Confronting an opioid crisis that has already claimed hundreds of Massachusetts lives this year, Gov. Charlie Baker has proposed legislation that would allow doctors and other medical professionals to hold addicts against their will for three days. Critics warn that the measure lacks evidence to support it, would violate civil liberties, and could even scare users away from seeking needed medical attention.
“The governor’s proposal is so radical I don’t think there’s any research specific on it, because nothing like this has ever been done,” says Bill Piper, director of national affairs at the Drug Policy Alliance. “We do know that treatment is generally more effective when it’s voluntary. You can’t force people to quit using drugs. It just doesn’t work.”
Gov. Baker, whose office did not respond to interview requests, has said that the crisis demands bold solutions. The legislation [3], which was introduced on October 15, “makes important changes to the way that we deal with people who suffer the most severe forms of substance use disorder, those for whom other forms of treatment have failed and who may only be treated on a compulsory basis,” he wrote.
Civil commitment for addicts who pose a danger to themselves or others already exists in Massachusetts and other states. Currently, state law [4] allows for certain people, including family members, police officers and doctors, to petition a court to have an addict committed for as long as 90 days. As of mid-September, about 3,250 people had been committed this year, according to the Boston Globe [5].
But the governor’s proposal, which also includes other measures like increased oversight of prescription opioids, would mark a major shift. Instead of a doctor or family member being required to petition a court to have an addict committed, medical professionals would receive the power to unilaterally impose a three-day commitment. The burden would then be on the drug user to object to that initial three-day confinement in court. After that, family members or a doctor could petition for the commitment of as long as 90 days.
Civil commitment holds clear appeal for family members [6] of an addict whose life appears to be spinning out of control toward a possible fatal overdose. But do such commitments do any proven good?
The research on compulsory treatment is inconclusive and often methodologically weak, says Karen Urbanoski, a scientist at the Center for Addictions Research of British Columbia and an assistant professor public health at the University of Victoria. Urbanoski says that without evidence as to its effectiveness—and, if so, under what conditions —such drastic measures may not be justified.
“If it is simply a punishment, we are not on good ethical ground to be doing this,” says Urbanoski.
Dr. Sarah Wakeman, medical director for Massachusetts General Hospital’s Substance Use Disorder Initiative, agrees that the research is mixed, and that good studies are lacking. She also shares concerns about the lack of treatment beds, and the possibility of scaring users from seeking medical attention. But she says that holding someone for 72-hours will help “save lives” and allow for doctors to help develop a long-term treatment plan that is voluntary.
“The goal of this legislation is to allow physicians to treat patients with addiction the same way that we would treat anyone with a life threatening illness who is unable to take care of themselves,” says Wakeman, who served on the governor’s Opioid Working Group [7].
Whitney Taylor, political director of the Massachusetts ACLU, worries that it might “backfire and increase overdoses” if people are shunted out to the street with no support after being held for 72 hours.
“I appreciate the rhetoric changing, and that people are now talking about treatment instead of incarceration,” says Taylor, who has a long history working in needle exchanges. Civilly committing someone, after all, is a form of incarceration, and she worries that “we’re just kind of tweaking the drug war and dressing it up to look nice.”
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There is a lack of consensus not only that civil commitment works but also over the state of existing research. Laura Schmidt, a professor of health policy in the School of Medicine at the University of California at San Francisco, says that “the literature suggests that people who are coerced into treatment do just as well as people who go voluntarily.”
But Schmidt says that expanding woefully insufficient treatment beds, increasing access to little-prescribed but very promising new medications, and putting the overdose-reversing drug naloxone into the hands of every heroin user are critical first steps.
“The number one issue from where I sit is the lack of available treatment slots and beds, and it’s a massive national problem,” says Schmidt. “We call it the treatment gap…what you will find is that we are able to serve 10-percent of the people.”
Civil commitment is a tough call. On the one hand, she says, forced treatment is no doubt better than jail, where addicts often end up. At the same time, it is hard to justify such drastic measures when so many basic measures to combat overdoses and addiction have not been accomplished.
