Faced with a statewide opioid epidemic, Governor Charlie Baker seems determined to disrupt the treatment rules for the medical community. Perhaps the most provocative proposal in his wide-ranging legislative package is a three-day commitment provision for addicts, allowing doctors to decide to hold them against their will, locked in a hospital, for 72 hours.
As the state Legislature prepares to hold a public hearing on Baker’s proposals on Tuesday, lawmakers must take special care in expanding the civil commitment law.
While Baker is right that longstanding regulations and assumptions must change to allow medical professionals and public health officials to address the epidemic, the drive to find a quick policy solution in this case could backfire. Sidestepping the courts to empower medical professionals to commit addicts involuntarily is fraught with complications and could have serious unintended consequences, damaging the doctor-patient relationship if addicts fear seeking medical treatment, and pushing more people into a system that is already beyond capacity.
The state’s current civil commitment law allows doctors to hospitalize and hold mentally ill patients against their will and without a court order for 72 hours if they’re deemed a threat to themselves or others. Baker proposes to add substance abuse patients to that category. The administration contends that involuntary commitment is designed only for emergency cases. “I wouldn’t expect doctors to use this frequently,” Baker said at an opioid forum recently.
But the old legal adage applies here: Hard cases make bad law.
Indeed, legislative leaders on Beacon Hill have raised questions about holding drug addicts without court authorization. Public health officials and hospitals raise legitimate concerns that should be addressed in tandem with the legislation. The Massachusetts Hospital Association and others are worried about the implications of additional crowding in their emergency departments. “The need to expand access to community-based services can be a substitute for hospital [emergency departments] and a place to discharge patients to get the support they need — such a proposal is not currently in the bill,” said Tim Gens, the association’s executive vice president.
There are some things to like in Baker’s bill — it would end the practice of allowing civil commitments that send addicts to MCI Framingham, for example. But expanding the civil commitment law seems, at best, self-defeating if there are not enough treatment beds or certified sober homes for recovering addicts who have just been released. That is a formula for burdening the health care system, endangering addicts, and putting the public at risk.