Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes

Matusow, Harlan; Dickman, Samuel; Rich, Josiah D.; Fong, Chunki; Dumont, D.; Hardin, Carolyn; Marlowe, Douglas B.; Rosenblum, Andrew

doi:10.1016/j.jsat.2012.10.004

Cited by 160 publications

(91 citation statements)

References 43 publications

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“…Acceptance was higher for buprenorphine than it was for methadone, a finding consistent with other research on MAT in drug courts, 42 although the means for both were below the mid-point. This may help partly explain why industry wide adoption rates of these medications remain low.…”

Section: Discussionsupporting

confidence: 89%

Counselor Training and Attitudes toward Pharmacotherapies for Opioid use Disorder

et al. 2016

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Background Methadone and buprenorphine have been demonstrated to be effective in the treatment of opioid use disorder (OUD), especially when combined with psychosocial treatment. Despite buprenorphine’s association with fewer withdrawal symptoms and lessened risk of abuse, compared to methadone, its adoption remains limited. Given the vital role that counselors may play in its successful implementation, their knowledge and perceptions of opioid agonist therapy may be facilitators or barriers to its acceptance. Methods Informed by diffusion theory, the current study examined perceptions of buprenorphine and methadone acceptability among 725 counselors employed in a nationally representative sample of substance use disorder treatment centers. First, we provided descriptive statistics about medication diffusion, extent of training received about the medications, and perceptions of acceptability of each medication. Then, we compared acceptability of opioid agonists with other treatment approaches for OUD. Finally, we conducted two ordinary least squares regressions to examine counselor acceptability of buprenorphine and of methadone. Results Descriptive statistics suggested that diffusion of information about buprenorphine and methadone was not complete, and training was not extensive for either medication. Counselors reported greater acceptability and training of buprenorphine compared to methadone. Methadone was rated as the least acceptable among all other treatment approaches. Multivariate analyses indicated regional differences, and that medication-specific training, adaptability, and educational attainment were positively related with perceptions of acceptability of either medication, even after controlling for organizational characteristics. Adherence to a 12-step orientation was negatively associated with acceptability. Conclusions Dissemination of information about opioid agonist therapy is occurring. Nevertheless, the fact that 20% of counselors admitted not knowing enough about either buprenorphine’s or methadone’s effectiveness is surprising in light of the extensive literature documenting their effectiveness. Future research should focus upon different types of training that can inform physicians, counselors and patients about the use of opioid agonist therapy.

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Section: Discussionsupporting

confidence: 89%

Counselor Training and Attitudes toward Pharmacotherapies for Opioid use Disorder

et al. 2016

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“…Despite some evidence base for prison TCs [13•], these programs are relatively expensive and treatment slots are scarce both in prison facilities, as well as the community. MAT, with a fairly strong evidence base, is rarely used in the CJS [26•, 70, 71]. …”

Section: Key Issues In Research and Practicementioning

confidence: 99%

“…Significant communication and collaboration problems, both within and between criminal justice and community-based treatment and health agencies, can thwart implementation of high quality services [73]. Resource constraints make the adoption of “expensive” EBPs unattractive and unlikely [70, 71, 73]. Criminal justice organizational cultures also can be highly resistant to change.…”

Section: Key Issues In Research and Practicementioning

confidence: 99%

Treating Substance Use Disorders in the Criminal Justice System

Belenko

Hiller

Hamilton

2013

Curr Psychiatry Rep

116

101

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The large number of individuals with substance use disorders involved in the nation’s criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health. Unfortunately, a low proportion of those who could benefit from treatment actually receive it while involved in the CJS. This article presents a review of recent research on the effectiveness of major substance abuse treatment interventions used at different possible linkage points during criminal justice case processing, including diversion, jail, prison, and community supervision. This is followed by a discussion of key research and practice issues, including low rates of treatment access and under-utilization of medication-assisted treatment. Concluding comments discuss principles of effective treatment for offenders and identify key gaps in research and practice that need to be addressed to improve and expand provision of effective treatment for offenders.

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“…With the advent of drug treatment courts and other diversion programs the number of persons with opioid addiction living in the community under court supervision has increased steadily. For example, in 2008, of 116,000 criminal offenders served by a drug court, between 9% and 19% had heroin or prescription drugs as the primary drug of abuse [42] [43]. Hence, in order to achieve a generalizable sample, there was a methodological imperative to be able to include such individuals.…”

Section: Ethical Issues Encountered In the Design Processmentioning

confidence: 99%

Ethical and clinical safety considerations in the design of an effectiveness trial: A comparison of buprenorphine versus naltrexone treatment for opioid dependence

Nunes

Lee²,

Sisti

et al. 2016

Contemporary Clinical Trials

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We examine ethical challenges encountered in the design of an effectiveness trial (CTN-0051; X:BOT), comparing sublingual buprenorphine-naloxone (BUP-NX), an established treatment for opioid dependence, to the newer extended-release injectable naltrexone (XR-NTX). Ethical issues surrounded: 1) Known poor effectiveness of one possible, commonly used Treatment as Usual control condition—detoxification followed by counseling without medication; 2) The role of patients' preferences for treatments, given that treatments were clinically approved and available to the population; 3) Differences between the optimal “usual treatment” clinical settings for different treatments making it challenging to design a fair comparison; 4) Vested interest groups favoring different treatments exerting potential influence on the design process; 5) Potentially vulnerable populations of substance users and prisoners; 6) Potential therapeutic misconception in the implementation of safety procedures; and 7) High cost of a large trial limiting questions that could be addressed. We examine how the design features underlying these ethical issues are characteristic of effectiveness trials, which are often large trials that compare treatments with varying degrees of existing effectiveness data and familiarity to patients and clinicians, in community-based treatment settings, with minimal exclusion criteria that could involve vulnerable populations. Hence, investigators designing effectiveness trials may wish to remain alert to the possibility of similar ethical issues.

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Medication assisted treatment in US drug courts: Results from a nationwide survey of availability, barriers and attitudes

Cited by 160 publications

References 43 publications

Counselor Training and Attitudes toward Pharmacotherapies for Opioid use Disorder

Counselor Training and Attitudes toward Pharmacotherapies for Opioid use Disorder

Treating Substance Use Disorders in the Criminal Justice System

Ethical and clinical safety considerations in the design of an effectiveness trial: A comparison of buprenorphine versus naltrexone treatment for opioid dependence

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