BOSTON — The state should scale back or eliminate a controversial law that allows people to be involuntarily committed to substance addiction treatment, according to a new report.
A state commission that reviewed the so-called Section 35 program also recommended ending the practice of sending men to correctional facilities for drug treatment, and called for expanding the number of beds at state-funded treatment centers.
Members of the commission — which included state officials, academics, physicians, substance abuse experts and others — also narrowly approved a recommendation that the state begin the process of "reducing or eliminating" the program, "as there is insufficient evidence of its efficacy to justify deprivation of individuals’ civil liberties."
A majority of the commission's 29 members supported a recommendation that involuntary commitment be used only in cases where "it is clear that the subject individual is in danger of causing severe immediate harm to self or others or loss of life above and beyond the harms that are routinely attendant upon the abuse of substances, such as death by overdose."
"Nobody loves the idea, but a majority of the commission members viewed the Section 35 program as a last-ditch effort to save someone's life," said John Rosenthal, a commission member and co-founder of the nonprofit Police Assisted Addiction and Recovery Initiative. "It's another tool in the box for families and law enforcement, but we need to make it more compassionate."
Massachusetts trial court judges have seen a sizable increase in Section 35 requests — from 5,903 in 2010, to 10,770 in 2018, according to the commission's report.
A majority of those requests were for adult drug abuse, according to the report, which noted that many of those committed under Section 35 were white, homeless males.
More than 80% requests for Section 35 orders in 2018 that were heard by judges — 6,048 — resulted in a person being committed for substance abuse treatment, according to the report.
Few get full treatment
Opioid addicts can be sentenced up to 90 days under the law, which also requires follow-up treatment once someone is released.
Observers say that seldom happens.
"If they’re lucky, they’ll be able to stay 14 days before they’re released," said Phil Lahey, a former Methuen city councilor and member of the nonprofit Merrimack Valley Prevention and Substance Abuse Project, which counsels families. "That’s just not enough time to get the treatment they need. They’re back on the streets. It’s a cycle that addicts just can’t break."
Lahey said the process of getting someone committed for treatment is difficult, and if an addict objects, as they sometime do, the judge can reject the petition.
"A lot of times the judge goes along with the addict and won’t commit him," Lahey said. "So the addict doesn’t get treatment, even if they’re a danger to themselves.”
Gov. Charlie Baker, a Republican and former health care executive, has said he wants to end the "pinballing" of overdosing addicts in and out of emergency rooms, which not only keeps them from getting help but endangers their lives.
Two years ago, Baker proposed involuntary commitments for those who pose a danger to themselves or others due to opioid addiction. That raised concerns about civil liberties and the ability of emergency rooms to hold an addict until a bed is available. Lawmakers ultimately rejected it.
The commission rejected proposals giving nurse practitioners civil commitment authority and allowing persons to be involuntary committed for up to 72 hours without a court hearing.
In March, Massachusetts was sued by group of 10 men who were involuntarily committed to addiction treatment. They argue that because the state no longer allows women to be involuntarily committed to prisons for addiction treatment, they shouldn't be held either.
Because of the lawsuit, Baker administration officials who served on the commission abstained from voting on several recommendations.
Most refuse screening
A 2016 law requires ER doctors to offer voluntary substance abuse screening to people treated for opioid overdoses. But a majority of those patients refuse the evaluation, according to health officials, who say the lack of participation is preventing addicts from getting into treatment.
The latest data show the number of opioid-related overdose deaths trending slightly downward, falling about 4% from 2016 to 2018.
In 2018, the number of opioid-related overdose deaths was 2,033. That’s 17 fewer than the 2,050 deaths in 2017. A year earlier there were 2,100 opioid-related overdose deaths.
Lahey, whose group counsels families dealing with addiction, said for the Section 35 law to be effective, courts need to keep opioid addicts for longer stays in treatment centers and expand the use of medication-assisted treatment. He recalls the story of a teenager who spent more than 45 days under a Section 35 order and has remained clean since his release.
"If Section 35 is done right, it will have an impact," he said. "It can save lives and help people break the addiction."
Christian M. Wade covers the Massachusetts Statehouse for The Salem News and its sister newspapers and websites.