Is one solution to the opioid epidemic to force those in danger of overdosing into treatment?

Hazelden Betty Ford's new Emerging Drug Trends report looks at involuntary civil commitments for addiction

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Jul 31, 2017, 14:58 ET

CENTER CITY, Minn., July 31, 2017 /PRNewswire-USNewswire/ -- As the death toll from the opioid epidemic continues to rise, more families, advocates and health care providers are looking at the option of forcing people into addiction treatment as one way to protect those in danger of overdose from harming themselves.

The topic received national exposure at a recent town hall hosted in Washington, D.C., by the Hazelden Betty Ford Institute for Recovery Advocacy and the Association of Recovery in Higher Education. The video-recorded event – held at George Washington University – looked at several ways to put overdose survivors on the road to recovery rather than back on the path of addiction.

Some advocates say carefully constructed civil commitment laws nationwide would provide a tangible alternative to desperate families who otherwise must choose between two bad options: watching addiction take its course, or getting their loved one arrested for a crime.

"We can't stand by and watch more people die without proper care and treatment," said one of the town hall speakers – Dr. Marvin D. Seppala, chief medical officer of the Hazelden Betty Ford Foundation. "We may need to intervene in extreme cases to pursue treatment, even when it is against the individual's wishes."

"Involuntary commitment is already used carefully, but regularly, to save lives and prevent harm from life-threatening mental illness," continued Seppala. "It's time we do the same for life-threatening addictions – all of them, not just opioids."

According to a new edition of the Hazelden Betty Ford Institute for Recovery Advocacy's Emerging Drug Trends report, produced in collaboration with the University of Maryland School of Public Health, 37 states and the District of Columbia have laws that allow for the involuntary commitment of individuals with a "substance use disorder," "alcoholism" or both, contingent upon a presentation to the court of substantial and reliable evidence of potential harm. In most states, however, these laws are seldom used, and many families, physicians and local judges are unaware of the option.

Now, in light of the opioid crisis that is claiming tens of thousands of lives annually, several states – from Pennsylvania to Alabama – are considering involuntary commitment laws for the first time or proposing changes to existing laws that would remove barriers to their use.

Nick Motu, vice president of the Hazelden Betty Ford Institute for Recovery Advocacy, said it is time to examine this idea on a national scale, noting that existing laws vary greatly in terms of who can petition the court, how difficult it is to get a petition approved, how long an individual can be committed and what type of treatment is mandated.

"Our involuntary commitment laws are inconsistent and lack established best practices and robust research," Motu said. "I'd like to see these laws resourced and studied a lot more as we move forward—with the same vigor we've funded and studied drug courts, for example."

The July 2017 report on involuntary commitment laws is the fourth edition of the new monthly Emerging Drug Trends report, designed to provide front-line treatment and research perspectives on America's No. 1 public health problem, addiction. The latest report describes the current status of commitment laws nationwide and sheds light on several considerations for policymakers.

Central to the premise of civil commitments is the reality that when people are addicted to heroin, prescription painkillers or other opioids, recovery is the only solution that will prevent the continued risk of overdose and death. And yet, the perplexing nature of addiction means the vast majority who have it either don't recognize the need for recovery or don't believe it's possible for them.

"Eighty-five percent of those in need of treatment for substance use disorder do not recognize they have this disease. They do not seek treatment and often continue life-threatening behaviors," Dr. Seppala explained. "At first glance, involuntary commitment appears to be an excessive response, but the neurobiology of addiction reveals that individuals with this disease have little ability to fully recognize the problem and can be driven to continued drug use, even when it puts their life at risk."

"If a person with a substance use disorder were thinking with a healthy brain, there would be no question about choosing treatment," added Charlotte Wethington, a recovery advocate and the initiator of Casey's Law, which many consider a model involuntary commitment law in Kentucky.

"People who are concerned with civil liberties more than people's lives are under the false assumption that people with severe substance use disorder are capable of rational decisions regarding their illness," Wethington continued. "The fact, according to decades of research on the brain, is that they are not. That's why so many people are coerced into treatment already—by the criminal justice system, employers or loved ones. Involuntary commitment laws just provide another tool to help us reach those who cannot be reached by other means."

Wethington, who also spoke at the recent national town hall, spearheaded the effort to enact Casey's Law after losing her 23-year-old son Matthew Casey Wethington to a heroin overdose.

"With substance use disorder, especially opioid use disorder, people are a danger to themselves because every use could be the last one. It is a matter of literally playing Russian roulette. Time is of the essence. This is not like waiting for a person to go from the first to the fourth stage of addiction. With opioids, the danger is now," Wethington said. "People who are severely addicted to opioids will go to any length to get the drug their brain is demanding. When they are without the drug, they are in a state of deprivation, as if they were starving to death."

This month's Emerging Drug Trends report provides insights on the following questions related to involuntary commitment laws for addiction:

What evidence of potential harm is necessary to involuntarily commit an individual with a substance use disorder?
For what length of time should an individual with a substance use disorder be involuntarily committed to treatment?
What kind of treatment would be most effective in situations where an individual is involuntarily committed?
What happens after treatment?
Do parents already have the right to involuntarily commit their minor children to addiction treatment?
Will involuntary commitment to treatment result in different outcomes than if the person voluntarily undergoes treatment?
Is there a way to make involuntary commitment laws less threatening to civil rights?
How can we better emphasize that privacy protections are in place for addiction treatment just like any other health care service?
Would it be possible to proactively gain formal consent from an individual for involuntary commitment that might be necessary at a later date?
Is the current addiction treatment system adequate for handling an influx of involuntarily committed individuals?

The full report is available here.

About the Hazelden Betty Ford Institute for Recovery Advocacy
Our mission is to provide a trusted national voice on all issues related to addiction prevention, treatment and recovery and to facilitate conversation among those in recovery, those still suffering and society at large. We are committed to smashing stigma, shaping public policy and educating people everywhere about the problems of addiction and the promise of recovery. The Hazelden Betty Ford Institute for Recovery Advocacy is part of the Hazelden Betty Ford Foundation, the nation's largest nonprofit treatment provider. Learn more at www.HBFinstitute.org and on Twitter @hbfinstitute.

About the Hazelden Betty Ford Foundation
The Hazelden Betty Ford Foundation helps people reclaim their lives from the disease of addiction. It is the nation's leading nonprofit treatment provider, with a legacy that began in 1949 and includes the 1982 founding of the Betty Ford Center. With 17 sites in California, Minnesota, Oregon, Illinois, New York, Florida, Massachusetts, Colorado and Texas, the Foundation offers prevention and recovery solutions nationwide and across the entire continuum of care for youth and adults. It includes the largest recovery publishing house in the country, a fully-accredited graduate school of addiction studies, an addiction research center, an education arm for medical professionals and a unique children's program, and is the nation's leader in advocacy and policy for treatment and recovery. Learn more at www.HazeldenBettyFord.org and on Twitter @hazldnbettyford.