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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.
Abstract:
Involuntary civil commitment (ICC) to treatment for opioid use disorder (OUD) prevents imminent overdose, but also restricts autonomy and raises other ethical concerns. Using the Kass Public Health Ethics Framework, we identified ICC benefits and harms. Benefits include: protection of vulnerable, underserved patients; reduced legal consequences; resources for families; and "on-demand" treatment access. Harms include: stigmatizing and punitive experiences; heightened family conflict and social isolation; eroded patient self-determination; limited or no provision of OUD medications; and long-term overdose risk. To use ICC ethically, it should be recognized as comprising vulnerable patients worthy of added protections; be a last resort option; utilize consensual, humanizing processes; provide medications and other evidence-based-treatment; integrate with existing healthcare systems; and demonstrate effective outcomes before diffusion. ICC to OUD treatment carries significant potential harms that, if unaddressed, may outweigh its benefits. Findings can inform innovations for ensuring that ICC is used in an ethically responsible way.
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