An Ethicolegal Analysis of Involuntary Treatment for Opioid Use Disorders

Abstract

Supply-side interventions such as prescription drug monitoring programs, “pill mill” laws, and dispensing limits have done little to quell the burgeoning opioid crisis. An increasingly popular demand-side alternative to these measures – now adopted by 38 jurisdictions in the USA and 7 provinces in Canada — is court-mandated involuntary commitment and treatment. In Massachusetts, for example, Part I, Chapter 123, Section 35 of the state's General Laws allows physicians, spouses, relatives, and police officers to petition a court to involuntarily commit and treat a person whose alcohol or drug abuse poses a likelihood of serious harm. This paper explores the ethical underpinnings of this law as a case study for others. First, we highlight the procedural and substantive standards of Section 35 and evaluate the application of the law in practice, including the frequency with which it has been invoked and outcomes. We then use this background to inform an ethical critique of the law. Specifically, we argue that the infringement of autonomy and privacy associated with involuntary intervention under Section 35 is not currently justified on the grounds of a lack of evidenced benefits and a risk of significant of harm. Further ethical concerns also arise from a lack of standard of care provided under the Section 35 pathway. Based on this analysis, we advance four recommendations for change to mitigate these ethical shortcomings.

Involuntary Hospital Admission in the Treatment of People With Severe Substance Use Disorder

“…In relation to beneficence, effective and evidence-based treatments for the primary SUD (eg, opioid agonist therapy, alcohol withdrawal management, anti-craving medications) were readily available. 11,12 Further, the admissions enabled connection to appropriate ongoing care, recognizing the chronic relapsing nature of addiction, and need for treatment beyond acute stabilization. 11 Most importantly, for each of these cases, inpatient stabilization and the opportunity to optimize treatment was likely life-saving.…”

“…11,12 Further, the admissions enabled connection to appropriate ongoing care, recognizing the chronic relapsing nature of addiction, and need for treatment beyond acute stabilization. 11 Most importantly, for each of these cases, inpatient stabilization and the opportunity to optimize treatment was likely life-saving.…”

The Other Infodemic: Media Misinformation about Involuntary Commitment for Substance Use

“…9 These false narratives have been cited as a reason to shut down syringe services programs 10 and have led to protests that prevented a supervised consumption space from opening. 11 Given prior literature establishing concerns around IC, 12,13 media outlets have a responsibility to provide accurate information and to combat misinformation. Emerging data demonstrate an increased risk of death following release from compulsory treatment for SUD.…”

“…Given prior literature establishing concerns around IC, 12,13 media outlets have a responsibility to provide accurate information and to combat misinformation. Emerging data demonstrate an increased risk of death following release from compulsory treatment for SUD 14 .…”

Drivers of Probation Revocation in Pulaski County, Arkansas

“…People on probation may be court-ordered to attend drug treatment and/or to submit to regular or sporadic urinalysis to test for recent drug use. Some jurisdictions have implemented mandatory, compulsory, or involuntary drug treatment laws though there are concerns about human rights violations, especially given only mixed evidence for the effectiveness of compulsory or involuntary commitment to treatment (Christopher et al, 2015; Coviello et al, 2013; Farabee et al, 1998; Lunze et al, 2016; Udwadia & Illes, 2020; Werb et al, 2016). When it comes to probation violations and revocations, these requirements may do more harm than good.…”