Friday, February 12, 2016

Expanding Coercive Treatment Is The Wrong Solution For The Opioid Crisis

Americans are suckers for "get tough" approaches. Though we are moving toward a a public health vision of how to deal with drug addiction, remnants of the old punitive approach persist. One of these is the move to coercive treatment. - gwcExpanding Coercive Treatment Is The Wrong Solution For The Opioid Crisis
by Leo Beletsky, Wendy Parmet, (Northeastern) and Amit Sarpatwari (Harvard)

Amidst a surging crisis of opioid abuse and overdoses, many policymakers have called for expanded use of coercive treatment. Many states, including Massachusetts, already allow physicians, police, and court officers to seek a court order authorizing involuntary addiction treatment (formally referred to as substance use disorder (SUD)). But new legislation, The Act Relative to Substance Use Treatment, Education, and Prevention (STEP) currently before the Massachusetts state legislature (H.3944) could expand the scope of involuntary treatment and reduce judicial oversight.

This proposal is an ill-considered response to a public health crisis. To be sure, policymakers face an understandable pressure to take decisive action. But this approach fails to balance that imperative for speed and public confidence with sound scientific, legal, and ethical principles.
The Legislation

As originally introduced by Massachusetts Governor Charlie Baker, The STEP Act would allow licensed physicians, nurse specialists, psychologists, and social workers (or, when such personnel are unavailable, the police) to impose a new 72-hour “hold.” During this three-day period, an individual could be restrained for emergency treatment and compelled to enter an inpatient treatment facility based solely on a reasonable belief “that failure to commit … would create a likelihood of serious harm.”

Following the 72-hours, the patient must be discharged unless he or she consents to treatment or a court orders commitment. A patient can request an emergency hearing to challenge the 72-hour hold, but neither a court order nor diagnosis by an addiction specialist would be necessary to authorize the initial detention.

Although this provision does not appear in the version of the Bill recently passed by the Massachusetts House, there are efforts to re-introduce it into the text as the House and Senate work to develop a final bill amenable to both bodies; there are also a number of other jurisdictions that may be considering similar policy tools.

The opioid crisis has complex underlying causes and defies simple solutions, but there is broad agreement that the treatment gap is a major driver of the current epidemic. Overall, only 11 percent of patients with SUDs are estimated to be receiving science-based treatment. In Governor Baker’s words, the STEP Act would tackle this problem by opening a “wider window” for emergency department personnel, other health care providers, and even concerned family members to engage SUD-affected individuals in treatment and risk-reduction interventions following acute episodes (e.g., non-fatal overdose).

Amidst a surging crisis of opioid abuse and overdoses, many policymakers have called for expanded use of coercive treatment. Many states, including Massachusetts, already allow physicians, police, and court officers to seek a court order authorizing involuntary addiction treatment (formally referred to as substance use disorder (SUD)). But new legislation, The Act Relative to Substance Use Treatment, Education, and Prevention (STEP) currently before the Massachusetts state legislature (H.3944) could expand the scope of involuntary treatment and reduce judicial oversight.

This proposal is an ill-considered response to a public health crisis. To be sure, policymakers face an understandable pressure to take decisive action. But this approach fails to balance that imperative for speed and public confidence with sound scientific, legal, and ethical principles.
The Legislation
As originally introduced by Massachusetts Governor Charlie Baker, The STEP Act would allow licensed physicians, nurse specialists, psychologists, and social workers (or, when such personnel are unavailable, the police) to impose a new 72-hour “hold.” During this three-day period, an individual could be restrained for emergency treatment and compelled to enter an inpatient treatment facility based solely on a reasonable belief “that failure to commit … would create a likelihood of serious harm.”

Following the 72-hours, the patient must be discharged unless he or she consents to treatment or a court orders commitment. A patient can request an emergency hearing to challenge the 72-hour hold, but neither a court order nor diagnosis by an addiction specialist would be necessary to authorize the initial detention.

Although this provision does not appear in the version of the Bill recently passed by the Massachusetts House, there are efforts to re-introduce it into the text as the House and Senate work to develop a final bill amenable to both bodies; there are also a number of other jurisdictions that may be considering similar policy tools.

The opioid crisis has complex underlying causes and defies simple solutions, but there is broad agreement that the treatment gap is a major driver of the current epidemic. Overall, only 11 percent of patients with SUDs are estimated to be receiving science-based treatment. In Governor Baker’s words, the STEP Act would tackle this problem by opening a “wider window” for emergency department personnel, other health care providers, and even concerned family members to engage SUD-affected individuals in treatment and risk-reduction interventions following acute episodes (e.g., non-fatal overdose).

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