How a Paraplegic Drug User Became a Victim of Involuntary Commitment – by Christopher Moraff – Feb 2019
New laws make it easy for anyone accused of having an addiction problem to be committed if they don’t agree to whatever treatment is recommended for them.
Involuntary commitment for people accused of having an addiction and not actively participating in treatment for it is becoming more common as more laws are being passed to make this legal.
Barely a day passes on my beat without my meeting someone with a harrowing story about the impact of zero-tolerance drug policies on their lives. But few of these stories have impacted me personally as much as that of a young man I’ll call “Jay.”
Jay was severely injured in a motorcycle accident in August 2017. At 23, he’s handsome and healthy-looking, and a father of two children—but the accident left him paralyzed from the chest down.
Jay relies on a catheter, and uses a wheelchair. And the first time I met him, he was several months into daily fentanyl and heroin use.
Jay suffers from Restless Leg Syndrome as a result of his accident, and experiences deeply unpleasant and painful sensations that make it almost impossible for him to sleep at night.
RLS, or “spasticity” when applied more generally to conditions known to cause muscle spasms, is pretty common in patients with severe spinal cord injuries.
Jay receives a prescription for 10mg oxycodone pills from his doctor. This is the lowest dose available, and has done little to relieve Jay’s physical pain, let alone his emotional anguish (which is often overlooked as a reason people use opioids, despite their extreme, if sometimes temporary, effectiveness in this area).
The dangers of unregulated fentanyl use, with no guarantee of dosage, are clear. But regulated fentanyl is sometimes successfully used to treat spasticity.
It takes an enormous effort for Jay to get himself out of his modified car—behind the wheel of which is the only place I’ve ever seen him—and into his wheelchair.
So he’s forced to rely on the services of other users to obtain his illicit drugs whenever he ventures into North Philly for this purpose.
on February 8, 2019, Jay had that encounter with police.
“I was sitting in my car in the driveway eating some food I just bought and heard a tap on my window and I looked up and saw two police officers there,” he told me. “I thought, what did I do?”
The officers instructed Jay to get out of his vehicle. They then placed him on a stretcher and wheeled him to a waiting ambulance.
Jay was taken to a local hospital, where was initially admitted to the ER due to some wounds on his leg that doctors said needed treatment.
Later he was visited by a psychiatrist, who informed him that his father had filled out paperwork seeking to force him into rehab under Section 302 of Pennsylvania’s code, covering mental health procedures and “involuntary examination.”
Jay had no choice in what was about to happen to him, even though he was being accused of no crime and was sitting in the driveway of his own home, on private property, minding his own business, when he was approached by law enforcement.
The National Rise of Involuntary Commitment
As the overdose crisis intensified, states began quietly revising their laws to allow for longer periods of commitment with fewer legal hurdles for people who use illicit drugs.
by March 2018, 38 states had laws on the books detailing procedures for civilly committing people with substance use disorders.
The researchers identified 16 states with especially invasive provisions, including the authority to legally restrain, medicate or even conduct surgery on a person they deem to be addicted to drugs—all without the individual’s consent.
“The arbitrary legal standards and procedures on these systems leave the door open to abuse, and do not provide patients with evidence-based treatment as a rule, placing patients at higher risk of overdose when they relapse.”
In some states the bar for compelling individuals into treatment against their will is extremely low.
Take Florida, for example, where an individual with substance use problems can be held for up to 90 days against their will with almost no regard for the principles of due process
A petition can be filed by “any adult with direct personal observed knowledge of the respondent’s impairment,” and must only show probable cause that the individual has “lost the power of self-control with respect to substance abuse” and is “incapable of making a rational decision regarding his or her need for care.”
Probable cause is among the lowest evidentiary thresholds in American jurisprudence
Some would see the rise of involuntary commitment as benign paternalism, but there’s nothing benign about it. It takes away basic rights and agency with little realistic legal recourse for the victim.
Even if we set ethics aside, questions of efficacy remain.
once the withdrawal period is over, it’s difficult for authorities to justify keeping a person. In that sense, compelled treatment is sub-par even by treatment standards.
Addiction experts say this could actually increase risk of overdose, as drug users return to the community without the physical tolerance they had only days or weeks earlier
Meanwhile, detaining a person who has committed no crime—based only on what they might do in the future—has potentially severe long-term repercussions.
“Involuntary commitment gives someone a lifelong marker that interferes with their ability to get health care coverage or own a firearm, and it could prevent them from getting certain jobs, like federal employment,” Mary Catherine Roper, of the the American Civil Liberties Union of Pennsylvania
Released But Isolated
Jay would find one of these consequences especially problematic. A firearms enthusiast, he would be barred from owning a gun for life under federal law, even if he never used drugs again.
Finally a psychiatrist visited him and told him that there were no grounds to keep him based on the petition that had been filed by his father.
She even listened to him about the beneficial effects fentanyl had on his condition and prescribed him several days’ worth of fentanyl patches.
But there were no refills.
So now a medical doctor knows that Jay needs opioids, gives him a prescription for the next few days, and then just leaves him hanging without any way to continue getting the prescription she agrees is necessary.
I don’t see how that can be viewed as anything other than medical mistreatment.
Jay is now at home, living in the same way except even more isolated.
Before he left, he asked me if he could borrow $40.
“My [oxycodone] script is up in a few days. I have a buyer lined up. I can pay you back then, I swear.”