Drug courts are specially designated to serve as alternatives to incarceration and to provide early access to substance use disorder (SUD) treatment under regular court supervision. Because a condition of drug court participation is agreeing to engage in SUD treatment, drug courts need treatment partners in the community. Primary care clinics offering medications for opioid use disorder (MOUD) can be important community partners and referral sources for drug courts.
What are drug courts?
The first drug court was established in Miami, Florida, during the height of the cocaine epidemic in 1989. Responding to the recognition that many people were repeatedly cycling through jails after being convicted of non-violent crimes associated with substance use, a small group working in the legal system began looking at alternatives to jail that would focus on treating addiction, addressing underlying psychosocial needs, and reducing the chance of future criminal-legal involvement. Although implementation details vary, the model typically involves:
- Screening and assessment of risks, needs, and responsivity.
- Judicial interaction.
- Monitoring (e.g., drug testing) and supervision.
- Graduated sanctions and incentives.
Treatment and rehabilitation services.[i]
These courts are typically “managed by a nonadversarial and multidisciplinary team including judges, prosecutors, defense attorneys, community corrections, social workers and treatment service professionals.”[i] In some counties, successful completion of treatment court can allow underlying offenses to be dismissed.
[i] Office of Justice Programs. (2022, July). Drug Courts. https://www.ojp.gov/pdffiles1/nij/238527.pdf
Can any individuals with drug related charges qualify for drug court?
Drug courts are an intensive intervention; on average, it takes 18 months for someone to complete the drug court’s program. For this reason, drug courts are reserved for individuals who are determined to be “high risk and high need.”[i] Here, “risk” refers to the factors directly related to re-offending; people are high risk when they have multiple past legal charges and a formal legal assessment suggests that they are unlikely to be successful going through the standard criminal legal system process (e.g., probation, incarceration). In addition, “need” need refers to clinical needs, and with high need indicating the severity of the use disorder and other psychosocial circumstances. Estimates suggest that drug courts serve less than 10 percent of people with drug offenses.
[i] National Association of Drug Court Professionals. (2018). Adult Drug Court Best Practice Standards: Volume I, p. 27. https://www.nadcp.org/wp-content/uploads/2018/12/Adult-Drug-Court-Best-Practice-Standards-Volume-I-Text-Revision-December-2018-1.pdf
Do all communities have a drug court?
Not all communities have drug courts, though the model has continued to increase in popularity. In 2019, there were over 3800 treatment courts in the U.S., including drug courts, mental health courts, driving under the influence courts, etc.[i] The National Drug Court Resource Center (NDCRC) Interactive Map Locator can help you find out if there is a drug court in your county or other surrounding counties in your state.
[i] National Drug Court Resource Center. (2022.) Painting the Current Picture: A National report on Treatment Courts in the United States. PCP_2022_HighlightsInsights_DigitalRelease.pdf (ndcrc.org)
Are drug courts effective?
Drug courts were developed as a criminal-legal intervention, and most research on them has focused on criminal-legal outcomes such as re-arrest, re-incarceration, and cost effectiveness. Meta-analyses have found that drug courts are associated with an average reduction in recidivism (re-arrest or re-incarceration) of 12 percent, and the most effective drug courts reduce recidivism by as much as 50 percent.[i]
[i] Marlowe, D. B., Theiss, D. S., Ostlie, E. M., & Carnevale, J. (2022). Drug court utilization of medications for opioid use disorder in high opioid mortality communities. Journal of Substance Abuse Treatment, 141, 108850. https://doi.org/10.1016/j.jsat.2022.108850
How might a clinic offering MOUD partner with drug court?
Often, drug courts will establish a Memorandum of Understanding or similar agreement describing a formal referral relationship and outline expectations for communication or record sharing. Patients must always sign a HIPAA-compliant release of information for the clinic to be able to share health records. The clinical team continues to provide assessment, treatment, and recovery supports as they would with any other patient, and clinical and medical records specific to SUD treatment are shared with the drug court as evidence that the patient is continuing to engage. In some communities, members of the treatment team participate in drug court staffings, though this is not always the case and is often dependent on funding.
If your clinic is interested in receiving referrals from local drug courts, first steps include:
- Confirming whether there is a drug court in your community. The National Drug Court Resource Center (NDCRC) Interactive Map Locator lists what types of courts exist in every county in the United States.
- Contacting your county courthouse to ask for contact information for someone on the drug court team, which could be the judge, the team probation officer, or someone else.
- Contacting the individual from the court team to introduce your clinic and the services it offers. Offer to meet with the team or to have them visit your clinic to discuss possible partnership.
Where can I get more information?
The American Society of Addiction Medicine, in collaboration with the National Association for Drug Court Professionals, hosts a free course about drug courts for SUD treatment clinicians, both online and in person. They also offer online office hours where clinicians can call in and ask questions related to drug courts.
Information for the course and the office hours can be found here.