The Appalachian/Midwest Regional Judicial Opioid Initiative (RJOI) was originally created in 2016 in response to the need for information, education, and resources to address the opioid epidemic in the region.

Soon after, it broadened its scope to include all substance use disorders and focused efforts on educating the judiciary on how best to support those afflicted through recovery, rehabilitation, and jail diversion programs designed to keep families together, reduce recidivism, and save lives.