Facilitating Opioid Care Connections: System level strategies to improve use of MAT and movement through the opioid care cascade for defendants in a new Opioid Court system

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In the context of a nationwide opioid epidemic, rates of opioid use (OU), opioid use disorder (OUD) and overdose (OD) disproportionately affect those in the justice system. Yet despite such high rates of OU and OUD, screening for and use of evidence-based treatments for OU and OUD, including medication to treat OUD (MOUD), are substantially underused in justice populations. Courts are an ideal point of intervention in the justice system to identify OU or OUD, and OD risk, and link defendants to treatment/MOUD in the community. However, less than 5% of defendants with drug problems are served by drug treatment courts. In response to the opioid crisis in New York State (NYS), where the propose project will take place, the Unified Court System (UCS) developed a new treatment court model – the opioid court model (OCM) - designed around 10 practice guidelines to address the flaws of existing drug courts and reduce OD, OUD, and recidivism via rapid screening and linkage to MOUD. In 2018, NYS began to expand the OCM across NYS with 9 “initial adopter” counties. Yet, given the innovation of the OCM, the exact barriers to implementation in disparate counties with a range of resources – and the strategies to overcome them – are largely unknown. We propose to integrate evidence-based implementation strategies to refine and evaluate OCM RISE, an implementation intervention that will allow the OCM, as framed by the 10 practice guidelines, to be scaled up across NYS. This UG1 proposal is from three PIs with complimentary expertise in the justice system, implementation science and developing treatment for OUD and its delivery in community settings, and is supported by a strong multi-disciplinary team to achieve study aims. Guided by Exploration Preparation Implementation Sustainment (EPIS) model and Social Cognitive Theory (SCT), Specific Aims are: 1) To refine OCM RISE using formative work with “initial adopter” counties that (a) identifies gaps in service provision by documenting OCM/opioid cascade outcomes; (b) identifies successes/challenges in operationalizing guidelines; and (c) characterizes the working relationships between county opioid court and treatment systems. 2). In a stepped-wedge design in 10 new counties compared to baseline treatment as usual (drug courts), to test, (a) the implementation impact of OCM RISE in improving implementation outcomes along the opioid cascade (screening/identification, referral, treatment enrollment, MOUD initiation); and (b) the clinical and cost effectiveness of OCM RISE in improving public health (treatment retention/court graduation) and public safety (recidivism) outcomes, exploring moderators: defendant gender, age, charge; county urbanicity and county OD rates. 3) To characterize and compare advancement through the stages of implementation of the OCM in the 10 new adopter counties, elucidating the inner- and outer-level EPIS- and SCT-derived factors that influence delivery of implementation strategies to inform OCM scale up; and (b) to explore the relationship between implementation stage completion and all opioid cascade, public health and public safety outcomes.