Involuntary treatment bill highlights sharp divide on how to deal with substance abuse disorder

One Arizona senator helped to involuntarily commit his brother who now refuses to speak to him. Another whose brother has been in and out of treatment and incarceration now works to treat those with opioid use disorder. A lobbyist told lawmakers that she made call after call to get help for a loved one, only to be refused. 

The number of those who work at the Arizona Capitol who have been impacted by the fallout of drug addiction shines a light on the pervasiveness of substance abuse disorder in the Grand Canyon State. 

But lawmakers at the Capitol, both Democrats and Republicans, as well as advocacy organizations, are sharply divided on whether court-ordered treatment for those dealing with addiction will save lives or exacerbate the problem. 

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Senate Bill 1578, sponsored by Sen. Justine Wadsack, R-Tucson, passed through the Senate on Wednesday by a vote of 20-10, with a few Democrats siding with Republicans in support. 

If passed into law, the bill would allow Arizonans to petition the courts to order treatment for their loved ones who suffer from substance abuse disorder, but who refuse to seek help on their own. 

At present, Arizona allows people to petition for court-ordered treatment for mental health disorders, but not for substance abuse disorders alone. 

Sen. Anthony Kern, R-Glendale, who voted against the measure, said he would never support a law that allowed court-ordered treatment, saying it goes against his belief in personal freedom. 

Those on the other side of the aisle who opposed the bill, including Sens. Juan Mendez of Tempe and Eva Burch, of Mesa, said that the proposal would only serve to hurt familial relationships and overburden a treatment system that is woefully inadequate. 

“I believe it is very well intended and think it is going to have terrible consequences,” Burch said on the Senate floor on Wednesday. 

Burch, who described herself as a medical provider who treats patients with opioid abuse disorder exclusively, said that involuntary treatment would hurt families, communities and those suffering from addiction. She added that the treatment system simply doesn’t have the resources or capacity to deal with it. 

But those who supported the bill spoke with passion about their belief that it would help those who were too sick to help themselves. 

Sen. Catherine Miranda, a Phoenix Democrat, shared her belief that if this law were in place at the time, it would have saved the life of 23-year-old Joshua Fox, who hanged himself while in custody of the Arizona Department of Corrections on Dec. 20, 2023. 

Fox, who Miranda said suffered from untreated schizophrenia, was convicted of manslaughter on Dec. 15 for stabbing his father to death in July 2021. Miranda shared that Fox had been previously released from multiple agencies that screened him for mental health issues because “it was just drugs.” 

“He never received appropriate care,” Miranda said. 

Mendez pointed out that the system in Arizona lacks the proper resources to care for those who are involuntarily committed to treatment. And he knows about that from personal experience. 

Mendez’s voice shook as he told his colleagues in the Senate that he once helped his family locate and involuntarily commit his younger brother, who has a severe mental illness and substance abuse issues. 

“Forcing my brother through this system had deep psychological  and emotional consequences for my family,” he said. 

Mendez described his brother’s involuntary commitment as traumatic, involving seclusion, restraint and filled with underpaid staff and guards who were “constantly sedating” him and changing his medication without an adequate explanation. 

“He’s never going to talk to me again,” Mendez said. “I’m dead to him.”

Mendez added that he wishes that instead of legalizing court-ordered treatment, the legislature would scale up its service for the severely mentally ill and those dealing with addiction so that people could get help before involuntary commitment seemed like the only option, and that those who do receive treatment get care that is adequate. 

“This proposal will only set up another vulnerable population to fail because we refuse to invest in the treatment they need,” Mendez said. 

But others with loved ones suffering from addiction say that the bill is the only way to get them the help they need. 

Rachel Streiff, organizer of the advocacy group “Mad Moms” told the Senate Judiciary Committee on Feb. 15 that she has a loved one whose life was saved via court-ordered treatment. 

“We’ve seen court-ordered treatment work for serious mental illness,” she said, adding that those in the throes of addiction often have poor insight and are unable to help themselves until their brains are free of drugs. 

During the same committee hearing, Wadsack told her fellow lawmakers that she was aware that some of them didn’t like the idea of involuntary treatment, but that, “in all honesty the alternative is usually going to be death, or overdose.”

Marilyn Rodriguez, a lobbyist for the ACLU of Arizona, countered that addiction is a complicated medical condition that almost always requires enthusiastic buy-in from the patient for any hope of success. 

“I have a deep personal connection to this legislation,” she said. “I understand where it’s coming from. I know that it’s well-intended. And I know how it feels to desperately want your loved one to get help. How futile the whole system can seem when you’ve called 911 for the 10th, 11th and 15th time only to be told by first responders that they can’t take her if she doesn’t want to go. I understand.”

Rodriguez described it as cruel to offer this proposal as an option for families when the necessary resources are not available to implement it successfully. 

The bill does not appropriate any funding for treatment, but relies on families to pay for it. The average cost of that treatment is $13,000, a cost that the vast majority of families cannot afford, she said. 

She added that the options for addiction care are lacking, especially for women and those living in rural areas, with not enough beds and long waitlists. Rodriguez asked the legislators why they wouldn’t first consider funding care for those suffering from substance abuse disorder who actually want treatment but who can’t pay for it. 

Next, the bill will head to the House for consideration.