Involuntary commitment of drug users wrong approach
There's no evidence that detention is effective in treating addiction
MASSACHUSETTS IS AIMING to tackle the opioid crisis head on. On Friday, the Joint House and Senate committee dealing with substance abuse is set to move forward on major legislation known as the CARE Act. Though the bill includes many good measures, it would also expand the dubious practice of involuntarily sending drug users to rehab. And that should worry the families and friends of people struggling with addiction.
Proposed by Gov. Charlie Baker, the CARE Act calls for strengthening research leading to evidence-based treatment and expanding access to naloxone, a drug used to treat overdoses in emergencies. The bill also improves oversight of treatment programs and facilities and prohibits programs from cherry picking patients based on their insurance.
These measures are an important expansion of our state’s efforts to address the opioid crisis. But when it comes to involuntary commitment of drug users, the bill does more harm than good.
A Massachusetts law known as Section 35 already permits courts to commit, for up to 90 days, individuals who have an alcohol or substance use disorder if there is a likelihood of serious harm if use continues. The problem is that there is no evidence supporting the effectiveness of involuntary commitment for substance use issues.
Take Joy, for example. As a young woman, she began to struggle with drugs in the wake of sexual assault and bullying. One day, she was arrested for soliciting sex for a fee. Wanting to help, her parents asked the judge to “section” her rather than charge her with prostitution. The judge agreed. There was no trial, no due process, and no possibility for appeal.
Against her will, Joy was sent to a locked treatment facility to detox, and then was released. Looking back, she feels that even if she had been offered a long-term placement, she would have turned it down because, “I wasn’t ready. I was just angry at everyone, at my parents, at the doctor, at everyone.” The only result of this action was Joy moving permanently into a life on the streets.
Another woman, Isabella, experienced Section 35 from the other side of the courtroom. Terrified by her husband’s drug use, she asked a judge to commit him and the judge agreed. When he was released, her husband returned home furious and burned her clothes. A few days later he died of an overdose. Heartbroken, Isabella continues to question whether she did the right thing by “sectioning” him. She wonders if the forced detox led to his overdose because his tolerance was lower, or whether his anger and sadness at what he saw as her betrayal led him to overdose.
The CARE Act would expand this type of civil commitment by authorizing medical professionals to arrange involuntary confinement for up to 72 hours, without a judicial hearing. This places doctors in an uncomfortable and untenable position, and could discourage people from seeking medical attention. In the event that a clinical professional is not available, the CARE Act also authorizes police officers to restrain and transport people to “an appropriate treatment facility” without a judge’s order. This provision presents a serious threat to individual rights and freedoms.
Effective treatment cannot be provided in 72 hours. And after that time, some individuals will return to the streets “dope sick.”For the women I know, this will be a set-up for sexual exploitation and assault. Some individuals will have a decreased tolerance, setting them up to overdose. Others might “consent” to remain in a closed treatment facility, although they would likely be too sick to provide meaningful informed consent. And those individuals who are brought before a judge after three days could find out that being confined increases the chances of a judge approving further confinement.
Expanding involuntary commitment may coerce more people into facilities that have not been proven effective and that run the risk of depriving Americans of basic rights. In response to the opioid crisis, we’d do well to hold fast to the fundamental medical rule of “first, do no harm.”