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Would involuntary commitment for addiction save lives?

November 2, 2017
by Jill Sederstrom
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As the opioid crisis continues to grow, the possibility of involuntary commitment for overdose patients is gaining more attention from advocates who see it as a necessary tool in the battle to save lives. However, many experts also acknowledge that there are significant legal and practical issues that still need to be addressed before the controversial strategy could be fully effective.

Involuntary commitment for patients with mental health concerns is a well-established practice in many states across the country, but using similar laws to force people with addiction disorders—who are outside the criminal court system—into substance use treatment is a much newer concept.

Many, like Charlotte Wethington, see the such a move as a powerful option to help patients who have either overdosed, so they might get the help they need to survive. Wethington, who lost her son Casey to an overdose in 2002, helped create Casey’s Law in Kentucky in 2004. The law gives parents, friends or relatives a pathway to intervene and get a patient into involuntary treatment for substance use disorders for a period of up to 360 days.

“The bottom line is you have to be alive to recover,” she says. “So, if recovery is our ultimate goal, then we need to use all the tools that we have in our toolbox to make that happen...or at least to facilitate that happening.”

An increasing number of state officials, parents and law enforcement officers have expressed interest in creating similar laws in other states.

“It’s certainly an area of great interest,” says Sherry L. Green, chief executive officer of the National Alliance for Model State Drug Law.  “We’ve received a number of requests, including from some governors and drug policy directors, to look into the possibility of drafting language for an effective civil involuntary commitment law.”

According to Green, more than half of all states that have some process written into existing laws that would allow for civil commitment; however, in some states, healthcare professionals, parents and loved ones are not aware such laws exist.

Green says this lack of knowledge is a sign that many of the laws are not being used consistently. 

“A lot of states started with involuntary commitment under mental health, and that’s fairly well fleshed out at the state levels. Those mental health commitment laws tend to be used extensively, and then when they were broadened to include substance use disorders, that’s less consistent and less used,” she says.

Getting help to those in need

Residents in the state of Florida have access to the Hal S. Marchman Alcohol and Other Drug Services Act of 1993 (Marchman Act). Under this law, someone with direct knowledge of another person’s substance misuse is able to petition the court to intervene in a two-step process.

Mark Astor, JD, founder of Drug and Alcohol Attorneys in Boca Raton, Fla., says the first step is petitioning the court to have the individual involuntarily assessed for treatment. This can be done on an ex-parte basis, meaning the subject of the filing doesn’t have to be aware of the proceedings. If the assessment is granted, the sheriff’s department collects the individual and brings him or her in for assessment on a five-day hold at a treatment facility of the petitioner’s choosing.

After that, a second petition is filed to secure involuntary treatment for the individual for a period of up to 90 days, although Astor says the treatment can be extended twice if necessary. There is also a hearing, he says, adding that the individual is entitled to contest the filing and have their own counsel.

Astor sees the law as a benefit in Florida, particularly because of the large number of people who come from out-of-state for treatment, often leaving family and friends many miles away.

“The Marchman Act at least enables the family to run to the courthouse and say, ‘Judge, my kid walked out of treatment,’ and can initiate something,” he says. “I think it’s a safety net for families.”

But while Astor notes the law’s advantages, he says it is not utilized nearly enough in Florida. There continues to be a lack of knowledge among treatment centers, parents and even emergency medical personnel about the law and its potential to initiate people into what could be life-saving treatment.

 

Legal and practical challenges

The involuntary commitment laws face logistical hurdles as well. Jessica Hulsey Nickel, president and chief executive officer of the Addiction Policy Forum, says communities that institute such laws need to ensure they have enough providers to serve patient needs.

“How well this works really does depend on having treatment capacity available,” she says.

Many state officials, Green says, are already struggling to find enough beds for those patients who actively want help for their addiction and are ready for treatment.

“They feel like they can’t really prioritize reserving treatment beds for people who don’t really want to be there in the first place,” she says.

There’s not only a need to increase the number of treatment centers overall, but many of those facilities would also need to be secured to ensure the safety and treatment efficacy of involuntary commitment patients.

“If you are committing someone to an unsecured facility, and because it’s involuntary and you don’t have any means of actually keeping them there, they can just walk out,” Green says.

Massachusetts, which allows for civil commitment under what’s known as section 35, solved this problem by creating several locked commitment facilities.

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Comments

Civil commitment, especially as it pertains to drug use, is way more complicated and nuanced than this article suggests. The notion that because someone might commit someone with the intention of saving their life automatically means that is what the most likely outcome will be ignores what we know to be true about the differences between those who use drugs and those who struggle with mental heath issues that laws like this were initially intended to support.
First someone with a mental health issue might benefit from something like this to stabilize medication, "Cool Off" from an psychological break, reconsider taking their own life, hurting them selves and/or hurting someone else.
Those who use drugs however the effects can be completely the opposite. Periods of sobriety (forced or otherwise) enhance risk of overdose and fatal overdose. Those who use drugs are often very capable of taking care of their basic personal needs, many are even working, maintaining relationships, housing, etc. Maintaining safe and supportive relationships with loved ones, law enforcement, first responders, and other medical personnel, and the "risk" of being committed against your will has a chilling effect on calling 911, agreeing to hospital transport, among other things.
If there is any evidence it is that civil commitment is more likely to increase a likely fatal outcome than it is to decrease. Traditional treatment (detox/residential) is a 50/50 proposition of success under the best conditions and as the article states these are not the best conditions for engaging in treatment. If individuals leave an experience of civil commitment without having embraced some level of engagement in recovery, they are exponentially more likely to overdose, less likely to call 911 for help at risk of being recommitted, less likely to go to the hospital if they do call for help, less likely to feel like they have a support system around them interested in what they want, and at higher risk of death as a result.
I empathize with those who feel like they have no other recourse, but the likely hood for a better long term outcome is to meet them where they are at, give them all the tools they need for safer use, implement policies and practices that encourage and reward calling 911 and engaging in any level of service following an overdose, and empower them to make a "healthier" choices about their own use.
Treatment and recovery is one positive outcome for those who use drugs, but it is not the only one.

Admiral125, you make an excellent point. I wonder if others have experience in applying these laws for those with addiction. What does the community overall think about the issue? Pros? cons?

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