The effectiveness of compulsory drug treatment: A systematic review

Abstract

Background Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment. Methods We conducted a systematic review of studies assessing the outcomes of compulsory treatment. We conducted a search in duplicate of all relevant peer-reviewed scientific literature evaluating compulsory treatment modalities. The following academic databases were searched: PubMed, PAIS International, Proquest, PsycINFO, Web of Science, Soc Abstracts, JSTOR, EBSCO/Academic Search Complete, REDALYC, SciELO Brazil. We also searched the Internet, and article reference lists, from database inception to July 15th, 2015. Eligibility criteria are as follows: peer-reviewed scientific studies presenting original data. Primary outcome of interest was post-treatment drug use. Secondary outcome of interest was post-treatment criminal recidivism. Results Of an initial 430 potential studies identified, nine quantitative studies met the inclusion criteria. Studies evaluated compulsory treatment options including drug detention facilities, short (i.e. 21-day) and long-term (i.e., 6 months) inpatient treatment, community-based treatment, group-based outpatient treatment, and prison-based treatment. Three studies (33%) reported no significant impacts of compulsory treatment compared with control interventions. Two studies (22%) found equivocal results but did not compare against a control condition. Two studies (22%) observed negative impacts of compulsory treatment on criminal recidivism. Two studies (22%) observed positive impacts of compulsory inpatient treatment on criminal recidivism and drug use. Conclusion There is limited scientific literature evaluating compulsory drug treatment. Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.

Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study

“…A systematic review 19 of compulsory inpatient and outpatient treatment strategies showed little evidence that compulsory drug treatment is effective in promoting abstention from drug use or in reducing criminal recidivism. This review did not, however, compare the effectiveness of CDDCs relative to evidence-based treatment, such as voluntary medical treatment with opioid agonist therapies.…”

Mandatory addiction treatment for people who use drugs: global health and human rights analysis: Table

“…39 There is no evidence that these centres are effective in treating drug dependence. 40 Rather, detention in such centres often leads to the denial or inadequate provision of medical care. 39 41 In China and Vietnam, compulsory drug detention centres are historically grounded in a system of "re-education through labour" that has detained dissidents and activists.…”

“…42 Detainees have been subject to human rights abuses, including extrajudicial and indefinite detention, physical abuse, and torture. [30][31][32][33][34][35][36][37][38][39][40][41][42][43] For example, in Cambodia, children with drug dependence were detained against their will, routinely beaten (sometimes with electrical cables), forced to work, and were subject to other abuses, including sexual abuse. 44 Evidence from compulsory drug detention centres is sparse but has supported concerns about the efficacy of mandatory treatment techniques.…”

“…44 Evidence from compulsory drug detention centres is sparse but has supported concerns about the efficacy of mandatory treatment techniques. 40 In a study in Malaysia, 86% of detainees reported cravings for opioids and other drugs even after months of incarceration, and 87% reported that they expected to resume drug use after release. 41 High relapse rates after release have also been reported in China and Cambodia.…”

Entre as asperezas do cotidiano e o brilho fácil: o manejo cotidiano do uso prejudicial de drogas

“…Indiscriminate mass round-ups of individuals in these scenes have been followed by their compulsory detention or hospitalization, a counterproductive measure explicitly condemned by United Nations agencies 7 and assessed as both ineffective and potentially associated with various human rights violations and harms, as shown in a recent systematic review 8 .…”