Opioid use and overdose disproportionately affect those in the justice system. In the context of a nationwide opioid epidemic, rates of opioid use, opioid use disorder (OUD), and overdose disproportionately affect those in the criminal justice system. In a nationally representative sample taken in 2016, 19.5% of individuals with an opioid use disorder who misused prescription pain relievers, and 42.5% of individuals who used heroin, reported recent contact with the criminal justice system.1 Yet despite such high rates of opioid use and OUD, screening for and use of evidence-based treatments for opioid use and OUD, including medications for opioid use disorder (MOUD), is substantially underused in justice populations.
Courts are a critical point of intervention for justice system practitioners to identify opioid use, OUD, and overdose risk, and link defendants to treatment/MOUD in the community. Nationally, justice system practitioners are handling a spike in opioid-related arrests—police, probation officers, and court staff are being trained to administer overdose reversal medication, and jail staff are overseeing the involuntary opioid withdrawal of incarcerated people. Jurisdictions across the country have begun to create opioid intervention courts to address these acute challenges.
In 2016, New York State launched the first opioid intervention court in Buffalo, NY to address the specific needs of defendants who use opioids. In 2016, New York State Unified Court System launched the first opioid intervention court in the US to address the needs of defendants with opioid misuse, aiming to reduce overdose, opioid dependence, and recidivism via rapid screening, linkage, and initiation of MOUD. During the recommended 90 days that a defendant is in the opioid intervention court, the prosecution of his/her case is temporarily suspended; participation is voluntary and is decided before a plea is entered at arraignment.
What is an opioid court/How do opioid courts differ from other treatment courts? Opioid intervention courts identify individuals involved with the justice system who are at risk of overdose, and rapidly link them to treatment, including MOUD. Stakeholders in drug treatment courts were faced with potential participants overdosing while awaiting entry into drug courts. As a result, a new model, the opioid court, was developed to ensure that individuals are clinically stabilized and provided linkage to treatment and recovery support services as quickly as possible. Unlike drug courts, which typically require an individual to go through the legal process of taking a plea before entry, opioid intervention courts suspend prosecution of the legal case while the participant is clinically stabilized. Upon completion of the short-term opioid court, participants may be returned to the regular docket, receive a disposition on their case, or be referred to a treatment court for continuing care.
New York State decided to expand the model across the state in 2018 and created guidance to do so by way of the Ten Essential Elements of Opioid Intervention Courts. In 2018, the NYS Unified Court System (UCS) began to expand this model to other counties due to its preliminary success. Drawing from the evidence base of drug court evaluation studies and lessons learned from the first opioid intervention court, in 2019, a national panel of experts - in collaboration with the statewide court system- convened to discuss the opioid court model and developed the Ten Essential Elements of Opioid Intervention Courts to guide court practice. In 2019, Judge Janet DiFiore set a goal that New York would have an opioid court in every jurisdiction in order to provide the court system with another method for combatting the opioid epidemic.
Ten Essential Elements Overview The Ten Essential Elements include:
  1. Broad legal eligibility
  2. Immediate screening for risk of overdose
  3. Informed consent after consultation with defense counsel
  4. Suspension of prosecution or expedited plea
  5. Rapid clinical assessment and treatment engagement
  6. Use of recovery support services (peer advocates and family support navigators)
  7. Frequent judicial supervision and compliance monitoring
  8. Intensive case management Program completion and continuing care
  9. Performance evaluation and program improvement2
These Ten Essential Elements cover both judicial and clinical aims, providing guidance for moving from the court to the community for treatment at each step. Thus, a central piece of the opioid court model is collaboration between justice and treatment systems. However, cross-system collaboration can often be hindered by conflicting missions and distinct cultures or belief systems.

Watch this video to see how to essential elements of opioid courts are operationalized in Buffalo, NY

There are unique challenges to implementing the Ten Essential Elements in each county, based on counties’ unique characteristics. Counties across NYS are unique in the burden of opioid use and overdose among court participants, the availability and accessibility of treatment services including Medications for Opioid Use Disorder (MOUD), the relationships between the court system, prosecution and defense that impact court eligibility guidelines and participant engagement, etc. Thus, their interpretation and implementation of the Ten Essential Elements might vary when put into realistic practice.
Project Opioid Court REACH, an implementation intervention, will ultimately provide a widely scalable blueprint for implementing opioid intervention courts across county contexts. In the context of a new court model, of which the cornerstone is cross-system collaboration, an implementation intervention is needed to guide the scale-up of opioid intervention courts to maximize their effectiveness across county contexts and permit widespread scalability.


  1. Winkelman, T. N., Chang, V. W., & Binswanger, I. A. (2018). Health, Polysubstance Use, and Criminal Justice Involvement Among Adults With Varying Levels of Opioid Use. JAMA Network Open, 1(3). doi:10.1001/jamanetworkopen.2018.05582007
  2. Center for Court Innovation (2019) The 10 Essential Elements of Opioid Intervention Courts.