In May 2019, lawmakers in Brazil passed legislation forcing rehab for people who use drugs. The move to require rehabilitation at private or religious treatment centers is part of broader legislation aimed at curbing drug trafficking and drug use in the country.
The policy changes include harsher penalties for traffickers, which raises the maximum penalty from five to eight years for traffickers leading criminal organizations.
The new law also strengthens the role of therapeutic communities in Brazil. These communities are often part of religious organizations and they can receive public funding and private donations.
The involuntary commitment of people who use drugs can occur on the recommendation of a family member or a public health official. Once someone is in a treatment facility, they will need medical approval for release.
The president of Brazil, Jair Bolsonaro, expressed full support for the changes, but there are critics of the forced rehab policy. Opponents of the new Brazilian law feel that it’s no more than a band-aid on a complex issue.
One critic of the legislation, Leon Ribeiro, who is a public health psychiatrist and was a member of the Brazil National Secretariat for Drug Policy, said that similar policies have failed and caused people who use drugs to want to run away from health professionals as a result. He calls it a punishment and a loss of freedom as a solution for people grappling with drug use or addiction.
Other people speaking out against the laws in Brazil say that it’s oppositional to what other countries are currently trying to do, which is approach the complexity of addiction as a health issue rather than a criminal justice issue. Before the new law, someone had to agree to hospitalization for treatment.
It’s important to note the distinctions between forced treatment and coercion. It’s not uncommon for family and friends of people who struggle with addiction to try to convince them to receive treatment — it can often be an effective approach. Forced treatment means someone receives it against their will and in a way that’s out of their control.
In the United States, around three dozen states have laws that will allow judges to require people to go to treatment for drug or alcohol addiction. There are also compulsory treatment laws in many states which allow someone to file a petition for mandatory treatment, and then a judge can sign off on that. The time someone has to spend in treatment under compulsory laws varies depending on the state. It can be anywhere from a few weeks to a few months. Such rulings are likely used in extreme circumstances, usually involving the person threatening to hurt another person or themselves.
Much like in Brazil, these laws are controversial in the United States as well. Opponents of the laws believe forcing someone into treatment against their will is ineffective, has ethical implications and can potentially violate constitutional rights. Supporters of the law feel that it’s the only way for people to receive treatment when they otherwise wouldn’t.
States that are especially impacted by the opioid epidemic, like Ohio and Kentucky, are working to lower the legal requirements for mandatory treatment, as have states like Indiana and Florida. In Florida, there is a new law allowing people with substance abuse issues to be held against their will for up to 90 days. The law requires that the person shows that they lost self-control as it relates to their substance misuse and is unable to make rational care decisions on their own.
The big question for policymakers is whether involuntary, mandatory treatment is effective. According to a 2016 meta-analysis of nine separate studies, there was no evidence of improved outcomes with mandatory, compulsory treatment.
Establishing such laws is a challenging process, particularly with the opioid epidemic as an ongoing crisis. Unfortunately, in cases of forced commitment, it may do more harm than good, but at the same time families, communities and countries are desperate to find ways to help people who misuse drugs and reduce overdose rates.
Silva de Sousa, Marcelo. “Senators in Brazil Pass Forced Rehab for Drug Users.” AP News, May 16, 2019. Accessed June 18, 2019.
Castaneda, Ruben. “Is Forcing People with Substance Use Disorder Into Drug Treatment a Good Idea?” U.S. News and World Report, July 19, 2018. Accessed June 18, 2019.