Reporting of substance use treatment quality in United States adult drug courts

Abstract

Background:

Adult drug courts are growing in popularity within the Unites States, but the quality of substance use treatment within drug court programs and the impact of drug courts on health and substance use treatment outcomes is largely unknown. We appraised the quality of United States adult drug court process evaluations and the inclusion of measures of substance use treatment quality.

Methods:

We systematically reviewed the adult drug court evaluations between 2008 and 2018 in accordance with recommended strategies for systematic grey literature search. We appraised evaluation quality using the Evidence for Policy and Practice Information and Coordination Center tool for process evaluations. We extracted recommended measures of substance use treatment quality, including measures related to screening and monitoring, diagnosis, service availability, service utilization, and outcomes.

Results:

Our search identified 112 evaluations. Process measures were included within 68 evaluations, 45% of which had poor data reliability. We found that less than 10% of evaluations reported substance use treatment quality measures related to service utilization, overdose, and mortality, while more than 75% contained criminal justice measures, including program graduation (completion of criminal justice proceedings) and participant recidivism.

Conclusions:

We found low uptake of measures of substance use treatment quality. The absence of data call into question the ability of drug courts to stem harmful substance use related health outcomes.

INTRODUCTION

In the United States, half-million people are in prison or jail for drug-related crimes (Wagner & Sawyer, 2019). Adult drug courts have been proposed as a way to reduce incarceration among people with substance use disorders by integrating substance use treatment into court settings (Meyer et al., 1997). While variation exists among programs, adult drug courts generally divert individuals from traditional criminal justice proceedings to a court-supervised treatment program after entry of a guilty plea, while a minority of courts divert pre-plea. (Schleifer et al., 2018). A judge then monitors an individual’s progress during court proceedings with input from prosecutors, defense attorneys, probation and parole officers, and treatment providers. Substance use treatment services are often provided via a partnership with one or more community substance use treatment providers (Meyer et al., 1997). The majority of adult drug courts accept adults accused of non-violent crimes committed in the context of substance use and aim to provide them access to a continuum of substance use care as according to the National Association of Drug Court Professionals ten key components of drug courts (Center for Substance Abuse Treatment, 1996; Meyer et al., 1997).

Since the introduction of adult drug courts in the United States in 1989, they have expanded to over 1,500 courts in 56% of counties in the United States (Marlowe & Hardin, 2016; Office of Justice Programs, 2020). The 2017 President’s Commission on Combating Drug Addiction and the Opioid Crisis called for the further expansion of drug courts in the United States, and the 2018 federal budget included a 50% increase in funding for drug courts to $165 million (Christie et al., 2017; NADCP, 2018).

The effectiveness of adult drug courts has been measured in terms of impact on participant recidivism or return to the criminal justice system. Previous meta-analyses found drug courts were associated with reduced recidivism, but also found few studies were rigorously designed (Mitchell et al., 2012; Shaffer, 2011). While there is ongoing debate about the interpretation of this research (Joanna Csete & Tomasini-Joshi, 2015; Marlowe & Hardin, 2016; Schleifer et al., 2018), it demonstrates the existence of over 150 independent studies on adult drug courts and recidivism. In contrast, the quality of substance use treatment within drug court programs and the impact of drug courts on health and substance use treatment outcomes is largely unknown. A recent study of participants randomly assigned to adult drug court or traditional adjudication in Baltimore found no difference in substance use related mortality after 15 years (Kearley et al., 2019). Peer-reviewed studies have shown low uptake of key treatment modalities, like medications for opioid use disorder (MOUD) among drug court programs (Krawczyk et al., 2017; Matusow et al., 2013; Schleifer et al., 2018), leading the Bureau of Justice Assistance (BJA) in 2015 to require access to MOUD for federal drug court grant funding (Merlowe et al., 2016).

However, these studies miss the vast majority of evaluations that have not been published in peer-reviewed literature. Since 2002, adult drug courts participating in the BJA Discretionary Grant Program (a minority of drug courts) have been mandated to conduct evaluations of program performance and state and local funding agencies may also mandate evaluation to ensure effective use of public funds (Sacco, 2018). Peer-review of these evaluations prior to dissemination has not been recommended (Heck, 2006; Rubio et al., 2008). These evaluations for government agencies create a body of grey literature on adult drug courts or literature outside of peer-reviewed or commercially published literature (Mahood et al., 2014). A previous meta-analysis of drug court impact on recidivism found over two thirds of evaluations were not peer-reviewed, despite not employing a systematic strategy to examine the grey literature (Shaffer, 2011). This grey literature guides programmatic and funding decisions related to adult drug courts at federal, state, and local agencies and the design of these evaluations may reflect the priorities of these agencies. Criminal justice agencies aim to promote public safety and punish people who break the law, and these priorities may conflict with the health promotion aims of public health and medical agencies. Criminal justice agencies may be reluctant or lack the expertise to effectively integrate substance use treatment quality measures into program evaluation. Previous United States Government Accountability Office reports raised concerns about the quality of drug court evaluations (Ekstrand, 2002, 2005). In response the National Institute of Justice, BJA, and the National Drug Court Institute (NDCI) formed an expert panel to improve drug court evaluation and the panel recommended all evaluations include measures of treatment services delivered to clients (called units of service) (Hardin & Kushner, 2008; Heck, 2006; Rubio et al., 2008; Sacco, 2018). The recommendations established best practices for drug court evaluation, but they were not tied to drug court program funding. A 2011 Government Accountability Office report noted improved evaluation of impact on recidivism did not examine results related to units of service measures for substance use treatment (Maurer, 2011). Therefore, we systematically reviewed the grey literature to appraise the quality of adult drug court process evaluations and the inclusion of substance use treatment outcomes. Incorporation of these measures are needed to monitor access and utilization of key substance use treatment modalities within adult drug courts and ensure drug court clients receive an adequate standard of care.

METHOD

We completed an environmental scan of publicly available adult drug court evaluations published between January 1, 2008 and July 1, 2018. We selected 2008 to start our scan in order to capture evaluations published after the publication of the 2006 NDCI recommendations on drug court evaluation and quality improvement and the 2008 National Center for State Courts State Wide Technical Assistance Bulletin on performance measurement of drug courts (Hardin & Kushner, 2008; Heck, 2006; Rubio et al., 2008). Given our focus on adult drug court grey literature, we did not include studies from academic databases such as Web of Science or PsycInfo. We excluded evaluations of other problem-solving court types (i.e. tribal courts, family court, or veteran courts which serve different populations and differ in program structure), evaluations not presenting original data, and evaluations of programs outside of the United States. Among evaluations reported annually, only the most recent evaluation was included. Adult drug court evaluations have two forms: 1) process evaluations documenting court workings and the services provided to clients including substance use treatment and 2) outcome evaluations examining if drug courts achieve their aims, such as reduced recidivism or improved client health (Heck, 2006). To establish our search strategy prior to conducting our research, we registered our study protocol on Open Science Framework (Appendix 1). Two changes to this protocol were made prior to our search: 1) we included studies published after January 1, 2008 rather than January 1, 2011 to ensure inclusion of studies published after NDCI and National Center for State Courts recommendations and 2) we included all evaluations regardless of funding source to avoid exclusion of evaluations completed without government funding.

In accordance with recommended strategies for environmental scans of the grey literature, (Godin et al., 2015; Porterfield et al., 2012) we first completed structured Google searches designed by the research librarian on our team identifying drug court evaluations. We conducted 51 google searches using concept terms for drug court and evaluation (Appendix 2). Because Google ranks search results by location, the search consisted of one general search, and one search for each state within the United States. Upon running a google search, the first 20 results were reviewed. If a potential evaluation was identified in this set of results, then the next 20 results were reviewed. If another potential evaluation was identified, then the next 20 results were reviewed until no additional potential evaluations were identified. Second, we completed hand searches of subject area websites (Table 1). Third, we consulted topic experts (53 drug court representatives in each US state and territory plus 12 academic experts) to identify additional evaluations. Topic experts were asked to share any original data evaluating substance use treatment within adult drug courts. Topic experts included authors of drug court evaluations or representatives from a national drug court stakeholder organization (i.e. National Association of Drug Court Professionals or the National Center for State Courts). State drug court representatives were the designated contact for drug court related inquires identified by the National Association of Drug Court Professionals. We contacted drug court representatives within these territories given criminal justice agencies may have previously elected not disseminate all relevant data.

Table 1:

Organizational subject area websites included within the environmental scan of adult drug court evaluations

Type of Organization	Organizationa
Government Agencies	US Justice Department Bureau of Justice Statistics US Justice Department Bureau of Justice Assistance US Government Accountability Office National Institute of Justice Substance Abuse and Mental Health Services Administration State Justice Departments State Health Departments
Public organizations	Bureau of Justice assistance Drug Court Technical Assistance/Clearing House Project – American University Urban Institute – Justice Policy Center National Association of Drug Court Professionals Center of Court Innovation Brookings Institute National Drug court Institute Washington State Institute for Public Policy Rand Corporation Macarthur Foundation Treatment Research Institute National Center for State Courts Abt Associates Mathematica Policy Research Council of State Governments

^aThe listed organization websites were each hand searched during the second step of the search for adult drug court evaluations.

Two team members reviewed identified evaluations to determine eligibility for inclusion. First, evaluations were excluded by review of the title, summary, or abstract. Then full-length evaluations were reviewed to determine final inclusion status. Disagreements were resolved by reviewing the evaluation together and reaching consensus.

Among included evaluations, two team members appraised process evaluation quality using the Cochrane recommended Evidence for Policy and Practice Information and Coordination Center (EPPI-Center) tool for process evaluations (Cargo et al., 2018; Shepherd et al., 2010). This eight-item EPPI-Center tool classifies the reliability of process evaluation findings as low, medium, or high based on factors such as appropriateness of the study sampling, data collection, and analysis methods (Appendix 3). We extracted measures of substance use treatment quality (Table 2), including measures related to screening and monitoring (i.e. urine drug screen), diagnosis (i.e. substance use disorder diagnosis), service availability (i.e. availability of MOUD and medications for alcohol use disorder), service utilization (i.e. utilization of MOUD and medications for alcohol use disorder), and outcomes (i.e. overdose deaths). Specifically, we included measures recommended by Substance Abuse and Mental Health Services Administration (SAMHSA), the NDCI, the Department of Health and Human Services, or the American Society of Addiction Medicine. Two research team members evaluated the reliability and extracted measures from each evaluation and disagreements were resolved by reviewing the evaluation with the first author to reach consensus.

Table 2:

Measures of substance use treatment quality extracted from adult drug court evaluations

Type of measure	Measure namea	Description
Process measuresb
General	Treatment organization	Type of partnering treatment organization(s)
	Treatment provider discipline	Discipline of partnering healthcare provider(s)
Screening and monitoring	Social needs assessment	Screening for social needs (i.e. housing or employment)
	Mental health disorder screening	Mental health disorder screening
	Unhealthy substance use screening	Unhealthy substance use screening
	Substance use laboratory testing	Substance use laboratory testing (i.e. urine drug screen)
Diagnosis	Mental health disorder diagnosis	Mental health disorder diagnosis (i.e. depression)
	SUD diagnosis	SUD diagnosis (i.e. cocaine use disorder)
Service availability	Psychosocial treatment options	Psychosocial treatment options (i.e. cognitive behavioral therapy)
	Availability of MAUDc	Availability of Acamprosate, naltrexone, or disulfiram
	Availability of MOUDc	Availability of methadone, buprenorphine, or naltrexone
Service utilization	Social interventions delivered	Connection to housing, employment or other services
	Psychosocial treatment delivered	Utilization of psychosocial treatment
	Utilization of MAUD	Utilization of Acamprosate, naltrexone, or disulfiram
	Utilization of MOUD	Utilization of methadone, buprenorphine, or naltrexone
	Duration of medication treatment	Length of receipt of MOUD or MAUD
	Connection to primary care	Frequency or portion connected to primary care services
Outcome measuresb
	Program graduation rate	Rate of court program completion
	Recidivism	Rate of recidivism
	All-cause mortality	Participant all-cause mortality
	Overdose deaths	Participant drug overdose deaths
	Retention in care after graduation	Utilization of treatment services after completion

^aMeasures were selected from the Substance Abuse Mental Health Services Administration, the National Drug Court Institute, the 2014 American Society of Addiction Medicine performance measures and the Office of the Assistant Secretary of Planning and Evaluation review of MAT guidelines.

^bProcess measures document court workings and the services provided to clients including substance use treatment and outcome measures examine if drug courts achieve their aims, such reduced recidivism or improved client health.

^cMAUD = medications for alcohol use disorder, MOUD = medications for opioid use disorder

We assumed that evaluations included all drug court measures collected and that no reporting, in any form, meant that the measure was not collected. Frequency of quality measures were analyzed descriptively, and the frequency of measures related to screening and monitoring were compared to the frequency of measures related to diagnosis, availability of services, and utilization of services using a chi-squared test. All hypothesis tests were two-sided. We completed our analyses in Stata 16 (StataCorp, College Station, Tx).

RESULTS

Our search identified 432 evaluations (384 via Google, 37 via hand search, and 11 via experts), of which 112 were included (excluded evaluations included 32 published prior to 2008, 67 duplicates, 88 evaluations of other problem-solving courts, 94 without original data, and 39 for other exclusions)(Figure 1). Among all evaluations, the median year of publication was 2012. Federal government agencies provided the funding for 30 (27%) of evaluations, while 74 (66%) of evaluations were completed by non-profit or for-profit organizations. Evaluations were most frequently of one adult drug court and were located on either a state government or non-profit organization website (Table 3). A list of all included evaluations is in Appendix 4.

Figure 1:

Environmental scan consisted of three steps: 1) structured Google searches, 2) subject area website hand searches, and 3) consultation with topic experts

Table 3:

Characteristics of adult drug court evaluations published between January 2008 and July 2018

Characteristic	All evaluationsa, n = 112	Process evaluationsb, n = 68
Year of publication, median (IQRc)	2012 (2010, 2015)	2012 (2010, 2015)
Funding agency, n (%)
Federal government	30 (27)	18 (26)
State government	57 (51)	36 (53)
County/municipal	10 (9)	8 (12)
Other	15 (13)	6 (9)
Evaluating agency, n (%)
Federal government	6 (5)	3 (4)
State government	25 (22)	16 (24)
Non-profit or academic	48 (43)	21 (31)
For profit	26 (23)	24 (35)
Other	7 (6)	4 (6)
Study sample, n (%)
One court	49 (44)	27 (40)
State sample 2 to 14 courts	32 (29)	23 (34)
State sample >14 courts	21 (19)	14 (21)
Regional sample 2 to 47 states	6 (5)	2 (3)
National sample >47 states	4 (4)	2 (3)
Location of evaluation, n (%)
State government website	39 (35)	31 (46)
Federal government website	7 (6)	3 (4)
Non-profit or academic website	39 (35)	14 (21)
For profit organization website	11 (10)	9 (13)
Other	16 (14)	11 (16)

^aIncludes both outcome and process evaluations.

^bIncludes all evaluations with process measures. “Location of evaluation” represents the location of the evaluation at the time it was first identified by the authors.

^cIQR = interquartile range

Process measures were included within 68 evaluations, of which 37 (55%) were of medium or high reliability. Primary factors limiting the quality of process evaluations included absence of the perspective of program participants and providing no description of the approach to data analysis. Almost 80 percent of evaluations describe the data collected, but half relied on only one source of data (intervention provider, court administrative documents, or court participants). Intervention providers were the most common source of data, n = 45 (66%).

Among all evaluations containing process measures (n = 68), a minority reported the type of treatment organization or discipline of the healthcare provider (Table 4). Process evaluations reported 57% of measures related to screening and monitoring. Measures related to diagnosis (16%, p <.001), availability of services (23%, p <.001), and utilization of services (9%, p <.001) were each present at a lower frequency relative to measures of screening and monitoring. Measures related to utilization of services had the lowest frequency of reporting.

Table 4:

Measures of substance use treatment quality extracted from adult drug court evaluations published between January 2008 and July 2018

Type of measurea	Measure name	Presence of measureb, n (%)
Process measures (n = 68)
General	Treatment organization	32 (47)
	Treatment provider discipline	11 (16)
Screening and monitoring	Social needs assessment	39 (57)
	Mental health disorder screening	35 (51)
	Unhealthy substance use screening	36 (53)
	Substance use laboratory testing	45 (66)
Diagnosis	Mental health disorder diagnosis	8 (12)
	SUD diagnosis	14 (21)
Availability of services	Psychosocial treatment options	23 (34)
	Availability of MAUDc	6 (9)
	Availability of MOUDc	17 (25)
Utilization of services	Social interventions delivered	21 (31)
	Psychosocial treatment delivered	6 (9)
	Utilization of MAUD	0 (0)
	Utilization of MOUD	5 (7)
	Duration of medication treatment	1 (1)
	Connection to primary care	2 (3)
Outcome measures (n = 112)
	Program graduation rate	98 (79)
	Recidivism	95 (77)
	All-cause mortality	1 (1)
	Overdose deaths	2 (2)
	Retention in care after graduation	7 (6)

^aMeasures were selected from the Substance Abuse Mental Health Services Administration, the National Drug Court Institute, the 2014 American Society of Addiction Medicine performance measures and the Office of the Assistant Secretary of Planning and Evaluation review of MAT guidelines

^bWe assumed that evaluations included all drug court measures collected and that no reporting, in any form, meant that the measure was not collected

^cMAUD = medications for alcohol use disorder, MOUD = medications for opioid use disorder

There was wide variation in the type of data collected by process evaluations, exemplified by the data collected for substance use disorder screening and diagnosis. Among 36 evaluations reporting on substance use disorder screening, 19 just reported that substance use disorder screening was available. A minority of evaluations reported on the specific methods used for substance use disorder screening (i.e. professional judgement, Texas Christian University drug screen, Substance Abuse Subtle Screening Inventory, Nebraska Simple Screening Instrument). Two statewide examinations of drug courts provided data on the utilization of screening (79% of drug courts in Idaho completed substance use disorder screening and 83% of drug courts in Colorado used a standardized substance use disorder screening instrument) (Carey et al., 2012; Owens, 2014). The 2011 Multi-site adult drug court evaluation found that 88% of drug courts included clinical assessments as part of drug court eligibility and 60% of drug courts used the Addiction Severity Index for screening, while 20% used an instrument designed by drug court staff (Zweig et al., 2011).

A similar pattern was observed among the 14 evaluations reporting on substance use disorder diagnosis. Seven evaluations reported substance use disorder assessment and diagnosis was available. A statewide evaluation of Colorado drug courts reported 88% of courts complete a substance use disorder assessment (Carey et al., 2012). An evaluation of drug courts in Texas found drug court participants were more likely to receive a substance use disorder assessment relative to a matched group of individuals undergoing traditional criminal justice adjudication (Prins et al., 2015). Finally, among Michigan drug courts, 98% of participants had a substance use disorder diagnosis (White & Kunkel, 2017).

Among all evaluations containing outcomes measures (n = 112), over 75% reported a measure of court program graduation and recidivism, while only a minority (<10%) reported a measure of all-cause mortality, overdose deaths, or retention in care after program graduation (Table 4). Only one study provided data on the rate of overdose death (2 overdose deaths among 29 participants)(Christensen et al., 2016), while another study documented the occurrence of overdose deaths among the courts under evaluation.

DISCUSSION

We systematically reviewed grey literature evaluations of adult drug courts within the United States from 2008 to 2018 and found low uptake of measures of substance use treatment quality, despite recommendations by the NDCI and the expansion of adult drug courts nationally. Substance use treatment quality measures related to service utilization, overdose death, and mortality were present in less than 10% of evaluations and stand in contrast to the greater than 75% uptake of criminal justice outcome measures related to court program graduation and participant recidivism. These results suggest adult drug court expansion and funding in the absence of high-quality data on participants’ access to substance use treatment and the success of drug courts to stem the harmful health outcomes of substance use disorders. Adult drug court evaluations incorporating the perspective of people with substance use disorders and data on drug overdose death are urgently needed to ensure the health of people with substance use disorders in these court programs.

These results are consistent with previous United States Government Accountability Office reports which raised concerns about the quality of drug court evaluations and called for improvements in accordance with the academic recommendations (Ekstrand, 2002, 2005; Maurer, 2011). These results suggest despite NDCI recommendations, uptake of units of service measures related to substance use treatment quality lag behind the uptake of the other recommended categories of measures, including court program graduation (completion of court mandated treatment), sobriety (urine drug screens), and recidivism. The lack of sufficient monitoring of substance use treatment quality within adult drug courts is concerning given previous reports raising concerns about the failure to provide a minimum standard of substance use care to court clients and criticism of a court structure which results in treatment decisions being directed by criminal justice officials rather than an independent healthcare provider (Joanne Csete & Wolfe, 2017; Mollman & Mehta, 2017; Schleifer et al., 2018).

These results examining the reporting of substance use treatment quality within the adult drug court grey literature are consistent with previous examinations of peer-reviewed literature (Krawczyk et al., 2017; Matusow et al., 2013; Mitchell et al., 2012; Shaffer, 2011). Shaffer’s 2011 meta-analysis on recidivism found 41 grey literature drug court evaluations. Upon utilization of a systemic approach to the identification of grey literature, this study identified 112 evaluations further establishing the unique importance non-peer-reviewed evaluations play in this field. The high count and frequency of grey literature evaluations containing a measure of recidivism is consistent with previous systematic reviews which found a large body of literature examining recidivism and together demonstrate a prioritization of this measure (Mitchell et al., 2012; Shaffer, 2011). Previous research raised concerns about the quality of substance use disorder screening and assessment within adult drug courts (Mollman & Mehta, 2017), and only one in five reviewed evaluations documented if a diagnosis was completed, suggesting inadequate oversight. Previous peer-reviewed studies demonstrated less than half of adult drug courts provide access to opioid agonist medications (buprenorphine and methadone) and participants in adult drug courts have reduced odds of receiving MOUD relative to people with OUD within the community (Krawczyk et al., 2017; Matusow et al., 2013). Results showing a low frequency of measures related to service utilization, including measures of MOUD and medications for alcohol use disorder, suggest a lack of prioritization of these measures among agencies commissioning or designing these evaluations. Future implementation and facilitation research should examine the barriers to utilization of the recommended measures of substance use disorder treatment quality within adult drug courts. Barriers such as lack of expertise, limited data collection resources, and beliefs that criminal justice agencies should not be involved with health promotion should be examined as possible targets for implementation interventions (Zielinski et al., 2020).

The limited evaluation of substance use treatment quality exists despite over a decades-long effort to promote access to MOUD within adult drug court programs by the NDCI, the BJA, and the SAMHSA (Hardin & Kushner, 2008; Merlowe et al., 2016). Our results suggest most drug court evaluations are not addressing these concerns. One reason may be because only one third of evaluations were funded by federal agencies. The BJA has previously leveraged federal funds in an attempt to shape local drug court programing. In 2015, the BJA announced courts could not receive discretionary grant funding if they denied access to a drug court program because a patient was receiving a MOUD (Merlowe et al., 2016). BJA and other federal agencies could similarly make funding support contingent on inclusion of key measures of substance use treatment quality within evaluations. However, these results illustrate the limitations of leveraging federal funding to shape drug court evaluation as a majority of the adult drug court evaluations were completed without federal funds. There are emerging alternatives to drug courts, such as the Seattle Law Enforcement Assisted Diversion (LEAD) program and the Eugene Crisis Assistance Helping Out On The Streets (CAHOOTS) program, which divert individuals prior to entry into a court program. State and local agencies should include measures of substance use treatment quality within future drug court evaluations to determine the best use of taxpayer dollars relative to these emerging alternatives (LEAD National Support Bureau, 2017; White Bird Clinic, 2020).

Finally, over 40% of the process evaluations examined in our study were determined to be of low quality. An identified source of potential bias was the frequent reliance on only intervention providers for evaluation data The quality of evaluations could be improved by collecting data from multiple perspectives, particularly the perspective of drug court participants and those denied entry into adult drug court. These results suggest greater inclusion of drug court participants and healthcare and public health experts in the design and implementation of drug court evaluation would strengthen the quality of monitoring. Given the overdose epidemic, data collection on overdose and mortality are urgently needed before further adoption of drug courts are recommended. Future implementation and facilitation research should examine possible barriers to examining overdose and mortality within drug courts such as lack of familiarity and reluctance to include measures of adverse outcomes.

Limitations

This study has several limitations. First, while this study employed recommended strategies for the systematic search of the grey literature, our study may not capture all adult drug court evaluations within the grey literature, such as evaluations not indexed by Google or identified by content experts. Additionally, this study did not systematically examine peer-reviewed literature on adult drugs and results within this literature may differ. Second, this study only examined evaluations between January 2008 and July 2018 and evaluations published before or after this period may differ. Third, while we document the frequency of measures present within drug court evaluations, evaluation authors or evaluating agencies may not have included all measures of quality for which data were collected. The NDCI should establish public reporting of all evaluation data as a best practice for drug court evaluation. Fourth, we examined substance use treatment quality measures for professional addiction treatment settings recommended by organizations like American Society of Addiction Medicine. Quality measures for mutual help groups may differ from our results.

CONCLUSIONS

Despite the promotion of drug courts in response to the ongoing drug overdose epidemic and calls for improving drug court evaluation, there exist limited data within the grey literature on adult drug court substance treatment services and outcomes. The limited data call into question the ability of drug courts to prevent harmful substance use related outcomes. Evaluations incorporating the perspective of people with substance use disorders and data on drug overdose death are urgently needed to ensure the health of people in these court programs.

HIGHLIGHTS.

Systematically reviewed the adult drug court evaluations within the grey literature Less than 10% reported measures related to service utilization, overdose, and mortality More than 75% contained criminal justice measures

ABBREVIATIONS

MOUD

medication for opioid use disorder

EPPI

Center Evidence for Policy and Practice Information and Coordination Center

SAMHSA

Substance Abuse and Mental Health Services Administration

NDCI

National Drug Court Institute