Coerced into Care: Involuntary Commitment Laws and Opioid Mortality

• In Event: Dying for Care: How Policy Shapes Opioid Mortality and Treatment Access

Abstract

Involuntary commitment (IC) laws for substance use disorder permit law enforcement, family members, or physicians to petition a court to compel an individual into treatment against their will. Use of these statutes has expanded alongside the opioid crisis, yet causal evidence on whether IC laws reduce opioid mortality remains scarce. Clinicians have raised the opposite concern: court-ordered detoxification without continued medication for opioid use disorder may elevate post-discharge overdose risk through tolerance loss.

This paper provides the first county-level evidence on the mortality effects of IC laws. We exploit staggered state-level adoption within a difference-in-differences framework, using the Borusyak, Jaravel, and Spiess (2024) imputation estimator to recover dynamic treatment effects robust to heterogeneous timing. We estimate that IC adoption increased opioid-involved mortality by approximately 5 deaths per 100,000 residents within five years of enactment. The effect is concentrated entirely in urban counties and counties with federally designated Opioid Treatment Programs; rural counties and counties without such infrastructure show null effects. This pattern is consistent with IC petitions being filed where treatment capacity exists to receive them, and raises the possibility that the recent expansion of IC statutes is iatrogenic precisely in the communities best positioned to deliver continuing care.

These mortality patterns motivate a closer look at how IC laws operate in practice. We examine heterogeneity in mortality effects by law enforcement discretion, maximum commitment duration, and legal grounds for commitment. The effects are similar across all three dimensions. We interpret this as evidence that mortality impacts are driven by general exposure to possible commitment, not by the specific features of how laws are implemented. The next step is to use ARCOS opioid shipment data to examine how IC laws affect local supplies of opioid treatment drugs. These outcomes will help us distinguish two mechanisms: increased mortality driven by involuntary commitment itself versus avoidance of voluntary treatment options that could trigger commitment.

Author

• Lance Gui, University of Mannheim
  Presenting Author