THE ISSUE

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As opioid use and overdose continue to pose a mounting public policy challenge in the US, access to evidence-based, affordable, and respectful treatment remains sparse. Perversely, legislators and officials are increasingly turning to civil commitment statutes to force drug users to in-patient “treatment” facilities. Many of these resemble prisons. More than half of US states currently have the authorizing statutes on the books, though the extent of their utilization is unclear. What is clear is that care provided in such state custody often fails to meet basic international standards for substance use disorder treatment; other elements of health care services in these facilities are often dismal. Aside from the obvious civil liberty implications, patients committed under these systems—many for periods of 90 days or more—face dramatically higher risk of relapse and overdose than those re-entering the community from voluntary treatment. 

 

Today, civil commitment mechanisms are playing an increasingly prominent role in opioid crisis response. The reasons for this are several. First, they provide desperate families of at-risk patients. police, and health care providers with a decisive and relatively immediate crisis response mechanism. Second, care provided under civil commitment statutes provides a work-around to the kind of waiting lists and navigation barriers that characterize efforts to access voluntary treatment in most jurisdictions. Third, involuntary treatment under state care is paid for through state funds (and to insurers, in some instances); the individual or the family does not bear responsibility for the costs. Fourth--and probably most importantly--involuntary treatment creates an outlet for our society’s carceral approach to substance use under the false veneer of a softer, gentler “public health” approach.

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Despite increasing utilization of these treatment mechanisms, little is known about the extent to which these provisions are being employed, and inadequate attention has been paid to articulating approaches to counter these carceral structures and laws through litigation or other forms of advocacy. Our research identifies the current national legal landscape for civil commitment of substance users, and assesses states' implementation of these provisions as a means for substance use treatment.

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