The Role of Civil Commitment in the Opioid Crisis
10 Pages Posted: 9 Mar 2018 Last revised: 20 Mar 2018
Date Written: March 6, 2018
As the opioid crisis deepens, a particularly controversial policy response is gaining traction: civil commitment. Civil commitment refers to the involuntary detention of individuals with substance use disorder (SUD), without resort to the criminal justice process, in order to separate them from access to the general population (including that population’s access to illicit opioids) and, in some instances, to offer some form of treatment. The medical, ethical, and legal questions surrounding civil commitment remain under-examined. Most importantly, this practice raises major issues related to civil liberties and public health.
This article seeks to shed light on civil commitment in the context of the opioid crisis, to sketch the existing legal landscape surrounding civil commitment, and to illustrate the relevant medical, ethical, and legal concerns that policymakers must take into account as they struggle to find appropriate responses to the crisis. Presently, thirty-seven states and the District of Columbia have civil commitment laws that appear to encompass involuntary confinement of persons with SUD, alcoholism, or both.
In short, the medical benefits of being forced to undergo treatment for opioid addiction are uncertain, and the legal and ethical concerns regarding civil commitment of those with SUD are substantial. The constitutional and other legal rules governing civil commitment were not developed in the context of SUD, and did not anticipate application to individuals with SUD. Nor have the statutory standards for civil commitment been developed in contemplation of the medically appropriate treatment for SUD, which is most often a combination of medication assisted treatment (MAT) and psychosocial treatment. In scope and kind, the opioid crisis appears to be beyond what the traditional legal framework of civil commitment has contemplated.The tensions among the values of individual civil liberty, societal public health, autonomy of the individual to choose treatment or decline it, and the state’s interest in protecting the welfare of its citizens give rise to difficult questions that require careful reflection and research. At the very least, the complexity of these questions ought to counsel policymakers against reflexively adopting restrictive, potentially draconian, and likely ineffective measures that may well do more harm than good.
Keywords: opioid crisis, civil commitment, criminal law, health law, addiction, public health
JEL Classification: K10, K14, K19, K32
Suggested Citation: Suggested Citation