Journal article
Differences in MOUD receipt by legal referral type in outpatient treatment
Journal of substance use and addiction treatment, Vol.184, 209888
05/2026
DOI: 10.1016/j.josat.2026.209888
PMID: 41577038
Abstract
Opioid use and opioid use disorder (OUD) are prevalent among persons with legal system involvement. Medications for opioid use disorder (MOUD) are recommended for treatment, yet access is limited for legal-involved populations. In outpatient treatment settings, persons with legal-system involvement are less likely to receive MOUD. However, the influence of the type of legal system involvement on MOUD access is understudied. The purpose of this study was to examine if MOUD receipt differs by the type of legal system referral among adults referred to outpatient treatment by the legal system.
Data came from the 2021-2022 Treatment Episode Dataset-Admissions (TEDS-A). The sample included 32,213 legal-involved adult admissions to outpatient treatment for primary opioid use. The independent variable was the type of legal system referral; court/diversionary, probation or parole, prison, or other. The outcome was whether MOUD was included in the treatment plan. Covariates included the following sociodemographic, substance use, and treatment-related variables: sex, age, race/ethnicity, education, employment, living arrangement, prior substance use treatment, co-occurring mental disorder, type of opioid use, attendance of a substance use self-help group, outpatient treatment type, injection drug use, past-month arrest, and past-month opioid use frequency. Multivariable logistic regression was used to examine associations of referral type with MOUD, adjusting for sociodemographic and treatment-related covariates.
Compared to court/diversionary referral, probation or parole referral (AOR = 0.80, 95% CI = 0.76-0.85), prison referral (AOR = 0.85, 95% CI = 0.76-0.94) and other referral (AOR = 0.42, 95% CI = 0.39-0.46) were each associated with lower odds of MOUD when adjusting for covariates. Use of other opioid analgesics and synthetic opioids was associated with lower odds of MOUD than heroin use (AOR = 0.48, 95% CI = 0.46-0.51).
MOUD access in the community varies by the type of legal system referral. To inform MOUD community linkage policies and practices, research is needed to identify gaps in referral processes for specific legal system institutions. Examining how opioid use behavior characteristics impact MOUD community linkage is an appropriate next step for future research.
Details
- Title: Subtitle
- Differences in MOUD receipt by legal referral type in outpatient treatment
- Creators
- John Moore - Florida A&M University - Florida State University College of EngineeringTanya Renn - Florida State UniversityChristopher Veeh - University of IowaSara Beeler - University of Illinois Chicago
- Resource Type
- Journal article
- Publication Details
- Journal of substance use and addiction treatment, Vol.184, 209888
- DOI
- 10.1016/j.josat.2026.209888
- PMID
- 41577038
- NLM abbreviation
- J Subst Use Addict Treat
- ISSN
- 2949-8759
- eISSN
- 2949-8759
- Publisher
- Elsevier
- Language
- English
- Electronic publication date
- 01/21/2026
- Date published
- 05/2026
- Academic Unit
- School of Social Work
- Record Identifier
- 9985130059802771
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