Table 4 Example quotations from free text responses

MOUD cost is a barrier to client access

• “From the dependency bench I have very little control over the specific drug treatment offered to the parents. I can learn how it works but if the department doesn’t offer any treatment of that type or pay for it this type of treatment is not going to happen.” - Respondent 30

• “Price dictates treatment” - Respondent 37

• “We have only had funding for Vivitrol and the flow of funds for methadone and suboxone are just now coming through.” - Respondent 1

Lack of MOUD education is a barrier to courts facilitating MOUD for clients

• “I know nothing of the side effects of the treatment and whether or not it would impair a parent’s ability to work, pass drug tests, and parent young children.” - Respondent 30

• “We were taught that methadone and suboxone were addictive when we were convinced Vivitrol was better. Now, the education and feelings are that all 3 are needed, all will be funded and that vivitrol is not appropriate in some situations. We all need to get on the same page and ensure that the proper training is given and that it is not steered by lobbying and big pharma for their own products and that our treatment providers prescribe the one that is best suited for each client!” - Respondent 1

• “Education to inform that M.A.T. should be viewed as medication (for some a lifelong medication) as opposed to a drug.” - Respondent 31

Many source of stigma toward MOUD, including outside of the court system

• “Individuals in recovery who are NOT using MAT may pass judgment to those who are using it. I have heard from several clients that use MAT that they feel ashamed or uncomfortable admitting that they are on MAT to others in recovery, specifically at support group meetings.” - Respondent 45

• “Difficult to find sober living homes and [peer support] fellowships that allow/support MAT” - Respondent 18

Court-provider relationship relationships can facilitate MOUD access or reinforce MOUD stigma

• “Collaborating with providers who are trustworthy is very difficult. We have a few identified but they cannot meet the full need of the courts let alone the community. Access to these medications in pharmacies play a role in the ability of community clients to get what they need in regards to treatment and the pharmacists are looking for treatment plans and legitimate providers as well. We still have a number of pill mills in our area and questionable prescribers, many have been previously fined by the licensing board. How do we identify and collaborate with other prescribers willing to work with us?” - Respondent 25

• “Due to no reputable methadone providers in our area, MAT programs have had a negative connotation previously.” - Respondent 24

• “…patients have been more successful when receiving therapy along with Naltrexone than therapy with the other forms of MAT as they are often still taking medications upon completion of the program and end up without any way of paying for the medications so they revert to prior habits or purchasing off the street which is dangerous.” - Respondent 42