Preventing overdose and promoting recovery through court navigation

The National Institute on Drug Abuse awarded Research Triangle Institute $3.189 million on September 30, 2025, under the Drug Use and Addiction Research Programs (CFDA 93.279) to conduct a hybrid Type I randomized controlled trial testing the effectiveness of peer-led court navigation in facilitating linkage to substance use disorder treatment for justice-involved individuals.

The study will deploy certified peer recovery specialists as court navigators in two Indiana county courthouses to provide treatment linkage services to individuals with substance use disorders passing through the justice system. The intervention will be compared against an information-only control condition. The research is guided by social cognitive theory and the Consolidated Framework for Implementation Research and includes assessment of implementation determinants alongside effectiveness outcomes, positioning it as an innovation project within the Justice Community Opioid Innovation Network Phase II Innovation Hub portfolio.

Performance occurs at Research Triangle Park, Durham, North Carolina through May 31, 2030. RTI International, a nonprofit research organization headquartered in Research Triangle Park, serves as the prime recipient.

Sub-recipients deliver implementation and research support. Chestnut Health Systems Inc. (awarded November 20, 2025) provides substance use disorder treatment expertise and implementation science capacity. Indiana University Indianapolis (awarded March 2, 2026) contributes clinical research infrastructure and court-based recruitment. Heluna Health (awarded February 19, 2026) provides behavioral health research administration and program evaluation services. The State of Indiana Office of Energy Development (awarded January 8, 2026) contributes state-level coordination and policy engagement support.

Abstract

We are proposing a hybrid type I trial to assess the effectiveness and implementation determinants of an innovative peer-led court navigator program that facilitates linkage to substance use disorder treatment. The courthouse is a venue where people with behavioral health needs who are justice-involved and at various points along the sequential intercept model converge in time and space; however, despite considerable attempts to link these populations to evidence-based treatment, outside of specialty court models, COURTHOUSES themselves are underexplored as an intervention setting. We will test whether court navigator intervention, led by peer recovery specialists and implemented in county COURTHOUSES, can be an effective strategy to facilitate linkages to substance use treatment. Court navigators are civilians who provide adjunctive legal-related services to those passing through COURTHOUSES, and the investigative team published pilot data demonstrating the feasibility of treatment linkage. Peer recovery specialists (persons with lived experience of substance use recovery) have been associated with reduced substance use outcomes and are being integrated into multiple criminal-legal intercepts and settings; however, peer-led court navigation is an innovative and unexplored approach within research and an ideal fit for a justice community opioid innovation network phase II innovation hub project. The proposed hybrid type I trial of a manualized court navigation intervention delivered by certified peer recovery specialists and compare the effectiveness through a pragmatic randomized controlled trial with an information-only control in two indiana COURTHOUSES. Guided by social cognitive theory and the consolidated framework for implementation research, our aims are as follows: aim 1: assess the effectiveness of court navigation VS. An information-only control on linkage to substance use treatment in a randomized controlled trial; aim 2: assess the effectiveness of court navigation VS. An information-only control on overdose and public safety outcomes in a randomized controlled trial; aim 3: explore barriers and facilitators implementing peer-led court navigation in criminal-legal systems. For the clinical trial, we will randomly select times of day that the court navigator intervention will be available and enroll 600 subjects over 24 months with 12 months of follow-up data by linking statewide administrative records. We will also conduct interviews to identify barriers and facilitators for implementing the intervention (N=64). The proposed study will be led by DR. Bradley RAY, an experienced research sociologist, and supported by an interdisciplinary investigative team of qualitative and quantitative experts with senior justice and behavioral health leaders from the indiana supreme court and indiana division of mental health and addiction. This study has the potential to identify a new setting (COURTHOUSES) and strategy (court navigation) for linking those in need to community-based behavioral health services, thereby improving public health and safety.