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Civil commitment for opioid misuse: do short-term benefits outweigh long-term harms?
  1. John C Messinger1,
  2. Daniel J Ikeda1,
  3. Ameet Sarpatwari2
  1. 1 Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Program On Regulation, Therapuetics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Ameet Sarpatwari, Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA; asarpatwari{at}


In response to a sharp rise in opioid-involved overdose deaths in the USA, states have deployed increasingly aggressive strategies to limit the loss of life, including civil commitment—the forcible detention of individuals whose opioid use presents a clear and convincing danger to themselves or others. While civil commitment often succeeds in providing short-term protection from overdose, emerging evidence suggests that it may be associated with long-term harms, including heightened risk of severe withdrawal, relapse and opioid-involved mortality. To better assess and mitigate these harms, states should collect more robust data on long-term health outcomes, decriminalise proceedings and stays, provide access to medications for opioid use disorder and strengthen post-release coordination of community-based treatment.

  • substance abusers/users of controlled substances
  • public policy
  • involuntary civil commitment

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  • Contributors JCM, DJI and AS all contributed to the final piece through conceptualising, writing and editing the work.

  • Funding AS receives funding from Arnold Ventures

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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