By David M. Greenwald
Last week we presented a critique of DA Jeff Reisig’s homelessness proposal. One of his more controversial planks was: “Amend California law to mandate state-funded treatment for seriously addicted drug users, including involuntary residential treatment, when appropriate.”
But there are questions about whether this in fact represents an evidence-based approach. Critics point out that “involuntary and immediate” cessation of use often does not lead to lasting recovery, as it only deals with the chemical side of the equation and fails to address the underlying reasons why the person turned to drugs in the first place.
More troubling is evidence that mandatory drug treatment is not effective in reducing drug use to begin with.
Researchers in a 2016 Boston University Medical Center study looking at current global evidence found “mandatory treatment for people with substance use disorders is not effective in reducing their drug use.”
They found, “mandatory treatment, which is defined as treatment ordered, motivated or supervised under the criminal justice system, done without a patient’s informed consent violates their human rights and does more harm than benefit to the patient.”
Instead, Bulat Idrisov, MD, MSc, and Karsten Lunze, MD, MPH, DrPH, from the Clinical Addiction Research and Education Unit at BMC and Boston University School of Medicine argue “that in order to reach successfully reduced substance use disorder rates, countries should consider implementing approaches that have been shown to be effective in rigorous scientific studies.”
“These strategies include community-based opioid treatment, including methadone and buprenorphine. In addition, they suggest that offering harm-reduction programs like needle exchanges and providing education about overdose medications such as naloxone to people with substance use disorders, as well as to their friends and family members.”
“The evidence presented in this article provides additional argumentation supporting the position of all UN organizations that mandatory treatment settings do not represent a favorable or effective environment for the treatment of drug dependence,” said Fabienne Hariga, MD, MPH, senior adviser to the United Nations Office on Drugs and Crime during the recent meeting in New York.
The doctor added, “The United Nations therefore calls on States to transition from mandatory drug treatment and implement voluntary, evidence-informed and rights-based health and social services in the community.”
The 2016 study backs up evidence cited by a study publish by the NIH which found: “Despite widespread implementation of compulsory treatment modalities for drug dependence, there has been no systematic evaluation of the scientific evidence on the effectiveness of compulsory drug treatment.”
Their meta-study found, “Evidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms. Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.”
The mandatory component was the first of five proposals put forward by Yolo County DA Jeff Reisig as a plan to reduce homelessness.
“Homelessness is an exploding humanitarian crisis affecting almost every community in California. Too many people suffering from severe mental illness and crippling addiction are being allowed to languish in filth and perish on our streets from disease, overdose and violence,” Reisig writes. “They need help.”
He argues: “Meanwhile, the quality of life for all Californians has dramatically declined as the crime and despair associated with the crisis has seeped across our state. There are real potential solutions to this crisis. They are not easy and they are not cheap. But, if California ever hopes to turn the tide, dramatic action is required.”
The other four points are:
- Expand conservatorship laws – make it easier to allow the seriously mentally ill and addicted to be conserved by loved ones and health professionals.
- Establish permanent drug courts and mental health courts in every county, where judges can collaborate with health professionals and all the parties to oversee a comprehensive treatment and rehabilitation plan.
- Build addiction and mental health facilities that can serve as secure treatment focused sanctuaries, not jails or prisons.
- Develop a statewide chain of drop-in-centers to provide free ongoing support and Medication-Assisted Treatment (MAT) to those on the path to recovery.
Maya Schenwar and Victoria Law in their book, Prison by Any Other Name, express concern that drug courts and state-mandated treatment are expanding the scope of the criminal justice system to treat people who actually may not need to be treated.
“Most people are not debilitated by physical dependence on the substances they use, whether they be alcohol, caffeine or heroin.”
But more importantly the solutions to those who are, may not be effective.
They found, “Graduating” from a state-mandated treatment program does not necessarily equal real recovery and healing.”
They argue: “Even if a treatment sentence doesn’t end in incarceration, there’s no guarantee it will transform a person’s life. In fact, if the underlying causes behind the drug use – poverty, trauma, the enduring impacts of racism and other oppressions, and so forth – aren’t address, the recovery may not last.”
Our chief criticism of the DA’s plan last week is that while they put forth a large number of enforcement-based remedies, there is no provision for rebuilding their lives, job training, counseling and affordable housing. Without those kinds of programs, they may remove the drug-component or potentially the mental health component without allowing them to move forward.
And this research suggests that these approaches are not evidence-based, with no firm research to suggest that such treatment actually works.
—David M. Greenwald reporting
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