Involuntary Residential Drug Treatment Is Associated With an Increased Risk of Overdose

Despite a lack of evidence supporting this strategy, people who use drugs are sometimes forced into drug treatment, often as an alternative to incarceration. Researchers used data from a longitudinal study of 671 people with injection drug use (PWID) in Tijuana, Mexico to investigate the association between involuntary drug treatment (IDT) and subsequent non-fatal overdose. Participants were interviewed every 6 months and asked about treatment and overdose in the intervening period. Most drug treatment in the area is provided by at residential centers that do not provide opioid use disorder medications.

• Over a 6-year period, 32% of participants reported at least one non-fatal overdose and 15% reported IDT at least once.
• On multivariable analysis, IDT was associated with recent non-fatal overdose (adjusted odds ratio [aOR], 1.76). Tranquilizer use (aOR, 1.92), using a “hit doctor” (i.e., someone who assists with injections, aOR, 1.68), daily injection use (aOR, 1.05), and younger age were also associated with overdose.

Comments: It is likely that treatment without opioid use disorder medications increases the risk of overdose regardless of whether it is voluntary or involuntary. It is possible that involuntary treatment with opioid use disorder medications, particularly long-acting injectable medications (i.e., buprenorphine or naltrexone), may reduce the risk of overdose. But regardless, it is wrong to force someone into treatment; forcing them into treatment without opioid use disorder medications is not only unjust, it is dangerous.

Darius A. Rastegar, MD

Reference: Rafful C, Orozco R, Rangel G, et al. Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs. Addiction. 2018;113:1056–1063.