Hon. Brian D. Burns
The Opioid Epidemic
Heroin, prescription pain relievers, and synthetic opioids like fentanyl have created a national epidemic. More than 70,200 Americans died from drug overdose in 2017, and more than two-thirds of these deaths involved opioids. Overdose deaths have increased by double-digit percentages each year since 2014. To complicate matters, fentanyl is increasingly contaminating the supply of cocaine, methamphetamine, and other drugs, often without users’ knowledge – putting even more people at risk of opioid overdose. The country’s first opioid intervention court, created with the explicit goal of saving lives, opened in Buffalo, New York in 2017.
The Essential Elements
1. Broad legal eligibility - Opioid intervention courts should accept the broadest range of charges possible, ideally including felony and misdemeanor charges. Eligibility for opioid intervention court should rest primarily on the defendant’s clinical needs rather than the crime charged.
2. Immediate screening for risk of overdose – Opioid courts should use a specialized screening tool to identify individuals who are at high risk of overdose.
3. Informed consent after consultation with defense counsel – Every person who screens positive for risk of opioid overdose and who also meets the jurisdiction’s legal eligibility criteria should be offered the opportunity to enter the opioid intervention court after consultation with defense counsel.
4. Suspension of prosecution or expedited plea – Opioid courts should concentrate on meeting participants’ clinical needs rather than on the legal posture of the case. The legal process should not interfere with the participant’s rapid engagement in treatment. In post-plea models, opioid courts should expedite the plea process and facilitate the rapid resolution of the legal case so that treatment inception is not delayed by legal procedures.
5. Rapid clinical assessment and treatment engagement – Defendants who enter the opioid intervention court should receive a comprehensive clinical assessment administered by a qualified treatment professional and should rapidly engage in individualized, evidence-based treatment services, ideally within 24 hours of arrest. Treatment plans should be developed in partnership with the participant and should consider each participant’s unique mental and physical health, trauma, and other needs. Medication-Assisted Treatment should be a core component of the program and should be offered to all participants as medically appropriate, following informed consent, and ideally within 24 hours of arrest. An abstinence-based option should be available for participants who do not wish to use opioid-based medications as part of their treatment plan.
6. Recovery support services – Opioid intervention courts should offer participants a broad range of evidence-based recovery support services. Support groups like Alcoholics Anonymous, Narcotics Anonymous, and similar groups—including secular alternatives—can be important supports to participants. Whenever possible, courts should utilize peer recovery advocates to help participants engage in the program and offer them additional guidance and encouragement.
7. Frequent judicial supervision and compliance monitoring - Opioid intervention courts should require participants to return to court frequently for supervision and monitoring—ideally every weekday—for at least 90 days. Participants should undergo frequent, random drug testing using evidence-based drug testing protocols.
8. Intensive case management – Case managers employed by the opioid intervention court or a partner agency should help to ensure that participants have necessary support systems during the critical stabilization period. Case managers act as liaisons between the court, supervision agencies, and service providers.
9. Program completion and continuing care – Opioid courts should require participants to complete a minimum of 90 days of treatment and supervision before leaving the program to achieve stabilization and lay an effective foundation for longer-term treatment. After this period, eligible participants should be assessed for possible enrollment in longer-term programs, like a drug court, mental health court, veterans treatment court, or other problem-solving court models, where they can continue to receive evidence-based treatment and achieve long-term recovery.
10. Performance evaluation and program improvement – Opioid courts should collect data around clearly-defined, participant-level performance measures, such as: date of arrest; date of screening for overdose risk; dates and types of assessment conducted; date of program entry; date of treatment inception; dates of overdose events (fatal and non-fatal); participant use of medication-assisted treatment (including type of medication used); participant use of other treatment modalities; dates of attendance at treatment; dates and nature of contacts with peer support specialists, case managers, and others; dates and frequency of drug testing and test results; dates and frequency of court check-in hearings; dates and nature of contacts between participants and treatment providers; dates of any re-arrests or technical violations; and other measures.