One of the most popular recent criminal justice innovations is the drug court, which spread rapidly after the first drug court in Dade County, FL was launched in 1989. Currently there are more than 1,200 drug courts around the country either in operation or in the planning stages, and more than 226,000 defendants have been served by drug courts. The drug court movement is largely a grassroots phenomenon, although some States are taking action to systematize this approach. As such, it is clear that the drug court movement is excelling to the next stage of development. The roundtable discussion presented herein had two main goals: (1) to discuss some of the strategic, conceptual, and practical challenges of bringing drug courts into the mainstream of court operations; and (2) to provide a template to drug court advocates for addressing these challenges. Some of the questions the roundtable participants debated included how to “go to scale” with drug courts and whether the goal should be to promote the continued replications of the drug court model or to advance the drug court principles and strategies for every courtroom. Other key questions included how innovation can be institutionalized and whether the drug court approach would lose effectiveness if it becomes institutionalized. Many roundtable participants agreed that going to scale with the drug court model meant not merely increasing the number of drug courts, but rather distilling the “active ingredient” or “essence” of the drug court model and to encourage the spread of drug court principles. One participant suggested that drug courts may fade out of existence as their principles become embedded in mainstream practice. The participants also discussed those elements of the drug court that are important to infuse into mainstream practice, such as the idea that sentencing is a long-term responsibility of the court and the incorporation of treatment agencies into the court model. Roundtable participants repeatedly voiced concern about how to ensure quality if the drug court model becomes institutionalized. Despite reservations, roundtable participants were cautiously optimistic about the possibility of drug courts becoming institutionalized as business as usual. An edited transcript of the 6 hour roundtable discussion is offered.