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An Ethicolegal Analysis of Involuntary Treatment for Opioid Use Disorders

Published online by Cambridge University Press:  27 January 2021

Farhad R. Udwadia  and
Judy Illes
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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.

Type
Independent Articles
Information
Journal of Law, Medicine & Ethics , Volume 48 , Issue 4: Climate Change and the Legal, Ethical, and Health Issues Facing Healthcare and Public Health Systems , Winter 2020 , pp. 735 - 740
Copyright
Copyright © American Society of Law, Medicine and Ethics 2020

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References

Ahmad, F.B., Escobedo, L.A., Rossen, L.M., Spencer, M.R., Warner, M., and Sutton, P., “Provisional Drug Overdose Death Counts,” National Center for Health Statistics, 2019, available at <https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm> (last visited August 21, 2019)+(last+visited+August+21,+2019)>Google Scholar
Substance Abuse and Mental Health Services Administration, “Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health,” Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, 2019, available at <https://www.samhsa.gov/data/> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Florence, C.S., Zhou, C., Luo, F., and Xu, L., “The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013,” Medical Care 54, no. 10 (2016): 901–906.Google Scholar
Special Advisory Committee on the Epidemic of Opioid Overdoses, “National report: Opioid-related Harms in Canada Web-based Report,” Ottawa: Public Health Agency of Canada, December 2019, available at <https://health-infobase.canada.ca/substance-related-harms/opioids> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Beletsky, L., “Involuntary Treatment for Substance Use Disorder: A Misguided Response to the Opioid Crisis,” Harvard Health Blog, January 25, 2018, available at <https://www.health.harvard.edu/blog/involuntary-treatment-sud-misguided-response-2018012413180> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Section 104 of Chapter 208 of the Acts of 2018, “Section 35 Commission Report,” July 1, 2019, available at <https://d279m997dpfwgl.cloudfront.net/wp/2019/07/0708_section-35-commission-report.pdf> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Christopher, P.P., Pinals, D.A., Stayton, T., Sanders, K., and Blumberg, L., “Nature and Utilization of Civil Commitment for Substance Abuse in the United States,” Journal of the American Academy of Psychiatry and the Law 43, no. 3 (2015): 313–320.Google Scholar
Pilarinos, A., Kendall, P., Fast, D., and DeBeck, K., “Secure Care: More Harm than Good,” Canadian Medical Association Journal 190, no.4 (2019): E1219–E1220.CrossRefGoogle Scholar
Woo, A., “Young Drug Users Should be Involuntarily Admitted into Care, B.C. Mom Says,” The Globe and Mail, November 26, 2018, available at <https://www.theglobeandmail.com/canada/british-columbia/article-young-addicts-should-be-involuntarily-admitted-into-care-bc-mom/> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Becker, D., “Group of Civilly Committed Men Sues Mass. Alleging Gender Discrimination In ‘Section 35’ Law,” CommonHealth, March 15, 2019, available at <https://www.wbur.org/commonhealth/2019/03/14/masac-section-35-lawsuit?fbclid=IwAR1jEh0pEx36GBJCXhkBIBP_sTA3legipBk6rFC85Hob3_IdEJnazcwSfqE.>(last visited August 21, 2019).(last+visited+August+21,+2019).>Google Scholar
Cramer, M. and Freyer, F.J., “Patients Call Plymouth Addiction Center a Mere Jail,” The Boston Globe, December 2, 2017, available at <https://www.bostonglobe.com/metro/2017/12/02/addiction-center-run-prison-system-draws-scrutiny-following-suicide/oWNbHtLRz8WiCoYus4doMO/story.html> (last visited August 21, 2019); “Section 35 Commission Report,” supra note 6.+(last+visited+August+21,+2019);+“Section+35+Commission+Report,”+supra+note+6.>Google Scholar
Bureau of Substance Addiction Services, “Section 35: The Process,” Mass.gov, available at <https://www.mass.gov/service-details/section-35-the-process.> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Cramer and Freyer, supra note 11.Google Scholar
Becker, D., “Prison For Forced Addiction Treatment? A Parent’s ‘Last Resort’ Has Consequences,” National Public Radio, April 20, 2019, available at https://www.npr.org/sections/health-shots/2019/04/20/712290717/prison-for-forced-addiction-treatment-a-parents-last-resort-has-consequences (last visited August 21, 2019).Google Scholar
Becker, D., “Is It Addiction Treatment Or Prison? A Look Inside A State Center For Involuntary Commitments,” CommonHealth, September 13, 2017, available at <http://www.wbur.org/commonhealth/2017/09/13/civil-commitment-substance-treatment> (last visited August 15, 2019).+(last+visited+August+15,+2019).>Google Scholar
Cramer, M., “Worse than Jail: Addicts Civilly Committed say DOC Abused Them and Failed to Treat Them,” The Boston Globe, July 14, 2017, available at <https://www.bostonglobe.com/metro/2017/07/13/worse-than-jail-addicts-civilly-committed-say-doc-abused-them-and-failed-treat-them/1kzQdRdO6F4QeQuYUiP54J/story.html.> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
John Doe 1, John Doe 2, John Doe 3, John Doe 4, John Doe 5, John Doe 6, John Doe 7, John Doe 8, John Doe 9, John Doe 10 vs. Carol Mici, Commissioner of the Massachusetts Department of Correction, Pamela MacEachern, Superintendent of MASAC at Plymouth, Thomas Turco, Secretary of the Executive Office of Public Safety and Security, Massachusetts Department of Correction; Monica Bharel, Commissioner of the Department of Public Health; Marylou Sudders, Secretary of Health and Human Services; Department of Public Health, Suffolk Superior Court, (2019), available at <https://d279m997dpfwgl.cloudfront.net/wp/2019/03/Section35Complaint.pdf> (last visited December 6, 2019).+(last+visited+December+6,+2019).>Google Scholar
Id.Google Scholar
Szalavitz, M., “Forced Rehab Isn’t the Solution,” Vice, January 9, 2018, available at <https://tonic.vice.com/en_us/article/qvwwkv/massachusetts-forced-rehab-law> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Moss, B., “Governor Baker Signs Legislation Ending Civil Commitments at MCI-Framingham for Substance Use Disorder,” Press Secretory (Governor’s Office), January 25, 2016, available at <https://www.mass.gov/news/governor-baker-signs-legislation-ending-civil-commitments-at-mci-framinghamfor-substance-use> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Werb, D., Kamarulzaman, A., and Meacham, M.C., “The Effectiveness of Compulsory Drug Treatment: A Systematic Review,” International Journal of Drug Policy 28 (2016): 1–9.Google Scholar
Wegman, M., Altice, F., Kaur, S., Rajandaran, V., Osornprasop, S., Wilson, D., Wilson, D., and and Kamarulzaman, A., “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,” The Lancet Global Health 5, no.2 (2017): 198–207.Google Scholar
Jain, A., Christopher, P.P., Appelbaum, P.S., “Civil Commitment for Opioid and Other Substance Use Disorders: Does it Work?” Psychiatric Services 69, no. 5 (2018): 374–376.CrossRefGoogle Scholar
Brooks, R.A., “Psychiatrists’ Opinions about Involuntary Civil Commitment: Results of a National Survey,” Journal of the American Academy of Psychiatry and the Law 35, no. 2 (2007): 219–228.Google Scholar
Anderson, A., “Involuntary Civil Commitment and Sobriety,” Master of Social Work Clinical Research Papers, Retrieved from Sophia, the St. Catherine University repository website, available at <https://sophia.stkate.edu/msw_papers/703> (last visited October 5, 2020).+(last+visited+October+5,+2020).>Google Scholar
The Commonwealth of Massachusetts, “An Assessment of Opioid Related Deaths in Massachusetts (2013-2014),” Chapter 55 Report, September 15, 2016, available at <https://www.mass.gov/files/documents/2016/09/tx/chapter-55-report.docx> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Section 35 Commission Report,” supra note 6.Google Scholar
Section 35 Commission Report,” supra note 6.Google Scholar
Section 35 Commission Report,” supra note 6.Google Scholar
Becker, supra note 18; Blanchard, S.K., “Massachusetts Incarcerates Men in the Name of Drug Treatment-Now They’re Suing,” Filter, March 20, 2019, available at <https://filtermag.org/massachusetts-incarceration-drugs-drug-treatment/> (last visited August 21, 2019).+(last+visited+August+21,+2019).>Google Scholar
Christopher, supra note 7.Google Scholar
Sordo, L., Barrio, G., Bravo, M.J., et al., “Mortality Risk During and After Opioid Substitution Treatment: Systematic Review and Meta-Analysis of Cohort Studies,” British Medical Journal 357 (2017): j1550; Susan, R.M., Borum, J., and Petrila, J., The Effectiveness of Involuntary Outpatient Treatment: Empirical Evidence and the Experience of Eight States (RAND Corporation, 2001).Google Scholar
Jones, C.M. and Mccance-Katz, E.F., “Co-Occurring Substance Use and Mental Disorders among Adults with Opioid Use Disorder,” Drug and Alcohol Dependence 197 (2019): 78–82.CrossRefGoogle Scholar
“Section 35 Commission Report,” supra note 6.Google Scholar
“An Assessment of Opioid Related Deaths in Massachusetts (2013-2014),” supra note 31.Google Scholar
“Section 35 Commission Report,” supra note 6.Google Scholar