According to a forthcoming study, there is little evidence that opioid addicts benefit from involuntary commitment, and the “legal and ethical” concerns raised by such strategies should make policymakers think twice about employing them.
“Like most medical treatment, addiction treatment depends on the patient’s voluntary cooperation,” says the study, to be published in a forthcoming issue of the Journal of Law, Medicine, and Ethics.
“Although some evidence suggests that certain types of people might benefit from involuntary treatment, a 2016 review of available data concluded that evidence does not suggest improved outcomes of compulsory treatment, and some studies suggested potential harm resulting from such treatment.”
In one example, the study points to concerns raised about the standard of care by a forced-treatment program in Massachusetts, where the state mental health code allows individuals to be involuntarily committed for periods of up to 90 days.
Some 6,500 individuals were committed to treatment in 2016, but a 2017 report by Boston radio station WBUR described one treatment facility—a former minimum security prison in Plymouth—as still reflecting a prison atmosphere:
Men arrive in handcuffs, they wear orange jumpsuits, and they’re monitored by correction officers.
While the study concedes that the spreading opioid epidemic requires “significant intervention,” it adds, “not every perceived solution is legitimate or desirable, no matter the scope of the crisis.”
Although civil commitment laws exist in 38 jurisdictions, the practice of detaining substance abusers who have not broken any laws is still rare.
The study observes that the infrequency of civil commitment for substance abusers is related to reluctance on the part of clinicians and others to spend money on forced treatment when availability of voluntary addiction treatment remains scarce.
In many states, the study notes, civilly committed substance abusers are unable to undergo medication-assisted treatment (MAT) due to state law or practice, even though a combination of MAT and psychosocial interventions is the standard of care for treating opioid abuse.
Moreover, in cases where MAT is prohibited by state law or practice, medical professionals are faced with an ethical dilemma.
“If they participate in the coercive achievement of abstinence during confinement, they are not only acting outside the ordinary standard of care for substance use disorder, they are also participating in creating the risk that the individual will accidentally overdose when discharged,” the study said.
Under Massachusetts state law, courts can issue orders of commitment to a person according to the likelihood of serious harm to that person or to others. Likelihood of serious harm can be demonstrated through evidence of intent to harm oneself or others, or if a person’s judgement is shown to be so impaired that “he is unable to protect himself in the community and that reasonable provision for his protection is not available in the community.”
The study was written by Ish Bhalla and Rocksheng Zhong of Yale University; and Nina Cohen, Claudia E. Haupt, and Kate Stith of Yale Law School.
åAnother reason why the practice of involuntary confinement for substance abuse is still rare is a “genuine societal ambivalence over whether substance abuse should be viewed as willed conduct or the consequences of unwilled affliction,” the authors wrote.
They cite a 1978 Supreme Court ruling in Addison v Texas that “a state cannot constitutionally confine without more a non-dangerous individual who is capable of surviving safely in freedom by himself or with the help of willing and responsible family members or friends.”
In light of the Supreme Court’s stance on civil commitment, many states call for evidence that a substance abuser has threatened, attempted, or caused harm to themselves or another person, or evidence that there is an imminent risk that the person will harm someone if not detained.
The third possible condition for involuntary confinement depends on whether the substance abuser is so incapacitated by their addiction that they cannot provide for the basic necessities of life, and there is no suitable provider for said needs.
The full study, entitled “The Role of Civil Commitment in the Opioid Crisis,” can be downloaded here:
This summary was prepared by TCR news intern John Ramsey. Readers’ comments are welcome.