In an analysis recently published in BMJ, which coincided with the UN High Level Meeting on HIV in New York, Boston Medical Center (BMC) clinician researchers assessed current global evidence and found that mandatory treatment for people with substance use disorders is not effective in reducing their drug use. In addition, mandatory treatment, which is defined as treatment ordered, motivated or supervised under the criminal justice system, done without a patient's informed consent violates their human rights and does more harm than benefit to the patient.

Bulat Idrisov, MD, MSc, and Karsten Lunze, MD, MPH, DrPH, from the Clinical Addiction Research and Education Unit at BMC and Boston University School of Medicine, in collaboration with researchers in Canada and Malaysia, assessed global data and found that countries often lack the capacity to treat substance use disorders. This happens because they are not able to offer the diagnostic and therapeutic modalities and providers trained in addiction medicine that are necessary for effective treatment.

The authors argue that in order to reach successfully reduced substance use disorder rates, countries should consider implementing approaches that have been shown to be effective in rigorous scientific studies. These strategies include community-based opioid treatment, including methadone and buprenorphine. In addition, they suggest that offering harm-reduction programs like needle exchanges and providing education about overdose medications such as naloxone to people with substance use disorders, as well as to their friends and family members.

"The evidence presented in this article provides additional argumentation supporting the position of all UN organizations that mandatory treatment settings do not represent a favorable or effective environment for the treatment of drug dependence," said Fabienne Hariga, MD, MPH, senior adviser to the United Nations Office on Drugs and Crime during the recent meeting in New York. "The United Nations therefore calls on States to transition from mandatory drug treatment and implement voluntary, evidence-informed and rights-based health and social services in the community.''