In 2014, the FDA approved Innovative Health Solutions’ wearable NSS-2 Bridge device for chronic and acute pain management. In 2017, the FDA cleared the device’s use for managing opioid withdrawal symptoms. Critics have raised substantive concerns about the evidence used to support the determination that the device could safely and effectively be used for opioid withdrawal, and the methods used by the manufacturer (both pre- and post-FDA approval) to gain support for the implementation of the device. The manufacturer and pharmaceutical companies have begun to engage with judges and other key personnel associated with drug courts and other court systems around the country with significant censuses of cases involving people who use opioids. This chapter draws upon empirical and theoretical research approaches to address significant ethical, public health, and oversight concerns raised by these burgeoning relationships, including the following questions: (1) How prevalent is industry-court personnel contact? (2) What do court personnel receive from industry? (3) How might such contacts affect the lives of justice-involved people who use opioids? (4) What ethical and health-related concerns arise with the development of such relationships? (5) What, if any, oversight do (or could) local and state court systems provide for industry-court personnel relationships?