ALBANY, New York — Medical professionals and advocates are expressing concerns about a provision of the heroin bill package being advanced by Governor Andrew Cuomo and the legislature, which would allow healthcare facilities to detain people who use drugs against their will for up to 3 days.
Central concerns of medical professionals and addiction treatment advocates include:
- It’s not drug treatment: Holding someone against their will and potentially forcing them to detox is not drug treatment. The bill provides few indications of the level of care provided by facilities, and there is no requirement that a physician be present for the delivery of the proposed “emergency services.” Although the bill requires the development of a discharge plan, its execution while a patient is under duress from being detained and potentially in withdrawal is highly problematic.
- It will likely increase preventable overdose deaths: A short term involuntary hold, whether for 48 or 72 hours, is very unlikely to result in sustained abstinence. There is strong likelihood of relapse following a forced detoxification. Forced abstinence will rapidly reduce opioid-dependent people’s tolerance, which consequently increases the risk of subsequent fatal overdose. If enacted, this legislation may lead to preventable overdose deaths.
- Few safeguards to prevent abuse: Any state action to deprive an individual of their liberty must be done as a last resort and with multiple layers of review and protection for the individual being sanctioned. In New York, Article 9 of the Mental Hygiene Law, for example, requires review by multiple doctors, prevents people who may have a conflict of interest from being involved in decision making regarding involuntary commitment, and affords other protections to people being held against their will. No such standards exist for people being involuntarily committed in relation to drug use.
- It dehumanizes people in need of help: the legislation presumes that people who use drugs have no capacity for rational decision-making and strips them of their rights and autonomy.
- Opposition by experts: Leading authorities on substance use and mental health in the state including the New York State Conference of Local Mental Hygiene Directors, Inc. and the Coalition of Medication-Assisted Treatment Providers and Advocates, have raised concerns about this bill for the reasons cited above. Drug policy should be guided by science and expertise of groups like these.
“We also strongly object to extending the period of involuntary detention from 48 to 72 hours. This additional period increases the likelihood that an individual’s tolerance to opioids drops and is likely to increase the risk of overdose upon resumption of opioids on release,” said Dr. Sharon Stancliff, medical director of the Harm Reduction Coalition.
“Compelling medical treatment and/or taking substances using patients into custody for a period of 72 hours would be both non productive and potentially life threatening,” said Dr. Randy Seewald of Briarcliff Manor, New York. “An opioid dependent individual after 72 hours of not using illicit drugs, or prescribed opioid medication will be suffering physical withdrawal symptoms, fatigue, depression, anxiety, and intense craving to use drugs. This will not produce the mental state needed for a patient to be cooperative with treatment and have a successful outcome.”
“To address the opioid and heroin epidemic we must use evidence-based strategies. Increasing access to treatments that are known to be effective, like methadone and buprenorphine, should be a top priority,” said Dr. Chinazo Cunningham MD, MS Associate Chief, Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center.
According to a public memo from the Coalition of Medication-Assisted Treatment Providers and Advocates, forced detoxification carries an 80% likelihood of relapse. Since forced abstinence lowers an individual’s tolerance to opiates, many patients will be at a greater risk for overdose upon release from involuntary detoxification than they would be if they had continued to use drugs.
“Instead of listening to the needs of people who use drugs and offering support to match, this proposal perpetuates New York’s shameful history of coercion with regard to drug use,” said Matt Curtis, Policy Director at VOCAL New York. “This bill will undermine our state’s 911 Good Samaritan law and overdose prevention programs and drive people in need away from care.”
In scientific studies directly comparing involuntary and voluntary drug treatment, involuntary treatment does not produce better outcomes in terms of sustained abstinence, and some studies have found negative effects from involuntary treatment. Given the substantial civil liberties issues involved in confining an individual against their will, the legislature and governor have a responsibility to ensure that such action is only taken in exceptional circumstances, with appropriate safeguards, and that there is strong evidence that such action will produce good outcomes. This proposal meets none of those standards.
“We have learned through trial and error – and much unnecessary pain and suffering – that a public health model is the only smart and compassionate approach to addressing substance abuse and addiction,” said Robert Perry, Legislative Director with the NYCLU at a recent press conference. “And yet legislation pending in Albany adopts several misguided compulsory treatment provisions. Let’s not make the same mistakes we made with the War on Drugs – drug policy must be based on upon evidence-based medical science.”
“As we shift toward a public health approach to drug use, we must ensure treatment policies are grounded in scientific evidence,” said Kassandra Frederique, New York State Director of the Drug Policy Alliance. “If the governor’s office wants to effectively address problematic drug use, then it must increase access to evidence-based treatment, rather than allowing for people to be forced into detention by others unqualified to make such a decision. A public health approach to drug use must prioritize the health and safety of people who use drugs.”
Date Published: June 14, 2016
Published by Drug Policy Alliance | VOCAL-NY