California Can Now Force Drug Users to Go to Rehab

A new law in California allows the state to force people who are addicted to drugs to get treatment, a move drug policy experts call an infringement of civil rights that could exacerbate the overdose crisis.

Governor Gavin Newsom signed Senate Bill 43 this week, expanding the state’s conservatorship laws to allow involuntary rehab for people “who are unable to provide for their personal safety or necessary medical care, in addition to food, clothing, or shelter, due to either severe substance use disorder or serious mental health illnesses.” 

Previously, the eligibility for conservatorship required someone to have a mental illness, but the new legislation means that someone who’s addicted to alcohol or drugs but doesn’t have a concurrent mental health disorder can still be forced into treatment. 

Conservatorship is a legal process through which a court can appoint a third party, such as a person’s family member, to be in charge of their care, including having them committed to mental health facilities. 

In an announcement about the law, Newsom’s office said “conservatorship can help break the cycle of repeated crises including arrest and imprisonment, psychiatric hospitalization, homelessness, and even premature death — and instead provide the care that can restore mental health and end the conservatorship.” 

Because conservatorships strip away a person’s autonomy in making decisions about their care, they make them vulnerable to abuse. One of the most high profile examples of an allegedly exploitative conservatorship was Britney Spears, whose father James was her conservator for 13 years; Spears said the conservatorship controlled every aspect of her life including forcing her to use birth control. In August, former NFL star Michael Oher, whose story was featured in the book and movie “The Blind Side,” filed a lawsuit against the couple who purported to adopt him, alleging they instead placed him in a conservatorship and used it to control his finances. 

This week Newsom also signed a bill that will allow the state to pilot “secured residential treatment” in Sacramento and Yolo Counties counties, giving people convicted of crimes due to drug addiction a choice between jail time or going to a locked rehab facility; the jail sentence will always be longer than the secured treatment stint. 

Jeannette Zanipatin, California director for the Drug Policy Alliance, said the laws counter evidence showing coerced treatment is ineffective. 

“There’s no science or evidence that demonstrates that coerced treatment for substance use is actually effective and in fact, it increases the chances that someone could die of an overdose either when they’re in the facility or when they are immediately released,” she said. 

The scant evidence showing a benefit to involuntary treatment is contrasted with much stronger evidence showing that coerced treatment doesn’t decrease recidivism or drug use. Going to jail can increase the risk of overdose when people are released, in part because drug tolerance goes down during periods of forced abstinence. 

California joins at least 37 other states that allow some form of involuntary drug treatment. The shift is significant considering the state accounts for 30 percent of unhoused people in the U.S., according to federal data. A 2022 report by Aurrera Health Group found that nine percent of Californians met the criteria for having a substance use disorder in the year prior. 

Zanipatin called the new measures “disappointing,” especially considering that in 2022 Newsom vetoed a bill that would allow safe drug consumption sites in Los Angeles, San Francisco, and Oakland. 

“There is definitely political pressure for policy makers to be able to point to things that they are doing because everybody is seeing and experiencing folks who are homeless, folks who have mental health issues and folks who have issues with substance use. And so there has been a shift in public attitude and having less patience for what everyone is seeing but not really understanding why we're at the point where we're at,” she said, noting that homelessness and substance use has gotten worse in the last few years in part due to COVID-19 and widespread economic hardship. 

She said she worries the loosened criteria around conservatorship will infringe on people’s civil rights and that it could create a “revolving door” where people are repeatedly placed in treatment programs that don’t meet their needs. Medication-based treatments—the gold standard for treating opioid addiction, which are more effective than abstinence—continue to be out of reach for many, she added. 

“The barriers to accessing methadone continue to be very high and very steep. And so even if we have some treatment modalities, the obstacles are just way too high… for people who are living on the streets.” 

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