Increased Risk of Death Following Compulsory Substance Use Treatment

In Sweden, individuals may be legally coerced into treatment for substance use disorder if they are not interested in entering treatment voluntarily, and they are deemed to be at risk of harming themselves or their families, or causing “irreparable damage to their futures.” Researchers examined 2000–2017 data on individuals who completed 6 months of compulsory treatment (the maximum duration; N=7929) and had a “regular” discharge (i.e., not deceased or discharged to jail, prison, or hospital) to determine mortality rates in the year following treatment discharge. During the study period, treatment programs did not offer medications for opioid use disorder.

• During a follow-up period of 6945 person-years, 494 individuals who received compulsory treatment died—a mortality rate of 7 per 100 person-years—substantially higher than age and sex-matched rates.
• Mortality rates were highest during the first 2 weeks after discharge, with a rate of 14 per 100 person-years versus 4 per 100 person-years for the remainder of the year.
• For deaths from “external causes” (including overdose and suicide), there was a hazard ratio of 2.6 during the first 2 weeks compared with the following 2 weeks.

Comments: While compulsory treatment is ostensibly intended to help individuals at high risk of harming themselves or others, this study suggests that it can be harmful, particularly if focused on abstinence as a goal. These results support a move away from coercive program-centered models of care toward voluntary patient-centered models focused on health promotion and harm reduction.

Darius A. Rastegar, MD

Reference: Ledberg A, Reitan T. Increased risk of death immediately after discharge from compulsory care for substance abuse. Drug Alcohol Depend. 2022;236:109492.