Civil Commitment for Opioid Misuse: The Need for an Ethical Use Framework

Cross posted from the Journal of Medical Ethics Blog

By John C Messinger, Daniel J Ikeda, and Ameet Sarpatwari

In the 12 months prior to September 2020, there were over 66,000 fatal opioid overdoses in the United States, a 36% increase over the previous year. Many scholars have hypothesized that this dramatic rise was driven at least in part by conditions brought on by the COVID-19 pandemic, including increased barriers to accessing treatment for opioid use disorder and loss of social support.

As the crisis has worsened, states have scrambled to devise interventions to slow the loss of life. One strategy that has gained favor in recent years is the use of civil commitment, which enables others to petition a court to forcibly detain individuals whose opioid misuse presents a clear and convincing danger to themselves or others. Between 2015 and 2018, 25 states amended or passed new legislation related to involuntary commitment for substance misuse generally. More recently, now-President Joe Biden offered support for expansion of “mandatory rehab” on the campaign trail.

Yet, despite political investment in the use of civil commitment for opioid use disorder, evidence of its effectiveness is sparse. Concern has also grown regarding the conditions within civil commitment facilities: investigations by the Prisoner’s Legal Services of Massachusetts found “dozens of consistent accounts of the unit where initial detoxification takes place, describing the unit as filthy and stinking of the vomit, urine, and excrement of patients in the throes of cold-turkey withdrawal…”. In the context of the COVID-19 pandemic, these conditions are not only inhumane but also dangerous due to high disease transmissibility within institutionalized settings. Indeed, civil commitment programs in Massachusetts have reported COVID-19 outbreaks affecting dozens of individuals.

Given these concerns, it is necessary to re-evaluate the use of civil commitment for treatment of opioid use disorder. In our article in the Journal of Medical Ethics, we review the merits of this intervention and propose a comprehensive, ethical framework for its limited use.

Ameet Sarpatwari

Ameet Sarpatwari is an Instructor in Medicine at Harvard Medical School, an Associate Epidemiologist at Brigham and Women’s Hospital, and Assistant Director of the Program On Regulation, Therapeutics, And Law (PORTAL) within the Division of Pharmacoepidemiology and Pharmacoeconomics. His research draws upon his interdisciplinary training as an epidemiologist and lawyer and focuses on the effects of laws and regulations on therapeutic development, approval, use, and related public health outcomes.

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