Sup­port grows for civil com­mit­ment of opi­oid users

Walker County Messenger - - News - By Chris­tine Vestal

Amid an opi­oid ad­dic­tion epi­demic that is killing more than 90 Amer­i­cans every day, there is a grow­ing move­ment to make it eas­ier for rel­a­tives and health care providers to quickly se­cure court or­ders to forcibly con­fine and treat peo­ple who are ad­dicted to drugs.

Most states have civil com­mit­ment laws pri­mar­ily de­signed to pro­tect peo­ple with men­tal ill­ness from them­selves and others. Many of the laws in­clude drug ad­dic­tion and al­co­holism as a jus­ti­fi­ca­tion for tem­po­rary con­fine­ment, or at least don’t pre­clude it.

But in prac­tice, most com­mit­ment laws have been in­ef­fec­tive when it comes to peo­ple who use heroin and other opi­oids, in part be­cause some judges have been leery of tak­ing away a per­son’s civil lib­er­ties for what so­ci­ety has long per­ceived as a moral fail­ing.

Un­like peo­ple with se­vere men­tal ill­ness, peo­ple who are ad­dicted to drugs typ­i­cally re­tain the men­tal ca­pac­ity to take care of their ba­sic needs, even though the chronic dis­ease al­ters the brain, mak­ing the per­son even­tu­ally value drug use above all else.

New Hamp­shire, Penn­syl­va­nia and Wash­ing­ton are con­sid­er­ing new civil com­mit­ment laws specif­i­cally de­signed for opi­oid use. Ken­tucky has gone back to the draw­ing board af­ter fail­ing to en­act a com­mit­ment law for opi­oid ad­dic­tion last year.

And in Massachusetts, the one state where civil com­mit­ment has been used ex­ten­sively for opi­oid ad­dic­tion, Repub­li­can Gov. Char­lie Baker wants to make it even more com­mon.

When they are in ses­sion, Massachusetts judges typ­i­cally ap­prove civil com­mit­ments within an hour. But when an over­dose oc­curs at night or on week­ends, rel­a­tives or physi­cians seek­ing an or­der are out of luck.

In May, Baker said he would re­new his push for a mea­sure, which he first pro­posed in 2015, that would al­low emer­gen­cy­room physi­cians to hold opi­oid-ad­dicted pa­tients for up to three days with­out a court or­der, when they fear pa­tients may harm them­selves by us­ing drugs again.

His­tor­i­cally, con­fin­ing peo­ple against their will has been fraught with moral and le­gal am­bi­gu­i­ties and haunted by re­ports of abuse.

But the par­ents of young adults who use opi­oids are push­ing state law­mak­ers and gov­er­nors to make in­ter­ven­tion eas­ier, even as physi­cians and state health of­fi­cials search for ways to break the cy­cle of re­peated over­doses.

Ad­dic­tion pro­fes­sion­als gen­er­ally agree that civil com­mit­ment can save lives. But they ar­gue that with­out ef­fec­tive treat­ment, con­fin­ing peo­ple with an ad­dic­tion may do more harm than good.

“Peo­ple who use sub­stances and have ad­dic­tions still have civil rights,” said Dr. Alex Wal­ley, di­rec­tor of an ad­dic­tion medicine fel­low­ship at Bos­ton Med­i­cal Cen­ter. “The real ques­tion is whether ef­fec­tive treat­ment is avail­able, which in the case of opi­oids, is go­ing to be med­i­ca­tion. And it’s not OK to limit it to just one medicine,” Wal­ley said.

Another con­cern is whether the state can en­sure that con­tin­ued treat­ment will be avail­able once the per­son is re­leased, he said.

Sel­dom used

Most states have civil com­mit­ment laws that al­low health pro­fes­sion­als and rel­a­tives to pe­ti­tion a court for the in­vol­un­tary com­mit­ment of peo­ple with drug ad­dic­tion or al­co­holism if they can be shown to be en­dan­ger­ing them­selves or others, ac­cord­ing to the Na­tional Al­liance for Model State Drug Laws.

But with the ex­cep­tion of Massachusetts, an­ti­quated state com­mit­ment laws are rarely used to de­tain peo­ple with opi­oid ad­dic­tions, for a va­ri­ety of rea­sons.

His­tor­i­cally the laws have been used so in­fre­quently to de­tain peo­ple with drug ad­dic­tions that many po­lice, fam­ily mem­bers, physi­cians and lo­cal judges are un­aware of them, said Sherry Green, pres­i­dent of the al­liance. And on the rare oc­ca­sion some­one tries to use a civil com­mit­ment law, county judges tend to be re­luc­tant to grant pe­ti­tions be­cause in­suf­fi­cient case law ex­ists to sub­stan­ti­ate tak­ing away a per­son’s civil rights, she said.

But the Massachusetts law is far from ideal. Ac­cord­ing to the Amer­i­can Civil Lib­er­ties Union, Massachusetts is the only state where peo­ple with ad­dic­tions who have not com­mit­ted a crime are held in pris­ons.

For years, women with drug ad­dic­tions were in­car­cer­ated un­der the state’s decades-old com­mit­ment law, known as Sec­tion 35, in a women’s prison where no opi­oid treat­ment was avail­able. Men were in­car­cer­ated in a separate men’s prison where they re­ceived treat­ment for their ad­dic­tions.

In 2014, the ACLU and other civil rights groups sued Massachusetts for lock­ing women up be­cause of their ad­dic­tions. The state re­sponded in 2015 by en­act­ing a law pro­vid­ing for women to be held in a state men­tal hos­pi­tal in­stead, and ren­o­vated the hos­pi­tal to in­clude opi­oid treat­ment beds des­ig­nated for women who have been civilly com­mit­ted.

But few locked fa­cil­i­ties of­fer all three ap­proved opi­oid ad­dic­tion med­i­ca­tions, said Dr. Sarah Wake­man, di­rec­tor of ad­dic­tion medicine at Massachusetts Gen­eral Hos­pi­tal.

In most of the rest of the coun­try, com­mit­ment of peo­ple with al­co­holism or drug ad­dic­tion is rare, and typ­i­cally brief, just long enough for them to sober up, Green said.

In all states, once a per­son with ad­dic­tion is com­mit­ted, the state be­comes re­spon­si­ble for their care un­til they are re­leased. Un­til now, she said, states have been re­luc­tant to make it eas­ier to com­mit peo­ple for drug ad­dic­tion be­cause most states lacked the re­sources to pro­vide the needed treat­ment.

Wide vari­a­tions

Com­mit­ment laws in seven states (Alabama, Ari­zona, Idaho, Illi­nois, Ne­vada, New Hamp­shire and Wy­oming) specif­i­cally ex­clude drug ad­dic­tion as a le­gal jus­ti­fi­ca­tion. And in five other states (Mary­land, New Jer­sey, New Mex­ico, Ore­gon and Utah) com­mit­ment laws for men­tal ill­ness make no men­tion of drug ad­dic­tion or al­co­holism and no separate laws ex­ist for drug use.

State laws also vary widely in the amount of time peo­ple can be held against their will, rang­ing from one day to one year. The con­di­tions that must be met to com­mit some­one also vary, as do the peo­ple who can pe­ti­tion for a com­mit­ment.

In Delaware and In­di­ana, any­one can seek com­mit­ment of a per­son they be­lieve is in need of treat­ment. Other states re­quire a fam­ily mem­ber, health pro­fes­sional or po­lice of­fi­cer to pe­ti­tion for a com­mit­ment. Some re­quire an ad­dic­tion treat­ment ad­min­is­tra­tor or state or lo­cal health of­fi­cial to make the re­quest.

The new bill in Penn­syl­va­nia, spon­sored by Demo­cratic state Sen. Jay Costa, would al­low par­ents to have a doc­tor ex­am­ine their adult child and write a treat­ment plan, and then ap­pear in court and ask a judge to make the plan manda­tory.

In New Hamp­shire, a bill spon­sored by Repub­li­can state Sen. Jeb Bradley would al­low fam­ily mem­bers to pe­ti­tion the court to have an ad­dicted per­son con­fined in the state men­tal hos­pi­tal for treat­ment.

Wash­ing­ton’s bill, pro­posed by Repub­li­can state Sen. Steve O’Ban, would amend an ex­ist­ing civil com­mit­ment law to add opi­oid use as a suf­fi­cient cause for com­mit­ment. Un­der the pro­posal, peo­ple may be de­tained if, within a 12-month pe­riod, they have been ar­rested three or more times for dru­gre­lated crimes; have been hos­pi­tal­ized for drug use; or have three or more vis­i­ble track marks in­di­cat­ing in­tra­venous heroin use.

Lack of treat­ment

Most ad­dic­tion ex­perts main­tain that be­cause drug ad­dic­tion is char­ac­ter­ized by com­pul­sive drug use de­spite harm­ful con­se­quences, the use of com­mit­ment laws is the­o­ret­i­cally ap­pro­pri­ate.

Re­search has shown that peo­ple who are co­erced into treat­ment for drug ad­dic­tion are just as likely to achieve sus­tained re­cov­ery as those who seek it vol­un­tar­ily.

In fact, the vast ma­jor­ity of peo­ple who go into ad­dic­tion treat­ment are pushed into it by pro­ba­tion, pa­role, drug courts, fam­ily mem­bers or em­ploy­ers, said Arthur Schut, a con­sul­tant and for­mer CEO of Ara­pa­hoe House, a re­hab cen­ter in the Den­ver metro area.

“It has the largest pop­u­la­tion of co­erced pa­tients in any med­i­cal field. The prob­lem is that you have peo­ple who are gravely

im­paired in terms of how their brains work and are a dan­ger to them­selves and of­ten are un­able to make the de­ci­sion to get treat­ment,” he said.

But with­out ef­fec­tive treat­ment, hold­ing peo­ple against their will can do more harm than good, said Dr. Mark Wil­len­bring, founder and CEO of the All­tyr Clinic, a re­hab cen­ter in St. Paul, Min­nesota. Af­ter with­draw­ing from opi­oids dur­ing con­fine­ment, peo­ple’s re­sis­tance to drugs de­clines and once they are re­leased, they are at high risk of over­dos­ing, even if they use the same dose of the drug they used be­fore.

“Civil com­mit­ment in most places isn’t re­ally treat­ment.” It’s typ­i­cally some type of 12-step pro­gram, if any­thing, he said. “Med­i­ca­tion is what works for opi­oid ad­dic­tion. It’s a set­tled mat­ter. It’s only con­tro­ver­sial from the stand­point of peo­ple who don’t like what the sci­ence shows.”

But for par­ents, short of hav­ing their adult chil­dren ar­rested for pos­sess­ing an il­le­gal sub­stance, civil com­mit­ment can be their only re­course.

“We need to find a way to make it eas­ier for fam­i­lies and loved ones to in­ter­vene to find help for adult chil­dren,” Mar­cia Tay­lor, pres­i­dent of the Part­ner­ship for Drug-Free Kids, said in an email. “This is a life and death mat­ter for count­less fam­i­lies and we need laws that pro­tect in­di­vid­u­als at risk of over­dose and help them get the med­i­cal treat­ment that they need.”

A Massachusetts woman whose daugh­ter died of a heroin over­dose is hugged by her other daugh­ter at a cer­e­mony marking Repub­li­can Gov. Char­lie Baker’s sign­ing of a pack­age of opi­oid ad­dic­tion mea­sures. Baker has pro­posed ex­pand­ing the use of civil com­mit­ment for peo­ple ad­dicted to opi­oids. (The As­so­ci­ated Press)

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