Improving Access to MOUD in Drug Courts through Inter-agency Collaboration: COLAAB Study - ABSTRACT Overdose is the leading cause of death for people reentering the community after incarceration. Yet most individuals with justice involvement fail to receive Medications for Opioid Use Disorder (MOUD), which can cut overdose mortality by up to 50%. Drug courts are an increasingly popular alternative to incarceration and mandate and supervise substance use disorder treatment. And while up to 80% of individuals in drug courts have opioid use disorder, fewer than 15% receive MOUD. Interagency collaborations between drug courts and local MOUD providers are necessary for the referral and maintenance of individuals in drug courts to evidence-based MOUD treatment. Known challenges to drug court-MOUD provider collaborations include negative beliefs, poor communication, a lack of awareness of local MOUD providers, and inefficient referral workflow. To address these challenges to collaboration and access to MOUD, we will adapt, implement, and evaluate a package of implementation strategies titled “Clinical Organization and Legal Agency Alliance Building” (“COLAAB”), which aligns with RFA-DA-25-062 to study implementation strategies improving public health and public safety collaborations. COLAAB uses theoretically grounded implementation strategies, including 1) bringing together drug court staff and MOUD providers for process improvements and coalition-building, 2) developing resource guides and communication aids, 3) conducting educational tours of MOUD agencies and court observations, and 4) using an academic liaison to facilitate interpersonal relationships and improve referral workflow. COLAAB was successfully piloted in three Massachusetts drug courts, demonstrating high acceptability, appropriateness, and feasibility. COLAAB now requires a large-scale, multi-site trial to examine implementation outcomes in a wider range of real-world settings and effects on organizational and MOUD service outcomes. Using the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we will conduct a hybrid type 3 effectiveness-implementation mixed methods, stepped-wedge, cluster randomized controlled trial implementing COLAAB in 16 adult drug courts (8 in Massachusetts and 8 in Florida). Our specific aims are: (1) adapt COLAAB for widespread implementation in Aims 2 and 3 using focus groups with drug court staff (n=80) and interviews with MOUD providers (n=32) and drug court clients (n=32), informed by the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS); (2) implement COLAAB and assess primary implementation outcomes of adoption and fidelity, and secondary of acceptability, appropriateness, feasibility, and implementation costs using mixed methods; and (3(a) examine the effect of COLAAB on organizational service outcomes of collaboration, negative beliefs, communication, referral processes, and awareness of providers; and (b) explore the effects of COLAAB on MOUD service outcomes of MOUD engagement. If successful, COLAAB could serve as a model for increasing MOUD access in drug courts nationwide through improving drug court-MOUD provider collaborations.
