Cumberland County’s next district attorney, Jonathan Sahrbeck, claims he will push for new legislation to force people into “drug abuse treatment” as part of his plan to confront opioid addiction.
Sahrbeck spoke highly of a controversial Massachusetts law known as “Section 35” throughout the campaign, which gives courts the power to force people into treatment for a substance use disorder (SUD). It’s a carceral response to a public health crisis that is familiar to Maine. In both states, treatment and health care options for people with a SUD are woefully inadequate, often limited to the dangerous practice of forced detox while warehoused in jails and prisons. Involuntary commitment is proposed as an alternative intervention for people who “can’t help themselves.”
While Sahrbeck wants a new law, Maine judges can already commit people with a SUD to a hospital for treatment. The statutory definition of a “mentally ill person” who can be involuntarily committed includes those who are “suffering effects from the use of drugs, narcotics, hallucinogens or intoxicants, including alcohol.”
There is significant research calling into question the medical efficacy of involuntary commitment for SUD. Addiction and harm reduction experts say the practice is harmful, ethically compromised, and yet another distraction from funding noncoercive, evidence-based outpatient alternatives.
Unfortunately, involuntary commitments for SUD are part of a larger trend of addressing health issues through the legal system. The Portland Press Herald reported a 17 percent increase in the number of commitments over the last decade (though it’s unclear how many involve substance use). Last year, judges approved 401 involuntary commitments, or 45 percent of all requests.
Unsurprising: "39%of those who had been [involuntarily] committed reported that they relapsed on the day of their release." Also, only 20% of people said that they received medication treatment during their commitment. https://t.co/F0hqv38kXm— Health in Justice Action Lab (@HiJAction) December 17, 2018
Anyone can initiate a request to involuntarily commit another in Maine. The initiator (most often a police officer) first finds a doctor or “other clinical person” to do a “certifying examination,” then locates an available treatment bed and transportation to it.
The individual is taken to a hospital, and the hospital may decide to file for a court order for commitment. In that case, a judge appoints two clinical professionals for an evaluation, one of whom can be chosen by the patient and their attorney.
If one or both find the individual has a legally defined mental illness or is likely to cause serious harm, a judge holds a hearing and decides whether that person should be hospitalized against their will.
The judge must find that there is “clear and convincing evidence” the person “poses a likelihood of serious harm”; that community care and treatment resources are unavailable; and that hospitalization is the best available means for treatment. The judge must also sign off on the individual’s treatment plan developed by the hospital.
Judges can order commitment for up to four months the first time, and up to one year every time after that. A commitment cannot be extended without a court order and those who are committed have a right to visitors.
Involuntarily committed individuals can be medicated by force. Though they’re technically not prisoners, they can’t leave, and can be placed in restraints and in isolation.
One nationwide review of involuntary commitments for SUD found “data on short- and long-term outcomes following commitment are surprisingly limited, outdated, and conflicting,” and that recent evidence “suggests that commitment does little to deter future substance abuse.” Another found “there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment.”
Furthermore, the availability of treatment beds and service providers in Maine is already terribly inadequate. Implementing our own Section 35 would likely make that situation much worse. Money is already being funneled into new locked facilities and, on his website, Sahrbeck notes he wants more of them built for SUD patients.
While Sahrbeck supports medication assisted treatment, some Section 35 facilities are strictly detox centers and blur the distinction between patient and prisoner. Patients leave at high risk of relapse and overdose similar to those leaving our jails. The last thing we need is to increase our capacity to put people in harm’s way.
Inevitably, funding inherently carceral approaches to SUD would mean less money for more medically efficacious approaches, like developing, funding, and connecting people to solid continuums of voluntary outpatient care that involves medication and therapy. These are the approaches Sahrbeck should support with the clout of his office.