Characteristics and experiences of people who use drugs with involuntary civil commitment (Section 35) histories in Massachusetts: 2017 to 2022

Sabrina S Rapisarda ¹, Joseph Silcox ², Katherine Nace ²

⁰Heller School for Social Policy & Management at Brandeis University, 415 South Street MS 035, Waltham, MA, 02453, USA; University of Massachusetts - Lowell, School of Criminology and Justice Studies, 113 Wilder Street, Suite 400, Lowell, MA, 01854, USA.

Journal of Substance Use and Addiction Treatment +

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December 8, 2025

View abstract on PubMed

Summary

Involuntary civil commitment (ICC) for people who use drugs (PWUD) is associated with higher overdose risks and more frequent naloxone use. Understanding these risks is crucial for improving public health policies for PWUD.

Area Of Science

Public Health
Substance Use Disorders
Health Policy

Background

Massachusetts law allows involuntary civil commitment (ICC) for individuals who use drugs (PWUD) into treatment programs.
Characterizing the experiences of PWUD with and without ICC is essential for understanding its impact on health outcomes.

Purpose Of The Study

To explore the associations between involuntary civil commitment (ICC) experiences and sociodemographics, substance use patterns, and subsequent health outcomes in people who use drugs (PWUD).
To examine the relationship between recent ICC and overdose risk, response, and preventive behaviors.

Main Methods

Analysis of survey data from 714 PWUD collected via mixed-methods rapid assessments between 2017 and 2022.
Comparison of participants with and without ICC histories, focusing on sociodemographic factors, substance use, and health outcomes.
Statistical analysis of associations between ICC experience and overdose events, incarceration, and naloxone administration.

Main Results

Participants with ICC experience were more likely to be men, White, housed, and co-using opioids and stimulants.
Individuals with one or more ICC experiences reported higher rates of personal and witnessed overdose compared to those without ICC.
35.1% of participants with recent ICC experienced an overdose, and 20.3% experienced incarceration post-ICC; naloxone administration was higher in those with ICC history.

Conclusions

Involuntary civil commitment (ICC) among people who use drugs (PWUD) is linked to increased overdose risk and more frequent use of naloxone.
Findings highlight the need to consider sociodemographic factors and substance use patterns when developing ICC policies for PWUD.
Tailoring future ICC policies to mitigate health and social harms for PWUD requires careful consideration of identified risk factors.

Keywords:

Coercive treatment Drug treatment Incarceration Involuntary civil commitment Involuntary treatment Overdose risk People who use drugs Substance use disorders