Medications for opioid use disorder (MOUDs), especially opioid agonists (i.e., buprenorphine and methadone), are the gold standard of care and can decrease mortality risks for people with OUD by 50%. However, a nationwide study found that fewer than one in 20 problem-solving courts refer participants to MOUD and some courts ban participants from MOUD utilization. Our pilot study with a convenience sample of Florida problem solving courts found most courts (90%) make case-by-case decisions regarding whether participants can use MOUD, begging the question of how such case-by-case decisions are made. In this study we will 1) describe case-by-case MOUD decision-making processes in problem-solving courts and, 2) identify factors involved in court MOUD decisions and how these factors affect court MOUD decisions. We will use an exploratory sequential mixed method approach beginning with focus groups of a previously identified sample of Florida problem solving court teams that make MOUD case-by-case decisions to describe the decision-making process and to identify decision-making factors. Next, we will use a statewide online survey of problem-solving court team members with experimental vignettes to test effects of decision-making factors identified through focus groups.