We all know about the frustration felt by families and first responders when someone refuses treatment following an overdose. Predictably, their question is: isn’t there a way to compel them to treatment? Here’s one solution:
Florida’s Marchman law allows for involuntary commitment once a qualified assessor determines an individual represents a danger to self or others. With fentanyl ODs, that’s not an especially difficult standard to meet.
The law itself has been on the books for decades but is most used by courts in the Tampa area. As the article notes, a judge might sentence someone to six months of outpatient counseling with medication, or to 30 days of residential treatment, or anything between. The average cost of treatment is $5,500 to $7,000. Once the Court order is in place, an individual who fails to comply can be picked up by a deputy and returned to Court.
Does it work? According to this article, some two thirds of Marchman commitments successfully complete a court-ordered program, either outpatient or residential.
As far as first responders are concerned, that’s better than another overdose, and also than eventually refusing naloxone to someone because of prior relapses.
Only certain centers are approved to accept Marchman commitments. Of course, Florida has more resources for treatment than many states, where it could be a real challenge to locate a bed.
It’s another example of the importance of close monitoring of outpatients. Perhaps the best illustration is the success of programs for select populations such as physicians and airline pilots. Many of those programs treat opioid users without relying on medication, and yet manage to achieve remarkable success rates– sometimes 80% over a five year period. They do it with counseling, close monitoring, and the application of leverage provided by a license.
There’s a lesson there if we pay attention.
Of course, compulsory treatment has long been a subject of intense controversy within the mental health and addictions fields. It’s an issue of civil liberties as well as a public safety. So I can’t predict how well this approach would fly in other jurisdictions.
My observation: Leverage can be an important factor in convincing patients to remain in treatment long enough to receive the benefits. And that’s worth remembering.