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Perceived Benefits and Harms of Involuntary Civil Commitment for Opioid Use Disorder
Elizabeth A Evans1, Calla Harrington1, Robert Roose1
1Elizabeth A. Evans, Ph.D., M.A., is an Associate Professor of public health at the University of Massachusetts Amherst. She received her B.A. from the University of California San Diego, her M.A. from Indiana University, Bloomington, and her Ph.D. from the University of California Los Angeles Fielding School of Public Health. Dr. Evans researches how health care systems and public policies can better promote health and wellness particularly among individuals at risk for opioid and substance use disorders, mental illness, and infectious diseases. Calla Harrington, M.P.H., M.S.W., L.C.S.W., is a Research Fellow in the Department of Health Policy and Promotion at the University of Massachusetts Amherst. Calla received her M.P.H. in Epidemiology from UMass Amherst, her clinical M.S.W. from Boston University, M.A., and her B.S.W. from Eastern University in St. Davids, PA. Robert Roose, M.D., M.P.H., F.A.S.A.M., is the Chief Medical Officer for Mercy Medical Center and affiliates. Dr. Roose received his M.D. and M.P.H. from the George Washington University School of Medicine and Health Sciences in Washington, DC. He received his B.S. from the University of Illinois at Urbana-Champaign, IL. He serves on the Quality Improvement Council of the American Society of Addiction Medicine and is a key contributor to opioid task forces in Massachusetts. Susan Lemere, M.S.W., L.I.C.S.W., received her M.S.W. from Smith College in Northampton, MA, a M.F.A. from Pine Manor College in Brookline, MA, and a B.A. at UMass Amherst. Currently, she is pursuing her Ph.D. in public health at UMass Amherst. David Buchanan, Dr.P.H., Professor Emeritus at UMass Amherst, received his B.A., his M.P.H., and his Dr.PH., from University of California Berkeley. He is a prominent expert in public health ethics.
Involuntary civil commitment (ICC) for opioid use disorder (OUD) can prevent overdose but carries ethical risks. Ethical use requires patient protection, last resort application, and evidence-based treatment to mitigate harms.
Area of Science:
- Public Health Ethics
- Addiction Medicine
- Mental Health Law
Background:
- Involuntary civil commitment (ICC) for opioid use disorder (OUD) aims to prevent overdose.
- However, ICC raises significant ethical concerns regarding patient autonomy and potential harms.
Purpose of the Study:
- To analyze the ethical benefits and harms of ICC for OUD using the Kass Public Health Ethics Framework.
- To provide recommendations for the ethically responsible implementation of ICC for OUD.
Main Methods:
- Application of the Kass Public Health Ethics Framework to identify benefits and harms of ICC for OUD.
- Review of ethical considerations, patient experiences, and treatment provision within ICC settings.
Main Results:
- Identified benefits: patient protection, reduced legal issues, family support, and immediate treatment access.
- Identified harms: stigma, punitive experiences, family conflict, loss of self-determination, inadequate medication, and long-term overdose risk.
Conclusions:
- Ethical ICC for OUD necessitates recognizing patient vulnerability, serving as a last resort, employing humane processes, and ensuring evidence-based treatment.
- Unaddressed harms can outweigh benefits, requiring careful consideration for responsible application and innovation.
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