New Laws Force Drug Users Into Rehab Against Their Will

Involuntary commitment laws are being opened up to allow some people to be detained for overdosing or even having visible track marks—in some cases up to 90 days.

Photo Illustration by Sarah Rogers/The Daily Beast

Debra Hicks went to work on Sept. 19, 2011, to teach California high school students about the Constitution. But that night she got a crash course on how easily her own civil rights could be violated, when she overdosed on her pain pills and a psychiatrist she’d never met involuntary committed her to Glendale Adventist Medical Center, near Los Angeles.

By the time she was released six days later, Hicks claims she had been placed in five-point restraints and “forcibly and unwillingly subjected to the use of strong antipsychotic medications”—according to an ongoing lawsuit against the facility.

Her only “crime,” she says, was having a bad reaction to her doctor-prescribed opioid medication.

Now lawmakers in at least eight states are considering bills that would make it even easier for drug users like Hicks to be forced into treatment against their will.

Proponents insist the bills are an unfortunate but necessary response to a troubling rise in the number of Americans dying from drugs like Oxycontin and heroin. But patients rights advocates say involuntary commitment is an overly extreme measure that will only make addicts’ lives worse.

Meanwhile, the private prison industry is waiting quietly in the wings, sensing an opportunity to get new business in the wake of declining prison populations.

“The idea of using the criminal justice system or civil commitment to compel drug users to accept treatment is ridiculous,” said Dr. Mark Willenbring, an internationally recognized addiction psychiatrist and founder of the Alltyr clinic in Minnesota. “Why aren’t we incarcerating people with heart disease who continue to smoke or people with diabetes who don’t manage their diet?”

According to the National Alliance for Model State Drug Laws, 37 states already have statutes that allow substance abusers who have not committed a crime to be briefly detained against their will. In most cases the legal bar is high—often requiring a finding that the person being committed has threatened to harm themselves or another person.

Over the past several years, however, states have been quietly revising their laws to allow for longer periods of commitment with fewer legal hurdles.

Kentucky and Ohio led the push. And in 2015 Mike Pence signed a law permitting involuntary commitment for drug users in Indiana.

Last year, Florida followed suit, passing a new measure that allows individuals with substance abuse problems to be held up to 90 days against their will. A petition can be filed by “any adult with direct personal observed knowledge of the respondent’s impairment,” and must only show probable cause that the individual has “lost the power of self-control with respect to substance abuse” and are “incapable of making a rational decision regarding his or her need for care.”

Lawmakers in New Jersey have been trying for the past two years to get a similar measure on the books there. The latest iteration of the bill, introduced by Democratic Assemblyman Joseph Lagana (Paramus), would allow a police officer with no addiction training to detain a person if they have “reasonable cause” to believe that the person is in need of involuntary treatment.

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A bill proposed this session in the Washington Senate would expand civil commitment to include individuals who have had three or more arrests “related to activities connected to substance abuse,” who have ever been in rehab or detox, or who have three or more visible track marks (PDF).

Three such bills are currently being considered in Pennsylvania, including one that would permit forced treatment for any individual who “has ingested an amount of drugs as to render himself unconscious or in need of medical treatment to prevent imminent death or serious bodily harm.”

Like many of the new measures, the bill would authorize up to 90 days of involuntary inpatient drug treatment.

Since most addicts are not “severely mentally impaired,” legal experts say that once they are detoxed it will become increasingly difficult to justify involuntary detention. That means that, in practice, the period of commitment is likely to be much shorter.

Addiction experts say that could actually lead to an increased risk of overdose, as drug users return to the community without the physical tolerance they had only days or weeks earlier.

“Often what will happen is that people will remain sober through treatment but then rapidly return to use as soon as they are out,” said Kirk Bowden, a certified addiction clinician and the former president of the Association for Addiction Professionals.

Lawmakers in New Hampshire, Alabama, Maryland, Michigan, and Mississippi are also considering broad civil commitment measures this session.

David Freed, district attorney for Cumberland County, Pennsylvania—where overdose fatalities doubled in 2016—supports the measure, and says states have a “moral obligation” to help drug addicts who he says won’t help themselves.

“The process should be seamless. It should be standard, and frankly, it should not be optional,” he testified last year.

But morality and medicine are frequently at odds, as Hicks’ case shows.

Like millions of other Americans, Hicks suffers from chronic pain issues, including fibromyalgia—a painful nerve condition—three herniated disks and two pinched nerves.

Her treatment includes seeing a pain management specialist, and taking prescribed medications that include opioid painkillers.

According to a lawsuit she filed in Los Angeles Superior Court, on the day her ordeal began Hicks had forgotten to take her morning dose of painkillers. As the hours wore on she found herself in increasing physical distress. By the time she got home that evening she says she was experiencing severe pain, and erroneously believed she needed to take more than her prescribed dose to make up for the missed one.

Hicks’ roommate found her passed out on the floor of the apartment they shared and called 911.

Though she managed to walk to the ambulance that would take her to the emergency room, doctors there told Hicks that, as a matter of protocol, patients who have suffered a drug overdose must speak to a psychiatrist before being released.  

According to her lawsuit, Hicks waited nine hours after she was discharged from the emergency room before a nurse informed her she was being detained under a 1967 law that  gives psychiatrists in California limited powers to hold a person who is dangerous to themselves or others due to mental illness against their will for up to 14 days.

Hospital records attached to Hicks’ lawsuit say her only formal diagnosis was “depression.” When Hicks attempted to leave the hospital—a full 24 hours after being released from the ER—she was chased down and brought back by local police and hospital security guards, she asserts in her complaint.

“The Hicks case is a dramatic example of how a person can be captured into a system by people who pretend to be trained to help but actually completely misunderstand the process,” said Hicks’ attorney, Gary S. Brown, in an email to The Daily Beast.

In court filings, the hospital does not dispute the facts of the case, but argues that it is immune from civil action under California’s civil commitment law—which requires only a finding of probable cause that an individual is a danger to themselves.

Brown, who has spent the better part of three decades defending clients who’ve been involuntarily committed, says that while patients can challenge that finding in court after a few days of confinement, the odds are often stacked against them.

While forcing substance abusers into treatment may provide temporary relief for family members who are dealing with an addicted loved one, experts say it offers little help for the person actually suffering from addiction.

A recent study published by the medical journal the Lancet found that heroin users forced into treatment “had significantly more rapid relapse to opioid use post-release” compared with those who voluntarily sought help.

Involuntary commitment also violates the ethics codes of some treatment organizations, such as the Association for Addiction Professionals (PDF).

Meanwhile, detaining a person who has committed no crime based on what they might do in the future has potentially severe long-term repercussions.

“Involuntary commitment gives someone a lifelong marker that interferes with their ability to get health care coverage or own a firearm, and it could prevent them from getting certain jobs, like federal employment,” said Mary Catherine Roper, of the the American Civil Liberties Union of Pennsylvania.

Once a civil commitment is on a person’s record, Roper says, it’s nearly impossible to get it expunged.

But there’s another, more pressing problem with involuntary commitment for substance abuse: Most states don’t have enough treatment beds even for the people who want them.

Massachusetts—which has permitted courts to force drug users into treatment for more than two decades—has so little bed space for drug addicts seeking help that those compelled into treatment are often sent to one of two state correctional facilities instead. Last year, the state actually had to pass a law to ensure that women who are involuntarily detained for drug abuse go to an actual treatment facility instead of jail.

Doctors say giving precedence to drug addicts who don’t want treatment will almost certainly make it harder for those who do want treatment to access it.

“There are waiting lists for treatment right now,” said Dr. Raymond Bobb, an addiction doctor in Philadelphia who treats patients with methadone and Suboxone. “Plenty of people are seeking treatment and waiting for spots to open up, do these people supersede them?”

That has caught the attention of the private prison industry—which has been refocusing its efforts on treatment and reentry services as states have moved to reduce the number of inmates in their correctional systems.

Pennsylvania lacks any secure drug treatment facilities—with the exception of those currently contracted by the Department of Corrections. In February, Gov. Tom Wolf announced the state would cut $40 million from its community corrections budget and plans to eliminate 1,500 halfway house beds.  

Weeks later private prison firm The GEO Group completed its $360 million acquisition of Community Education Centers, which operates five residential reentry facilities in Pennsylvania. The GEO Group spent more than $112,000 lobbying lawmakers in Harrisburg over the past 12 months.

Correct Care Recovery Solutions (CCRS), a subsidiary spun off by GEO Group in 2013, also operates residential psychiatric treatment hospitals, as well as the only privatized civil commitment facility in the country (in Florida). In addition to Pennsylvania, the company manages facilities in several states where civil commitment measures are being considered.

New laws that would put thousands of otherwise innocent Americans into locked treatment units could potentially be a windfall for the company and others like it. But like so many other failed policies in the War on Drugs, it will be the most desperate and marginalized Americans who will pay the price.