Involuntary Administration of Long-Acting Injectable Antipsychotics for Competency Restoration

In implementing the decisions in the landmark case Sell v. United States, jurisdictions have adopted mechanisms for the involuntary medication of defendants to restore competency to stand trial. These procedures attempt to balance the liberty and privacy rights of the accused against the government's responsibility to ensure timely prosecution and fair trial. The question of which medications are most appropriate for this goal, however, remains open. This article reviews the legal status of the administration of long-acting injectable (LAI) antipsychotics for sustained competency restoration. We explore case law and discuss the theoretical and empirical benefits and drawbacks to this practice, considering recent technological advancements in LAI development. Some courts have regarded LAI use pursuant to Sell as equivalent or superior to immediate-acting medications, whereas others have regarded LAIs as either more intrusive or medically riskier. We conclude that the use of LAIs may be carefully integrated into treatment plans to restore and maintain trial competency amid competing interests.