December 01, 2023
Thom Carroll/for PhillyVoice
A state Senate bill currently awaiting a committee vote would make Pennsylvania the 38th state to involuntarily hospitalize people who overdose.
State Senators Dan Laughlin and Anthony Williams introduced a bill in October that they said would help people with substance use disorders “regain control of their lives.” But overdose prevention advocates began objecting to the bill almost immediately after Laughlin (R- Erie) announced it, warning that it won’t stem the tide of overdoses, and may even cause harm.
Senate Bill 962 would make Pennsylvania the 38th state to involuntarily hospitalize people who overdose. Laughlin, who said he’s lost family members to the opioid crisis, said involuntary hospitalization could encourage people to seek long-term treatment.
“The goal would be, in that initial 120 hours, to simply let them sober up enough that you can have a clear-headed conversation with them and say, ‘Look, we want to help you get better. And this is the path that we can help you on,’” Laughlin said in an interview.
Pennsylvania has the 10th-highest number of overdose deaths in the country adjusted for population, according to the Centers for Disease Control and Prevention, with 5,449 deaths in 2021. Laughlin’s press release for the bill noted that emergency services in Pennsylvania used nearly 90,000 doses of naloxone, an overdose reversal medicine, from January 1, 2018, to July 15, 2023, and there were 52,570 emergency room visits in that time due to opioid overdoses.
Here’s how the bill works: Anyone who requires the use of naloxone or is taken to a hospital for an overdose can be examined for a substance use disorder. This examination must be performed at a treatment facility within two hours of the person’s arrival.
If the facility determines that the person has a substance use disorder, they will receive involuntary treatment, which lasts up to 120 hours (five days). Laughlin said most people would likely be discharged at this point. But the treatment facility can apply to extend the treatment by up to 20 days, or longer with subsequent court orders.
The Court of Common Pleas would have the power to order longer treatment — for people already in involuntary treatment and people who are not — if it receives a petition from the treatment facility, the county administrator or a responsible party.
This would require a hearing, for which the person would be assigned a lawyer, and medical professionals would propose a treatment plan. The court can order someone up to 90 days of assisted outpatient treatment or involuntary hospitalization. If the person is diagnosed with “severe substance use disorder,” the court can hospitalize them for up to a year, and will require a hearing to discharge them. All of these orders can be extended through subsequent hearings.
The bill stipulates that voluntary treatment will be preferred to involuntary, that the treatment facilities cannot be prisons, and that people who are receiving treatment through the bill cannot be prosecuted for using drugs.
The problem? There’s little evidence that involuntary treatment for substance use disorder works, and involuntary hospitalization hasn’t reduced overdoses much in the states that have tried it, according to Sean Fogler, a Philadelphia-based doctor who is in recovery and researches stigma around substance use disorder.
West Virginia has an involuntary commitment policy and still has the highest rate of overdoses in the country; Massachusetts’s government found that people who go through its involuntary treatment policy are more than twice as likely to die of an overdose than people who complete voluntary treatment.
“Addiction, I would say, is a disease of isolation and disconnection,” Fogler said. “Pulling people off the street and forcing them into treatment can cause a lot of harm. Because it drives isolation and disconnection and actually increases the stigmatization of the disease.”
The bill’s five-day treatment is also unlikely to work once people are released, said Alice Bell, who leads the overdose prevention project for Prevention Point Pittsburgh. Statistically, people are at increased risk of overdose after they stop medication-assisted treatment and especially after they go through withdrawal.
The threat of involuntary hospitalization may even dissuade people who use drugs from seeking medical care or calling the paramedics when they or their friends overdose, Bell and Fogler said.
Even if the treatment did work, Bell argued, it’s simply unethical to force people to treat their medical conditions.
“Do we force people to take insulin if they have diabetes?” Bell asked. “Do we force people to take high blood pressure medication if they have high blood pressure, and they might die if they don’t take it?”
The bill also ignores the barriers to treatment for people who want it, Bell argued. Methadone, the most effective medication for opioid use disorder according to medical professionals, must be taken every day, and can only legally be administered at a clinic. But many small towns don’t have clinics, Bell said; she knows people who drive two hours into Pittsburgh every day to get methadone.
It’s also not clear whether Pennsylvania’s treatment facilities have the capacity for the new patients they would receive through the bill. Laughlin said he doesn’t know whether treatment centers will have capacity, but thinks they will be able to build their capacity to handle the demand over time.
The bill is sitting with the House Health and Human Services Committee, and isn’t scheduled for a committee vote. Laughlin said it will take a while to get passed. He assumes the bill will undergo many changes as different groups offer input.
“Even though there are folks that are opposed to the bill, the genesis of the bill is that we care about these folks, and that we’re trying to help them,” Laughlin said.
“The legislators who sponsor these bills, I think probably their hearts are in the right place,” Bell said. “I think it is a misguided effort to just do something.”
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