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Editorial: Holding overdose victims at hospital intriguing idea, but problematic

Among legislation recently discussed by the Board of County Commissioners to be considered in Annapolis next year is a proposal Dennis Frazier, R-District 3, introduced that would call for mandatory hospital holds for individuals who have overdosed on heroin or other opioid drugs.

Specifically, the proposal would require "any individual who has ingested an amount of drugs as to render himself or herself unconscious or in need of medical treatment to prevent imminent death or serious bodily harm, would be made subject to an involuntary emergency examination, treatment and counseling regimen for a period not to exceed 12 hours," similar to a 72-hour hold for someone who is considered to be suicidal.

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It's an intriguing solution to one of the more frustrating issues facing first responders who revive individuals who have overdosed on heroin or opioids with naloxone, but then have no way of getting that person help. Inevitably, many people who are revived will overdose again and again, and are resuscitated over and over, without ever getting into a treatment or counseling program.

Requiring they be hospitalized for any amount of time theoretically increases the chances of getting a user help they need. Of course, it's not that simple.

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Once a person is revived, they can choose to go to the emergency room for evaluation and treatment, but cannot be forced. Many refuse. Even those who do go are usually only there a few hours, and hospital staff cannot force them to stay. Once an individual is no longer in a state that puts them in immediate danger, or unless they admit to suicidal tendencies, there is little that can be done to keep them hospitalized against their will.

When they get out, painful withdrawal symptoms may have already set in, leading drug users to seek out their next high, which is more accessible than treatment.

A subject must want to get help. If an overdose victim cannot be convinced moments after being brought back from the dead that they are better off getting treatment than being back on the streets using, what are the odds of convincing them in the next 12 hours? Or 24? Or 72?

But if they do change their mind, there need to be measures in place to get these individuals into detox and treatment immediately and seamlessly. Frazier has also proposed legislation that would do exactly this, requiring "licensed detoxification centers provide a discharge plan for each client completing a substance abuse disorder treatment program, which must include a mandatory same day out-patient or in-patient session of behavioral counseling and a long-term follow up counseling regimen to prevent relapse and ensure continuity of care." Without that piece, it's hard to see how forcing someone to be held at a hospital for any amount of time would be beneficial.

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There's also a matter of civil liberties. In 1972, the Supreme Court ruled that involuntary holds are a "massive deprivation of liberty." For many, any sort of involuntary hold would be a nonstarter.

We hate to be dismissive, but we think the idea needs a bit more vetting and other pieces in place — like what happens when someone being held agrees to treatment — before we can get fully behind it. With that said, we would still encourage our legislators to introduce the proposal so some discussion can take place in Annapolis this upcoming session.

Opioid drugs are a problem in all of our communities and likely one area where bipartisanship can shine through. Getting lawmakers from across the state and across the aisle to weigh in on a proposal such as this may help determine the best ways to implement it, or if it should be implemented at all.

Editor's note: This editorial has been updated to include additional information regarding proposed legislation.



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