Report: The Drug Treatment Debate: Why Accessible and Voluntary Treatment Wins

Forced treatment often forces abstinence, without offering effective treatment options or connections to follow-up care post release. While detained, people are unlikely to have access to the most effective treatment, medications for opioid use disorder (MOUD), which cut overdose risk in half. Also, people are unlikely to be connected to services within their communities following their release. When someone’s tolerance is lowered and they cannot access effective treatment or harm reduction services, their overdose risk increases significantly.

Beyond increasing risk of death, forced treatment causes harm in many other ways:

• Perpetuates systemic racism: People of color, especially Black people, are overrepresented in forced treatment settings. This is in part because of a lack of funding for community-based addiction services. Also, these settings often mirror jail/prison- so people of color with addiction are more likely to be treated as a “criminal” rather than as a “patient” by healthcare personnel.

• Disrupts lives and alienates people from their community: While in forced treatment, people can lose any stability they may have had – from housing, to employment, to health insurance. They may lose contact with sources of support like friends, family members, and community organizations. This isolation deepens a sense of loneliness and despair that makes it harder to heal.

• Leaves people powerless in the face of potentially harmful treatments: People in forced treatment lose the freedom to decide what treatment options they receive. They are often subjected to harmful and/or ineffective treatments such as aversion, electroconvulsive, or work therapy.

These issues highlight the need for a compassionate and equitable approach to addiction treatment that maintains dignity and personal choice.

Forced treatment uses the same punitive approach as criminalization, but repackaged as “good for” people who use drugs. Tens of thousands of people across the country are being forced into jails or jail-like conditions, where they lose their freedom and must endure questionable treatment methods. Treatment is healthcare, but people cannot heal in carceral conditions and without the freedom to decide what is best for themselves.

In countries where it’s common, such as the U.S., research consistently shows that forced treatment can cause:

• higher rates of relapse when compared to voluntary, community-based treatment services,

• avoidance of healthcare in response to stigma and shame,

• higher rates of infectious disease and bloodborne virus transmission,

• and inadequate medication and staffing.

Treatment is not one-size-fits-all. There are many effective treatment options that, when accessed voluntarily, actively support recovery.

Forcing people who use substances into treatment strips people of agency over their own bodies and lives. People who use drugs can and should control their own treatment decisions, including choosing not to receive it and opting for harm reduction.