Addressing the crime reduction and harm reduction divide - promoting opioid agonist therapy in the US drug courts

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The reduction of harm due to illicit drug use is a common goal of law enforcement and public health sectors. However, law enforcement and public health policies to achieve this goal are often at odds. The burgeoning drug court model in the U.S. provides a unique opportunity to blend law enforcement and treatment approaches to intervene at the drugs-crime nexus. In the U.S., however, vocal resistance to modalities thought of as “harm reduction,” and an emphasis upon supply reduction over demand reduction may hinder realization of the full potential for the drug court treatment model. To illustrate the current socio-political environment in the U.S., this paper begins by examining contributions to the reduction of drug-related harms by the law enforcement and healthcare sectors. Through the example of opioid substitution for opioid use disorders, we then posit a framework under which these often disparate entities may engage in cooperative policies to reduce the individual and societal harms caused by illicit drug use.