Opinion: Why forcing people with addiction into treatment won’t work

As doctors treating addiction everyday in the Bay Area, we care for patients who have to fight not only a ruthless disease but also a medical system that is inadequately equipped to help them. California Senate Bill 43, by expanding the definition of grave disability to people with substance-use disorder without providing any new resources or funding, will not help our patients.

Consider Tim (not his real name), a polite and soft-spoken 28-year-old who came to the clinic after his first overdose in 2022. We quickly got him started on buprenorphine, a medication for opioid use disorder that is proven to save lives. Tim maintained sobriety for a few months prior to relapsing and then continued to seek help in urgent cares and hospitals. Sometimes he would be restarted on buprenorphine, but he was often discharged without medication or without further follow-up. Tragically, after many missed opportunities for treatment, he passed away last spring from a fentanyl overdose.

Tim’s problem was not a lack of motivation to seek treatment but the inaccessibility of the treatment he desperately sought. Instead of addressing the profound need for more addiction services and resources in our state, SB43 exposes people with substance-use disorder to the risk of losing their autonomy. Anyone with this designation could be forced into involuntary treatment and assigned a conservator.

At a basic level, this approach will fail simply because there are no medical treatments for addiction that work in an involuntary setting; success is predicated on voluntary patient participation. On a deeper level, this approach pulls from the same dark chapters of medical history that promoted insane asylums, eugenics and forced sterilizations. We should be especially concerned that this could worsen racial inequity, mirroring trends in the incarceration and mistreatment of Black and Brown individuals in our criminal justice system.

We already lack treatment access in our state; if SB43 is enacted, this problem would become more severe. The facilities and providers required for individuals to complete mandated treatments simply don’t exist.

Tim’s situation is unfortunately all too common. Addiction medicine has life-saving, effective interventions. But too often, detox and medication treatments aren’t offered or are not available to people with Medi-Cal, California’s Medicaid program. For instance, our state does not have any robust public reimbursement system for medically monitored detox, making it impossible for patients to voluntarily seek care until they have grown sick enough with life-threatening withdrawal symptoms to merit hospital admission.

Fixing that problem by developing accessible, medically monitored detox services would be just the start. We need to support addiction consultation services for people with substance-use disorder admitted to our public acute-care hospitals — just like the cardiology-consultation services that are available for patients admitted with heart attacks. We need to build clinics providing low-barrier, same-day access to medications for alcohol- and opioid-use disorders. We need to improve our capacity to treat individuals in custody with substance-use disorder. To make any of this possible, we need to improve reimbursement for all of these services so that it is financially viable for organizations to serve Medi-Cal patients; this is the only way to build sufficient capacity to meet our community’s needs.

With communities desperate for solutions, our state Legislature has an opportunity to make California a better place for people with addiction without resorting to SB43. Reforming the California Mental Health Services Act provides an opportunity to begin this process. We should seize this chance to expand funding for substance-use treatment and increase access to residential facilities.

Our biggest problem is not that people refuse treatment but that we lack adequate treatment options for people who want help but can’t access it. Let’s start not by coercing people into forced treatment but by offering treatment to the many Californians seeking our help.

Dr. Jack Pollack and Dr. Rachel Sussman are family medicine physicians who also practice addiction medicine in San Jose.