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October 2, 2019

Criminalization of Opioid Civil Commitment

Author Affiliations
  • 1Warren Alpert Medical School, Brown University, Providence, Rhode Island
  • 2Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
  • 3Boston University School of Public Health, Boston, Massachusetts
JAMA Psychiatry. 2020;77(2):111-112. doi:10.1001/jamapsychiatry.2019.2845

The US opioid epidemic is characterized by a high rate of opioid overdose deaths (47 600 in 2017 alone) and a low rate (<5%) of self-perceived treatment need among individuals who misuse opioids.1,2 One strategy to address this problem is civil commitment for opioid misuse, which is currently permitted in Washington, DC, and 38 states. These statutes, like their mental health counterparts, give judges authority to order individuals into treatment when their opioid use poses serious risk of harm or substantially impairs their decision-making. While it remains to be seen whether this controversial strategy can help decrease overdose deaths, an alarming trend toward criminalization of civil commitment threatens the success of these laws. In this Viewpoint, we examine this phenomenon, discuss how it undermines the therapeutic intent of commitment laws, and consider legal objections. We end with a proposal for reforms.

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    1 Comment for this article
    Involuntary commitment of drug users wrong approach
    Susan Sered, PhD | Suffolk University
    In Massachusetts the governor seems intent on continuing to fund using the civil commitment process to send men to prison for treatment. Legislation ended this practice for women several years ago. As a sociologist who works with women who cycle through treatment programs, jails and shelters of various sorts, it is clear to me that involuntary commitment fails to meet the goal of treating substance mis/use and threatens the basic civil liberties of people caught in the process.
    For a variety of reasons – including a shift in media portrayals of the race of drug users – we are currently
    experiencing a cultural and judicial movement away from criminalization and toward medicalization of substance mis/use. While treatment tends to be more benevolent than punishment, civil commitment blurs the boundaries between the two. While physicians may feel frustrated in terms of what to do with patients who continue to mis/use psychotropic substances, they should not allow themselves to be drawn into putting their professional stamp of approval on that blurring.
    Our legal system, like that of other modern democracies, insists that an individual should not lose his or her freedom without the due process of law. A doctor, committing people without an opportunity for those people to be represented by counsel, will be asked to serve as both prosecutor and judge – a position that directly contradicts principles of US jurisprudence and places doctors in an uncomfortable and untenable position vis-à-vis their patients. Knowing that doctors have this power will, I fear, serve to discourage people who could benefit from immediate medical attention from seeking assistance.