Todd Kerensky, MD speaks out against involuntary commitment for treatment of SUD

Courtesy: Chris Van Buskirk/State House News Service

Involuntary treatment programs at jails and prisons in Massachusetts for people with substance use or alcohol disorders can create "inhumane" settings and lead to relapses post-release, critics of a section of state law that allows civil commitments for treatment said outside the State House Wednesday morning.

Prisoners' Legal Services of Massachusetts, the Massachusetts Society of Addiction Medicine, and a health professional at Boston Medical Center are backing a pair of amendments from Rep. Ruth Balser (D-Newton) to the House's fiscal 2023 budget that would remove funding for what are known as Section 35 programs run by the Hampden County Sheriff's Office and the Department of Correction.

Balser's first amendment (332) would strike from the state budget roughly $2.5 million in funding for the Hampden County Sheriff's Office to run a program in Western Massachusetts as well as $21.9 million for the Department of Correction to run the Massachusetts Alcohol and Substance Abuse Center (MASAC), a facility in Plymouth that houses civilly committed people for a detoxification program of up to 90 days.

Her second amendment (333) would require judges who civilly commit a person to a secure facility for treatment send them to one licensed or approved by the Department of Public Health or Department of Mental Health, but not a jail or other correctional facility. It also directs the health and human services secretary to ensure there are an adequate number of beds at DPH- or DMH-approved facilities.

Deborah Goldfarb, who works with Boston Medical Center's Grayken Center for Addiction, said she has worked with "countless" men who have been involuntarily committed to treatment by medical providers, police, or family members.

"Overwhelmingly, these men ... suffer inhumane treatment and insufficient care while in these facilities, and have quickly relapsed post-release," Goldfarb said. "Perhaps even more damaging was the loss of trust in the addiction or medical community after this occurred. Sending males to correctional facilities for treatment is not only ineffective, it is damaging."

Men who are civilly committed in Massachusetts for substance use and alcohol disorder treatment can be sent to treatment programs run by correctional facilities or jails like those administered by the Hampden County Sheriff's Office and the Department of Correction.

Spokespeople for the Hampden County Sheriff's Office, Department of Correction, and Wellpath, the company the state contracts with to run the MASAC, did not respond to requests for comments.

Chapter 123, section 35 of state law allows a qualified person like a police officer, physician, spouse, or relative to request a court order requiring someone to be civilly committed and treated involuntarily for alcohol or substance use disorder.

The state says involuntarily treatment should "be the last option."

"Outcomes are often better if an individual is motivated and willing to engage in treatment, in the least restrictive environment," the state says on a webpage describing the law. "Often, just the threat of being committed will influence an individual to enter treatment voluntarily."

South Shore Health's Medical Director Of Addiction Medicine and Massachusetts Society of Addiction Medicine President Todd Kerensky, MD said substance and alcohol use treatment should be grounded in four principles of medical ethics: autonomy, beneficence, do no harm, and justice.

"We can have a reasonable debate about whether involuntary treatment is potentially helpful or harmful, or maybe both," Kerensky said. "But what we should all agree on is that forced treatment violates people's autonomy and putting people in jail to receive treatment is by definition unjust."

The proper setting for Section 35 is not a new debate on Beacon Hill. A 2016 law stopped the practice of sending women civilly committed for substance use disorder treatment to prisons and instead refers them to hospitals.

In 2019, lawmakers heard testimony on legislation from Balser and Sen. Cindy Friedman that would only allow a civilly committed person of any gender to be sent to a secure facility approved by the departments of Public Health or Mental Health.

The Hampden County Sheriff's Office runs the Stonybrook Stabilization Centers in Springfield and Ludlow, both places where men ordered to enter treatment can end up. At the 2019 hearing, Sen. Eric Lesser said "hundreds of people will potentially be put on the street" if the facilities closed because other options did not exist in the region.

"It would be a humanitarian emergency, in my opinion, in Western Massachusetts," he said at the hearing.

A legislative commission created to study Section 35 involuntary commitments found there was limited high-quality, peer-reviewed research on the efficacy of such treatments for alcohol and substance use disorders.

Of the 29 commission members, only six voted in favor of a recommendation to "commence a process with the goal to reduce and/or eliminate the use of Section 35." Three members voted against the recommendation, 13 abstained, and seven were listed as absent.

The commission also recommended the state prohibit civilly-committed men from receiving treatment for addictions "at any criminal justice facility" so long as state officials funded or procured third-party or state-operated beds to offset on a one-to-one basis any diminished bed capacity. Of the 29 members, 13 voted in favor, one in opposition, eight abstained, and seven were listed as absent.

In documents submitted to the commission, the Stonybrook Stabilization and Treatment Center at Ludlow said its staff and officials are committed "to providing a safe, secure and structured treatment-program environment where you can take stock in your life, make a new beginning, learn and grow."

"This is accomplished through medically monitored detoxification services, educating you with the tools to affect positive change and plans for aftercare in order to promote a healthier and more meaningful lifestyle upon your return to the community," an orientation manual said.

Bonnie Tenneriello, a staff attorney with Prisoners' Legal Services of Massachusetts, said the state needs to stop "making anguished family members risk sending a loved one to prison in order to get treatment."

"People with addiction should not be saddled with the shame of prison," Tenneriello said. "Our lawmakers should feel shame to continue this horrific policy. We must offer real treatment and truly make this a state without stigma."