Opioid use disorder is a deadly manifestation of the disease of addiction. The condition leads to the premature deaths of over a hundred Americans, every day. In 2016, some 64,000 people died from overdose across the country — more are expected to succumb in 2017. An "epidemic" is perhaps the only word to be used in describing the severity of the opioid crisis in America.
As with most serious health conditions, finding solutions is particularly tricky. However, if experts and lawmakers agree on one thing it’s that addiction treatment is our best recourse. Substance use disorder treatment works, having helped a significant number of people break the cycle of addiction. Those who keep on the path of recovery can live meaningful and productive lives into old age. Without that type of assistance, there isn't a guarantee that an individual will survive to the end of a given year.
Encouraging people with opioid use disorder to seek treatment is more critical than ever. The rise of synthetic opioids like fentanyl and carfentanil has dramatically increased the risk of overdose. More times than not, individuals are unaware that the heroin they just bought contains an iteration of synthetic opioid. They administer their heroin as usual, which under normal circumstances carries the risk of overdose, only to find that they bit off more than can be chewed. Synthetic opioids are exponentially more potent than what’s seen in the typical bag of heroin. So toxic that the overdose reversal drug naloxone often proves an ineffective antidote.
A heightened prevalence of synthetic opioids begs the question: Is it possible to protect opioid addicts from this invisible foe? That may seem like a simple question, but answering the poser is philosophical.
Are Opioid Addicts a Danger, to Their Self?
We could rephrase the above question to say: How can an addict be protected from their self? Hopefully, we can all agree that addiction treatment services are the most effective tool at our disposal. Individuals with opioid use disorder are no longer at risk of overdose when they are in recovery. Treatment is the surest way to develop the skills necessary for a program of lasting recovery.
Under ideal conditions, a person with alcohol or substance use disorder seeks help on their own accord. They see that the path they are on is only leading to one inevitable end, prompting them to make moves to correct course. Unfortunately, the disease of addiction is both cunning and baffling; even when someone knows they need assistance, they often resist. When that occurs, some suggest mandating individuals to treatment.
Persons exhibiting signs of being a danger to their self and others are often committed to psychiatric evaluation. The standard for commitment is 72 hours, giving clinicians time to assess the level of threat. After that period patients are usually released, but there are times where longer lengths of commitment are in order. Some people view opioid use, or overdose more specifically, as a form of suicide. With that in mind, there is an argument to be made for mandating addiction treatment. Court ordered addiction rehab is a practice that occurs more often than you would think.
Addiction-Related Civil Commitments
The practice of asking the courts to protect individuals from him or herself is happening across the country. Parents, at their wit's end, will turn to the judge and plead for help in saving their child’s life. In fact, over 30 states have laws allowing for addiction-related civil commitment, The Washington Post reports. There were more than 6,000 civil commitments in Massachusetts last year, alone. While it can be easy for some people to see the benefits of mandating treatment, the policy may not have the desired outcome.
Michael Stein at the Boston University and Paul Christopher at Brown University examined this subject. They wrote an opinion piece warning that the efficacy of civil commitment is unknown, potentially doing more harm than good. They bring up three valid points worth consideration:
- Research is lacking and there isn’t any evidence that civil commitment saves lives. Those forced into treatment may just bide their time until release. With diminished tolerance, the risk of overdose death is particularly high.
- Given that civil commitment is a response to the level of imminent risk, shorter stays may be warranted. How can a judge be tasked to decide what length of stay is most effective for a given individual?
- As the number of civil commitment instances grows, greater funding will be needed to pay for beds and facilities.
Stein is chair of health law, policy, and management at the BU School of Public Health. He is the author of “The Addict: One Patient, One Doctor, One Year.” Christopher is an assistant professor of psychiatry and human behavior at Brown University.
Opioid Use Disorder Treatment
We need studies to guide the crafting of new commitment laws and the revision of existing ones. How long should commitment last? What services should be required during commitment that increase the chances of a safe release back to the community? Without data, judges will face desperate parents and their children and continue to direct commitments one by one, restricting civil liberties without knowing whether they are reducing overdose deaths or if the clinical and public health resources are justified.”
Even without science to back up the effectiveness of civil commitment, it’s relatively easy to see problems. It’s well established that mental illness doesn’t respond well to force. Compassion is considered to be the most effective method of encouraging people to seek treatment. Mandates imply that an individual has done something wrong. Mental illness is not a crime, over 2 million Americans have an opioid use disorder.
Despite the fact that commitment is not a criminal charge, it’s likely that individuals subject to it will feel punished. It may not be a criminal charge, but it’s a decree backed by the force of law. If one violates the terms of the commitment, it’s probably safe to assume there will be repercussions. There are many different roads one can take to find addiction recovery, force and ultimatums have rarely led to beneficial outcomes.
Consider an Intervention
At PACE Recovery Center, we offer a multi-pronged approach to our men's addiction treatment program and philosophy because we understand that our clients are complex beings. Having a place where men can delve into their underlying issues, which have caused them to resort to substance use and self-defeating behaviors, is the core philosophy of PACE.