By the time Morgan Godvin stood before a judge in Portland, Oregon, her life had spun out of control in all the ways we associate with severe addiction. “I tried to destroy my life with heroin,” she told Filter. “I drained my finances, ruined my relationships. It wasn’t enough to stop using.” As her finances dried up and her insurance benefits ran out, she thought she had only one choice: to turn herself in to detox in jail, aided by a Suboxone script.
“You’re so brave!” the judge gushed, proud of the young woman turning her life around by embracing the tough road of incarceration. It didn’t work out as planned.
“When I went to the jail and I asked for my prescription Suboxone, they laughed in my face.”
Godvin underwent a torturous seven-day detox. And that wasn’t the end. She resumed using heroin more than once, and every time she did, she cycled in and out of jail. Her stints behind bars have changed her life forever. “I can’t apply for loans. I couldn’t find a place to live, I’m not eligible for FAFSA [federal student aid].”
In 2020, Oregon’s Measure 110 decriminalized drug possession. People caught with small quantities of drugs like heroin, methamphetamine or cocaine no longer faced arrest or jail, but a $100 civil fine. A fine that would be waived if you call a helpline to get a needs screening, after which you could choose to be referred to treatment or services, but with no obligation. There’s a major treatment shortage in Oregon, but Measure 110 has sought to address that by allocating millions from cannabis tax revenues toward treatment and services.
If people are given a choice between jail or involuntary treatment, the thinking goes, we can help them get healthy, even if they think they don’t want to stop using.
Now, Oregon voters are poised to vote on whether to make illicit drug use a crime again. Critics say the 2020 measure has created a culture of lenience that breaks down public order and hurts, rather than helps, people who use drugs. If they’re instead given a choice between jail or involuntary treatment, the thinking goes, we can help them get healthy, even if they think they don’t want to stop using.
Supporters of this notion have been growing louder. On January 4, the Wall Street Journal published an op-ed by Dr. Sally Satel, a senior fellow at the conservative American Enterprise Institute, and Kevin Sabet, CEO of the Foundation for Drug Policy Solutions, arguing for forced addiction treatment: “Addiction Treatment Can Work Even When It’s Not Voluntary.” Satel is a psychiatrist who’s written that therapy culture is eroding Americans’ self-reliance, while Sabet is a former White House drug policy advisor who vocally opposes marijuana legalization.
The two dress up a carceral argument as a push for treatment.
“Popular opinion holds that an addict cannot be helped until he or she wants to quit, and there is overwhelming agreement among experts that it is preferable for people to choose to enter care rather than be forced into it,” they write. “But research has borne out the conclusion of a 1990 Institute of Medicine report that ‘criminal justice pressure does not seem to vitiate treatment effectiveness, and it probably improves retention.’”
“Forced treatment is incarceration,” a frustrated Godvin countered. (Godvin now serves on Oregon’s Measure 110 Oversight and Accountability Council, as she has described for Filter, and on the board of The Influence Foundation, which operates Filter.)
She added that since most people who quit drugs resume use at some point, they’ll end up in jail under this kind of plan—not magically “cured” by a single stint in treatment. People who use opioids are acutely vulnerable to overdose when they’re released from incarceration with lowered tolerance.
Good treatment, meanwhile, is woefully lacking in the United States, Godvin continued. On a recent visit to Portugal, which has its own long-established decriminalization model, she said she saw upwards of 80 percent of drug users offered voluntary treatment under the framework opt in.
“The fact that you have to force people into treatment tells you everything you need to know about the quality of treatment,” she concluded of the US. “It’s not that people don’t want to control their addiction—they just don’t want to be humiliated and abused.”
“There is good evidence that such coercive measures for substance use increase the risk for things like overdoses and death compared with doing nothing at all.”
Dr. Ryan Marino, a toxicologist, emergency physician and addiction medicine specialist at University Hospitals Cleveland Medical Center, said that in his opinion, it’s simply unethical to force a medical decision on an adult.
“Personal opinions aside, the facts are that involuntary treatments—better referred to as coercive—are less successful and cause more harms than voluntary treatment,” he told Filter. “There is even good evidence that such coercive measures for substance use increase the risk for things like overdoses and death [compared with] literally doing nothing at all.”
In the past decade, the philosophies of harm reduction and drug decriminalization have made major inroads in the medical and social service spaces. But the backlash to these trends has been severe.
Prominent critics, like Michael Shellenberger, author of San Fransicko: Why Progressives Ruin Cities (2021), conflate visible street homelessness with drug addiction and crime, and argue that the truly “compassionate” solution is to strip people of agency and institutionalize them against their will.
During his 2022 California gubernatorial campaign, Shellenberger pledged to create the dystopian sounding “Cal-Psych” in order “to remove addicts and the mentally ill from the street through voluntary drug treatment and psychiatric care, as well as by working with the courts to oversee involuntary care through conservatorship and assisted outpatient treatment,” according to his organization’s website.
Shellenberger’s campaign failed, but such ideas have gained significant public traction. In San Francisco, perceptions of homelessness and public drug use led to the ouster of reform District Attorney Chesa Boudin in 2022. His successor, Brooke Jenkins, pledged to charge people who sell drugs with murder in overdose cases, while Mayor London Breed cracks down on homelessness and drug use. Neither homelessness nor crime have abated under their watch.
Marino noted that coerced treatment is nothing new, and that decades of evidence shows it doesn’t work. “Anyone suggesting coercive treatment in 2024 either doesn’t know what they’re talking about or is intentionally misleading because they have a personal agenda to push.”
Photograph by Kindel Media via Pexels