Drug abuse has always been a difficult public health problem to tackle, as evidenced by our country's many failed attempts at reform. Trial-and-error, along with some scientific evidence, has allowed us to learn what doesn’t work: arresting addicts and trying to incarcerate the country’s population out of a drug problem. We haven’t yet found the perfect formula for hampering an opioid epidemic, but we’re certainly leaning toward harm reduction and rehabilitation rather than prosecution.

In something of an opposite move, between 2013 and 2015, the Russian Federation amended its laws to allow courts to mandate those who use drugs to undergo treatment. Officials have said the new laws will act as motivation for treatment, something the country’s people desperately need. Drug use in Russia increased after the break-up of the Soviet Union, and the United Nations Office on Drugs and Crime estimated that there were 1.8 million opiate drug users in the country in 2014.

But does forcing addicts to get treated really work? In an attempt to understand the “acceptability and efficacy of legislative approaches mandating treatment of drug approaches,” The Boston Medical Center conducted an analysis of global evidence on the topic.

Russia is not the first nation to introduce mandatory treatments; many Latin American and Asian countries have done so as well. Mandatory treatment is defined as “any form of drug treatment that is ordered, motivated, or supervised by the criminal justice system.” It ranges in severity from quasicompulsory — where patients are offered a choice between incarceration and treatment — and compulsory, where authorities mandate treatment without “allowing the patient to give consent, and do not allow the individual to decline treatment or choose the type they receive.”

The analysis found that mandatory detention for treatment occurs in many countries, and hundreds of thousands of people are detained for periods ranging from a couple months to several years in parts of Asia. The researchers found no evidence that such drug centers, which are often run by police and military rather than health professionals, are effective in treating drug dependence. In fact, these facilities lead to an “inadequate provision” or complete denial of medical care.

The problems start with grouping drug addiction patients with other “undesirable” detainees, including homeless people, sex workers, and those with alcohol dependence. Research focused on Malaysia found that compulsory drug detention centers were not very good at curbing symptoms of addiction — 86 percent of detainees reported craving opioids even after being incarcerated for months. Eighty-seven percent said they expected to resume drug use after they were released.

On top of ineffectiveness, several studies showed detainees suffered human rights abuses. In Cambodia, for example, youths who were jailed for drug dependence were forced to complete physical labor, and physically and sexually abused. A study from China, meanwhile, showed that drug centers even had a negative effect on health issues associated with injection drug use — the odds of contracting HIV rose with the number of times an addict underwent compulsory treatment.

Regardless of the extra abuses many suffer in compulsory treatment, it turns out mandating treatment is, in itself, a problem. “Mandating treatment conflicts with human rights principles as stated in the International Covenant on Economic, Social, and Cultural Rights, a legally binding UN treaty signed by over 160 member states, including Russia,” the analysis reads. “These principles include informed consent, the ability to withdraw from treatment, the right to confidentiality, non-discrimination in health care, and freedom from interference.”

The authors argue that instead of enforcing this kind of treatment, which is both ineffective and in violation of UN policy, a more community-based treatment plan could be the way to go. Equitable access to evidence-based treatment should be the goal, they wrote, and countries like Russia should reconsider their current stances against harm reduction therapies. Though harm reduction initiatives are still rather new, evidence has shown that in countries where they’ve been implemented, like Canada and the UK, they’re much more effective than other methods.

Dr. Fabienne Hariga, senior adviser to the United Nations Office on Drugs and Crime, addressed the analysis at a recent meeting in New York, and said it provides support to the UN position that mandatory treatment settings are not effective.

“The United Nations therefore calls on States to transition from mandatory drug treatment and implement voluntary, evidence-informed and rights-based health and social services in the community,” she concluded.

Source: Lunze K, Idrisov B, Golichenko M, Kamarulzaman A. Mandatory Addiction Treatment for People who use Drugs: Global Health and Human Rights Analysis. The BMJ. 2016.