Objectives: 1. Identify the core principles of harm reduction and understand where judicial guardrails are necessary to maintain safety, accountability, and treatment integrity. Rural and underserved jurisdictions face unique barriers to implementing medications for opioid use disorder: limited providers, long travel distances, unreliable transportation, and inconsistent access to pharmacies or telehealth infrastructure. Presented by Judge Geno Salomone (Ret.), this session provides judges with practical, jurisdiction-appropriate solutions to expand treatment access despite these constraints. Participants will explore strategies that reduce gaps in care, strengthen local partnerships, and ensure that geography does not determine who receives life-saving medication. Objectives: 1. Identify the structural challenges that prevent rural and underserved participants from accessing and sustaining MOUD, including provider scarcity and transportation obstacles. 
Harm reduction is an essential component of any modern MOUD strategy, but without clear boundaries, it can become misunderstood, misapplied, or perceived as permissive rather than protective. Courts must balance compassion with structure, ensuring that harm reduction practices support engagement, reduce mortality, and promote stability—while still maintaining accountability and public safety. Presented by Chief Cynthia Herriott (Ret.), this session provides judges with a practical framework for implementing harm reduction approaches that are clinically sound, ethically grounded, and operationally disciplined.
2. Apply structured court practices, such as clear expectations, communication protocols with providers, and measured responses to relapse, that support harm reduction without weakening supervision.
3. Build a balanced model that uses harm reduction to stabilize participants while maintaining consistent judicial oversight and evidence-based boundaries.
2. Implement practical solutions—such as telemedicine integration, mobile MOUD services, pharmacy partnerships, and flexible supervision requirements—to bridge treatment gaps.
3. Strengthen coordination with community health networks, corrections partners, and state agencies to build stable, long-term MOUD access in resource-limited jurisdictions.
