Imprisoning drug addicts doesn’t seem to have slowed down or reduced the spread of drug addiction, and it is costly. Research suggests that treating drug addicts instead is more effective and less costly, but not all addicts want to be treated, even if the alternative is prison.

Forcing addicts into treatment is a possibility, though difficult because of civil liberties protections. It’s not clear if such treatment is effective, however.

A 2014 article on the National Institute on Drug Abuse website claims that “Most studies suggest that outcomes for those who are legally pressured to enter treatment are as good as or better than outcomes for those who entered treatment without legal pressure”.

By contrast, a 2018 article from US News & World Report states that “A 2016 meta-analysis of nine studies in the International Journal of Drug Policy found no evidence of improved outcomes with compulsory treatment.”

The US News story goes on to say that “a study by the Massachusetts Department of Public Health of clients served between 2011 and 2014 found that patients who received involuntary treatment died of an opioid-related overdose at more than twice the rate of people who had voluntary treatment” (1.4 percent vs. 0.63 percent).

That’s not really a fair comparison, however, as a Massachusetts Department of Health and Human Services spokesperson pointed out. “Patients who are committed for treatment … are appropriately among the sickest, most complex and at the greatest risk for an overdose. It is inappropriate to directly compare the treatment outcomes of two different populations: one group that is actively seeking treatment and the other [that] is not.”

An opponent of involuntary commitment of drug addicts points adds that one reason for the higher death rate may be the type of rehab offered, which often does not include “evidence-based care” such as medication-assisted treatment (MAT) with buprenorphine or methadone for opioid abuse. There is a prejudice against using these drugs because they also are opioids and can be abused themselves.

Another possibility is that after completing rehab and a period of sobriety, the patient is unaware that they have lost some of the tolerance for drugs that they had built up over time. The dosage that once made them pleasantly high might now be lethal.

Another critic says involuntary clinics often don’t include mental health counseling, which ignores the possibility that the addiction may be complicated by a dual diagnosis.

As for the discrepancy between NIDA and US News, there may not be one. Both conclusions could be correct. The NIDA article refers to “legal pressure”, while US News describes “compulsory treatment”. Presumably, an addict can resist pressure, even if it means going to jail or prison. With compulsory treatment, there’s no choice.

Maybe the comparison should be with how many addicts who didn’t receive addiction treatment died of an overdose. If that number is higher than how many died after compulsory treatment, forced rehab might still be worthwhile in certain cases.

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