efficacy of evidence based MOUD. 2,34 The findings of this study suggest that training did not significantly influence intent to refer through buprenorphine efficacy due to a respondent's predetermined beliefs about MOUD and the perceived risk of diversion-rather than the efficacy of the buprenorphine.…”

“…Despite the limited potential for nonprescribed buprenorphine use, there is evidence to suggest criminal/legal professionals are particularly concerned about the diversion of the drug within the criminal justice system. 12,13 It should be noted that there is a preponderance of evidence suggesting that non-prescribed use of buprenorphine is due to unmet treatment needs and the avoidance of withdrawal. [14][15][16] Despite demonstrated effectiveness in reducing illicit opioid use, buprenorphine remains underutilized in community correctional settings.…”

“…Buprenorphine is a partial opioid agonist, binding to opioid receptors with less intensity than full agonists, such as methadone. Despite the limited potential for nonprescribed buprenorphine use, there is evidence to suggest criminal/legal professionals are particularly concerned about the diversion of the drug within the criminal justice system 12,13 . It should be noted that there is a preponderance of evidence suggesting that non‐prescribed use of buprenorphine is due to unmet treatment needs and the avoidance of withdrawal 14–16 …”