Ethical Issues Related to Drug Abuse & Addiction

Instructor: Elizabeth Nyang

Elizabeth teaches counseling classes at the university level, has a private mental health practice and a doctorate degree in counseling psychology.

Most people that use drugs are not aware of the impact ethics can have on their use and treatment. Substance abusers can be court ordered into treatment involuntarily. In some places, women and men are encouraged to get contraception to reduce the likelihood of drug-addicted babies. Women, in some programs, get paid to use implanted birth control devices. Civil commitment is also sometimes used as a form of control.

Involuntary Commitment

Julie is a social worker in a substance abuse clinic. She recently went to her doctor about her anxiety and the doctor prescribed lorazepam. After three days, her vision was blurry, and she accidentally took too much medication and overdosed at work. She was transported to the nearest emergency room where she was involuntarily committed into an inpatient substance abuse program. When someone is involuntarily committed, a doctor(s) certifies that the patient is at risk of harming themself or others and is in need of treatment. Each state has a law that governs the involuntary process. Julie lives in Maryland, and the law requires that she have a hearing before an administrative law judge, within ten days of admission, to determine if she still meets the requirement for emergency treatment.

According to the National Alliance for Model State Drug Laws, in 2017, 37 states, and the District of Columbia had laws that allow for the involuntary commitment of people that abuse, or are addicted to, drugs. The psychiatrist at the hospital admitted Julie because she had an unusually large amount of lorazepam in her system. According to Julie, it was an accidental overdose of a prescribed medication. Since Julie was nonresponsive when admitted to the hospital, she was unable to give an explanation for the overdose. She was hospitalized for one week in a locked facility. She was released with an option to meet with a counselor for outpatient treatment. She decided to refuse treatment after discharge. There are 37 states and the District of Columbia that have involuntary commitment Laws.

Civil Commitment

The National Institute on Drug Abuse reports that there were over 64,000 deaths from drug overdose in 2016. To reduce this high number and prevent more deaths, substance abusers and alcoholics are often court-ordered into treatment. When this happens, a family member or neighbor will go to the court and apply for a petition to have the person admitted to the emergency room for a substance abuse assessment. The judge will issue a Civil Commitment to have the police go to the person's home, and take them to the hospital involuntarily. Some people consider civil commitment to be a violation of their civil rights. They believe that they are forced to pay for, and receive, the treatment they do not want. Ethically, doctors or therapists that do the clinical evaluation and certification (that treatment is needed), do so under state law in good faith. The same rules that apply for involuntary commitment also apply for the Civil Commitment. Under civil commitment, after release, the patient may also be petitioned by the court to continue with outpatient treatment.

People committed into treatment believe their civil rights are violated.
Ethics

Doctors take a medical oath of nonmaleficence to do no harm to the patients they treat. These physicians respect the patient's autonomy, or their ability to consent to or deny treatment. Many patients that go into the emergency room for substance abuse treatment may be mentally capable of deciding to refuse treatment. State laws give doctors guidance on how to proceed when intervening for patients not able to make the best decision for themselves, and at the same time, protecting the best interests of the citizens. Doctors follow the guidance of the emergency petition process.

Female Sterilization

While there are more male substance abusers than females, women face different ethical issues. Project Prevention offers birth control to female addicts to reduce the likelihood of babies being born addicted to drugs. The agency puts posters up in homeless shelters, methadone clinics, and needle exchange programs to get participants. Many people that oppose Project Prevention believe that this program deprives poor, vulnerable, addictive women of their reproductive rights.

War on Drugs

A topic that often gets a lot of attention is the violation of civil rights of African Americans and other minorities through the war on drugs.

Large numbers of African American men were incarcerated during the war on drugs.
Prison

In 1982, the Reagan administration declared the War on Drugs in the interest of public safety and security. African Americans and Hispanics in inner cities became the primary enemies, not the big drug cartels, in other countries that supply the drugs. Over the years, millions of African Americans were incarcerated and their civil rights violated. About 10% of African American males between the ages of 25-29 were arrested, and placed in jail. In 1991, 86% of those arrested for drug offenses were African American males, while 76% of drug users in the United States were white in 1992.

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