Families push to get addicts committed
Involuntary treatment may be last chance for those enslaved to opioids
Five years ago, Lauren Davis was in “a living hell on Earth” as she tried desperately to push her best friend into treatment for opioid and alcohol addiction.
“He was in repeated crisis, repeated overdose, repeated suicide attempts,” Davis recalled of her friend Ricky Garcia. A Seattle resident, Davis sought help everywhere, from social workers to doctors, and got the same response: “I’m sorry, he’s dying, and there’s nothing you can do.”
Even though Garcia was clearly a danger to himself, he had to agree to treatment voluntarily. The law in their home state of Washington did not allow for involuntary commitment for individuals with substance abuse disorders.
Today, Garcia is alive and sober — and Washington’s law is about to change. Next spring, the state will open its first locked treatment facility and accept petitions to compel addicts into substance abuse care.
Across the country, advocates and terrified parents are pushing policymakers to expand the use of involuntary commitment laws as a tool to combat the opioid epidemic. It’s a controversial tactic that has logistical and constitutional implications.
“What are we locking people into, for how long, and what happens afterwards?” asked Sarah Wakeman, medical director for substance use disorders at Massachusetts General Hospital. She said studies suggest coerced treatment is not effective. “If we are going to be removing someone’s autonomy … it’s concerning if we’re doing that in a way that’s not even effective over the long term,” she said.
Proponents argue it’s a vital, last-resort option as the opioid crisis kills more than 90 Americans every day.
“This whole discussion of civil commitment is about to explode because of this epidemic that we’re trying to survive,” said Charlotte Wethington, who pioneered a Kentucky law in 2004 that allows parents to seek courtordered addiction treatment for their adult children. Wethington’s crusade began after her son, Casey, died from an overdose.
“I’ve been working with states all across the country,” Wethington said, adding that she’s been flooded with calls and emails from parents asking her, “Can someone help me get this law started?”
More than 30 states have involuntary commitment laws for people with substance abuse disorders, according to a new report from the Hazelden Betty Ford Institute for Recovery Advocacy. Although those statutes are used to confine people with serious mental illnesses, they are rarely used to hold those with substance abuse disorders.
In some states, such as Ohio, it’s so difficult to get a petition approved that many families don’t even try. In other states, “judges and attorneys are hesitant to move forward” in part because of civil rights concerns, said Marvin Seppala, chief medical officer at the Hazelden Betty Ford Foundation. “It’s really hard to take someone’s freedom away, and it should be,” he said, but “it’s a horrible mistake (not to use involuntary commitment laws) with all these deaths taking place.”
When he started his addiction practice in the late 1980s, Seppala said, it was rare for a patient to die from substance abuse. Now, it’s “commonplace” because opioids are so deadly, and families call him asking what they can do to keep a loved one alive.
The best option, he often tells them, is to press charges — to get their child arrested and away from the danger of overdosing — then hope the legal system will connect them to treatment.
Seppala and others push for a broad re-examination of civil commitment laws across the country. They face at least two major hurdles — the practical questions about the capacity and effectiveness of locking up thousands of addicts and the legality of doing that.
“There’s just not enough treatment beds anywhere,” said Karem Hanson, a health policy analyst for the National Conference of State Legislatures. “Every state is facing a shortage. If everyone was to come knocking on the door for treatment, they wouldn’t know where to put everybody.”
Also, Hanson said, “there’s just the slippery slope of mandating someone going into treatment. That’s a violation of their civil rights.”
“Already in some states, when privately run treatment centers are full, individuals who are civilly committed are sent to more basic programs housed in prisons,” the Hazelden report notes. “Holding people against their will is not justifiable if the treatment they receive is ineffective.”
Or worse, non-existent. That’s what happened in Massachusetts when officials started using the state’s involuntary commitment laws to incarcerate addicts.
While men were sent to a state hospital that offered opioid addiction treatment, women were sent to a prison that did not. After the American Civil Liberties Union sued, the state moved to open treatment beds in a mental hospital, spending nearly $6 million to fund 60 treatment slots for women.
Seppala pointed to Washington state as a model for legislators to address the capacity problem. When lawmakers expanded the state’s civil commitment laws, they funded the construction of nine secure treatment facilities that had a total of 144 beds.
Operating those will cost the state about $15 million a year, and federal Medicaid funds will cover an additional $14 million annually. The state could save money in reduced emergency room visits and law enforcement costs.
Davis said the law — named after her friend Ricky, 31 and sober for five years — sets a “very high” bar for involuntary treatment, so it did not ignite civil liberties concerns. “We’re really talking about people who are at imminent risk of dying,” she said.
Wakeman said the push to expand commitment laws is a wellintended response to desperate families trying to keep relatives alive, but it does not address the lack of outpatient opioid treatment. “The research we have doesn’t suggest that coerced treatment in the form of civil commitment is an effective strategy,” she said. “What we know works for opioid use ... is generally long-term management with medications and ongoing followup with trained clinicians.”
Davis, who runs a recovery advocacy group in Washington, conceded that her home state’s locked treatment facilities could be overwhelmed. “I get calls every week from parents … and their child is dying today. It’s heartbreaking to say, ‘I’m praying your child will live six more months,’ ” until the first 16-bed facility is ready, Davis said. When its doors open, “people think it will be full in 30 minutes.”
“This whole discussion of civil commitment is about to explode because of this epidemic that we’re trying to survive.” Charlotte Wethington