United States drug courts and opioid agonist therapy: Missing the target of overdose reduction

Highlights • Agonist therapy for opioid use disorder (OUD) is often inaccessible in the US at a time of high overdose mortality.• OUD therapy could be offered by drug treatment courts as an alternative to criminal prosecution for some drug offenses.• Many drug courts, however, reject gold-standard agonist therapies, seeing them as “another form of addiction”.• Drug courts often prefer to offer extended-release naltrexone, but it is costly and requires pre-treatment abstinence.• Drug courts have had limited success in improving access to OUD treatment at a time of high overdose mortality.