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This page was developed to assist problem-solving courts, and the professionals that work in them, with the unique challenge opioid misuse poses in the criminal justice population.
Opioids: The term opioids refers to a class of drugs, both legal and illegal, that act on particular receptors in the brain. Doctors prescribe opioid medications to treat moderate-to-severe pain, often after injury or surgery or for health conditions such as cancer. They work by attaching to the receptors on nerve cells in the body and brain, reducing the intensity of pain signals and feelings of pain. Opioid pain medications are generally safe when taken for a short time and as prescribed by a doctor, but because they produce euphoria in addition to pain relief, they can lead to dependence and misuse. When misused, opioid pain relievers can lead to addiction, overdose incidents, and deaths. 1 In addition to prescription medications, opioids are also used in illegal street drugs such as heroin. 2
Opioid crisis: The recent increase in opioid-related overdose deaths is often referred to as the opioid crisis or opioid epidemic. Emergency department visits for opioid overdoses rose 30 percent in the United States from July 2016 through September 2017, with the greatest increase occurring in the Midwest with a 70 percent rise in opioid overdoses. In specific areas around the country, the increase in opioid-related deaths is considered an epidemic. An epidemic refers to the occurrence of more cases of a disease than expected in a given area or among a specific group of people over a particular period of time.4
Overdose: An overdose is when a person takes an amount of a drug that causes serious, acute harm to the body, or even death.
Fatal overdose: A fatal overdose is a death due to consuming too much of a drug. This is also known as an overdose death.
It is important to understand that not all overdoses are fatal, especially when reviewing data and research on these topics.
Prescription drug misuse: According to the National Institute on Drug Abuse, prescription drug misuse means taking a medication in any way other than how it was prescribed by a doctor.5 Taking a larger dose or taking a medication prescribed to someone else, even for a health concern or pain, is still considered misuse. Misuse of prescription opioids is a serious public health concern in the United States.
Opioid use disorder: An opioid use disorder is a measurable, medical diagnosis that manifests as a pattern of distress and dysfunction in a person’s life because of opioid use. The symptoms include the following:6
Opioid use disorders are diagnosed on a scale of severity depending on how many symptoms are present within a 12-month period:
Mild opioid use disorder: presence of 2-3 symptoms
Moderate opioid use disorder: presence of 4-5 symptoms
Severe opioid use disorder: presence of 6 or more symptoms7
Opioid withdrawal: Withdrawal occurs if a person’s body has grown accustomed to the release of opioids in the brain and then the person stops or decreases their use of opioids. Symptoms of opioid withdrawal include dysphoria, nausea, vomiting, GI upset, tremor, restlessness, muscle or joint aches, sweating, pupillary dilation, diarrhea, yawning, fever, insomnia, irritability, and anxiety.8
Medication-assisted treatment (MAT): MAT is the use of certain medications, such as buprenorphine, methadone, and naltrexone, to treat opioid use disorders and prevent opioid overdoses. MAT drugs are divided into two classes based on the way in which they suppress withdrawal symptoms and cravings. The first set of drugs are called antagonists, and they work by blocking opioids from attaching to the opioid receptors in the brain and activating them. The second set of drugs are called agonists, and they work by activating those receptors but to a much lesser degree than an opioid would. Advocates of MAT encourage its use in treatment alongside counseling and behavioral therapies. MAT, when used to treat opioid use, is also referred to as medications for opioid use disorders or pharmacotherapy.
An overdose occurs when a person takes an amount of a drug that causes serious, acute harm to the body, or even death.
Opioid overdose is life threatening and requires immediate emergency attention. Recognizing the signs of opioid overdose is essential to saving lives.
Call 911 immediately if a person exhibits any of these symptoms:15
Naloxone, also known as Narcan, is a medication that rapidly reverses opioid overdoses. Naloxone binds to opioid receptors to not only block the effects of opioids but also reverses the effects of opioids. This medication is administered as an injection or as a nasal spray. It can take as little as 20 minutes to be trained to administer naloxone. Many states have made naloxone easily attainable without a prescription.16
Some people may hesitate to call 911 if they think that someone has overdosed; however, the time that is wasted debating whether to call emergency services can be critical to saving that person’s life. Many states have enacted legislation to encourage people to seek medical attention for an overdose or to seek follow-up treatment after naloxone has been administered. This type of legislation is often referred to as Good Samaritan Laws. These laws generally provide immunity from arrest, charge, or prosecution for certain drug offenses when a person who is experiencing an opiate-related overdose or observing one calls 911 to seek medical assistance. These laws vary by state, but it is estimated that 40 states and the District of Columbia have enacted a Good Samaritan Law.17
To find out the laws governing naloxone administration and availability in your state, visit Prescription Drug Abuse Policy System.18 http://pdaps.org/datasets/laws-regulating-administration-of-naloxone-1501695139
Law Enforcement Naloxone Toolkit to support law enforcement agencies in establishing a naloxone program in their jurisdiction.
Medication-assisted treatment (MAT) is the use of certain medications to treat opioid use disorders and prevent opioid overdose. MAT drugs help in recovery by suppressing withdrawal symptoms and cravings.
Common medications include:
MAT augments the chemistry of the brain. The medications currently approved to treat opioid addiction are divided into two classes:
Buprenorphine acts as a partial agonist and antagonist at the same time.
Both classes relieve physiological cravings and stabilize body functions as it goes through withdrawal. The goal of MAT is to decrease the use of the more addictive and lethal opioids and stop the cycle of addiction. Advocates of MAT encourage its use in treatment alongside counseling and behavioral therapies.
Online Course on Medication-Assisted Treatment. This online training curriculum was “designed to educate drug court professionals on medication-assisted treatments (MAT) for substance use disorders with a major focus on opioid use disorders.”
Extended-Release Naltrexone. National Drug Court Institute, 2013.
Medication-Assisted Treatment for Opioid Use Disorder in the Criminal Justice System. American Association for the Treatment of Opioid Dependence, Inc.
Naloxone: Overview and Considerations for Drug Court Programs. National Drug Court Institute, 2016.
Medication-Assisted Treatment in Drug Courts: Recommended Strategies. Center for Court Innovation and Legal Action Center, 2015
On October 26, 2017, under section 319 of the Public Health Service Act, the Department of Health and Human Services declared a nationwide public health emergency to address the opioid crisis, as directed by President Donald J. Trump.19 This was one of the preliminary recommendations made by The President’s Commission on Combating Drug Addiction and the Opioid Crisis.20
The federal government identified five specific strategies that the Department of Health and Human Services will implement:
Many agencies, including the Center for Disease Control, the Food and Drug Administration, the Department of Justice, the Department of State, the National Institutes of Health, the Department of Defense, the Department of Veterans Affairs, and the Department of Health and Human Services have been directed to address the opioid crisis through pre-existing and new programs. For more information about public health emergency declarations under section 319 of the Public Health Service Act, visit the Public Health Emergencies website, managed by the Office of the Assistant Secretary for Preparedness and Response, under the US Department of Health and Human Services.
The President’s Commission on Combating Drug Addiction and the Opioid Crisis
Fact Sheet: President Donald J. Trump is Taking Action on Drug Addiction and the Opioid Crisis
The opioid crisis is complex and thus solutions to the crisis need to be multifaceted and multidisciplinary. Solutions are also not universal, each jurisdiction will develop responses based on their unique needs. However, successful responses usually begin with collaboration across many fields.
In 2016, the New York Unified Court System launched an opioid court in Buffalo, the first of its kind in the country. The opioid court provides immediate intervention, treatment, and supervision for defendants who are at risk of an opioid overdose. Learn more about the model here.
For more details about policies to combat the opioid crisis and how one treatment court transformed their model to respond to their community’s opioid crisis, watch NDCRC’s webinar “Responding to the Opioid Crisis: National and Local Approaches.”
The webinar covers:
Accompanying issue brief: U.S. Opioid Crisis: Causes, Effects, and Steps Being Taken