My family is threatening me with legal action if I don’t quit opiates? What can they do?
While laws regarding mental health vary from state to state, here in the state of Florida, there has been a statute since 1993 known as the Marchman Act. This unique law addresses drug addiction specifically. The Marchman Act makes it possible to court order a person into treatment for up to six months, according to expert Florida attorney, Marc Astor, in his article about the Florida Marchman Act and how it compares to the Baker Act.
What does it mean to Baker Act someone?
There is another law known as the Baker Act which is often used as a verb. To “Baker Act” a person means to send them to involuntary treatment for mental illness. This may include substance abuse, but it can generally apply to any mental health situation where a person is a danger to themselves or others. The Baker Act is useful, but limited. It allows for involuntary treatment of mental health issues for only up to 72 hours. This is not nearly enough time to address a serious addiction problem. More likely, it can cause a serious rift in a family and result in further substance abuse. While the Baker Act can help in many situations by getting people with mental illness much needed medical assistance, substance abuse is a different kind of mental illness.
I know what I am doing and I don’t want my family involved in my affairs.
If you are using heroin or fentanyl or any other opiate recreationally, you may not believe that you have a problem with substance abuse impairment. As long as you have access to your drug, you believe that you can work and care for your family. In fact, coworkers and family members may not even have any idea that you are using drugs. Unfortunately, your ability to rationalize your behavior can lead to denial about your situation. Addiction is a serious mental health condition that affects your ability to make a rational decision.
You may find yourself incapable of quitting on your own.
Mothers have left their young children in the car unattended while buying heroin from the dealer. People have injected heroin, fentanyl or even opiate pills while sitting in their car in a parking lot. In fact, these actions are not uncommon at all. If you have been in these or similar situations, you may be aware that you have a problem, but you want to handle it on your own without involving help from family. The issue is that it can be difficult to distinguish the motivation for your decisions. Is it that you have reason to believe they will disrupt your life in a negative way or that you simply want to continue using drugs for “just one more day”?
Is involuntary mental health institutionalization for opioid use a bad thing?
I have seen the frustration of family members over re-occurring opioid relapses. Mothers don’t know what to do about their adult sons or daughters going back to the streets for more heroin. Unfortunately, in today’s high tech society, access to potent opioids is easier than ever. Drug dealers are using ride sharing services, such as Uber and Lyft to deliver drug packages. Dealers will show up at your door with a text or instant message. Social Media has made it ever more difficult to delete a bad person from your life, such as a drug dealer. You can delete a phone number from your phone contact list, but then you have to consider other actions, such as unfriending and unfollowing on various social media platforms.
Preventing self harm.
So, how do mothers, fathers, husbands, wives and siblings of a drug user try to stop the self-harm? In some cases, they put their confidence in new forms of medication that last for a full month at a time. Meds such as Vivitrol and Sublocade are examples of these new monthly injectables to control opioid addiction. I have witnessed mothers who see these treatments almost as chemical leashes that can give them a sense of security that their child is safe from opioid overdose. While these treatments do have a high success rate, there are many cases where it seems like nothing can stop a loved one from going back out to use heroin again. Overdose is always a risk with heroin. No one is safe from it, no matter how much confidence they put in their heroin dealer.
Can a long-term treatment facility make a difference?
In Florida, we have seen many fly-by-night substance abuse treatment programs. Many of these store front rehabs provide the minimum required services to meet state and federal requirements. They are more interested in a patient’s insurance card than they are in assisting the patient in getting clean and staying clean long-term. On the other hand, there are good programs that really work. One example is a program in California that has a minimum stay time of five months. In an episode of The Rehab Podcast, which you can download here, the guest describes his experience in the five month program that includes intense physical activity and team building. This contrasts to his experience in bouncing around between at least 30 Florida rehabs. This is not to say that all Florida rehabs are bad. One serious problem with the traditional rehab model is that one month or less is generally not enough to make a difference. Not only does a program have to provide high quality mental health services and therapy, it must do it for an adequate time period.
If my family uses the Florida Marchman Act to force me into mental health treatment for six months, how will I ever forgive them?
At first, when you are court ordered to get an examination for substance use and then you find yourself forced into admission to long-term rehab and mental health services, you may be very resentful. When you are assigned to a legal guardian or legal custodian, you may resist and refuse involuntary examination and admission to psychiatric care at first. Placement into a treatment facility can be stressful, especially when you find that your heroin and “freedom” have been taken away. When you are taken into custody and no longer have control over your affairs, you may hate the family members who are behind the legal actions. This is not unusual. And, if rehab is not successful, you may feel justified in your feelings against your family. Yet, if the Marchman Act is used to petition for your admission to a strong rehab program and you are able to regain self-control and overcome opioid addiction, you will likely thank your family for their help. Involuntarily being forced into emergency admission and stabilization is unpleasant at first, but can result in a positive, life-changing experience.
What if I refuse to go along with the Marchman Act? What if they put me in rehab and I just leave?
After placement in involuntary mental health services for substance abuse, some patients do get up and walk away from rehab. Initially, if the Baker Act is used to put you in a psychiatric facility, you may find yourself locked up, almost like being in jail. Yet, afterwards, most rehabs are not like jails or prisons. While it is recommended that you stay, no one is going to physically force you not to leave. However, if you have been placed involuntarily in a program with the Marchman Act, when you leave, you will be essentially breaking the law. At this point, your family, with the help of an expert attorney, may have an investigator track you down to return you to substance abuse treatment. While this enforcement may seem extreme, they are concerned for your health and they are aware that even one accidental overdose can be tragic.
Is there a way to overcome opioid addiction without any need for the Florida Marchman Act or Baker Act?
You may feel that your situation is hopeless. When you try to quit heroin on your own, you get sick. No one understands how bad withdrawal sickness can be if they have not experienced it. At 72-hours, cravings and sickness get to be so bad, it can be nearly impossible to resist the temptation to go back for more heroin just one more time. While you protest getting help, you may secretly wish for your loved-ones to force you to get help. Involuntary help, via the Marchman Act, may actually be a welcome relief for you. However, if you believe that putting your life on hold for up to six months is impossible, there are alternatives. If you are addicted to an opioid, such as heroin, you may want to consider medication-assisted treatment. This is treatment that uses medications such as methadone or Suboxone.
The Suboxone alternative to the Marchman Act.
If you get started on Suboxone, you will not have to deal with prolonged withdrawal sickness or intense cravings. Many patients describe the feeling of treatment as being like they were never addicted in the first place. There are few, if any, side effects from the medication. There is even a monthly form of the treatment medication so you don’t have to think about it between doctor visits. This form of treatment may be ideal for patients who are in critical life situations where long-term rehab can be detrimental. For example, a mother of young children may be able to return to normal functioning where she is able to fully care for her children successfully while on medication assisted treatment. Alternatively, if she is committed to long-term rehab, she may lose custody of her children and have difficulty regaining custody. The separation of mother and children can also be very difficult for the children. Some patients are worried about destroying their career or company by going to rehab. While we should always put our health and lives first, I have known patients who were in the midst of building successful business startups while also dealing with opioid addiction. By putting their company-building activities on hold for months at a time, they may be giving up a once-in-a-lifetime opportunity. Medication assisted treatment is a voluntary option that can help you to get your life back under control and allow you to continue with little or no down time.
Can they still use the Baker Act or Marchman Act if I am doing well on Suboxone?
This is an important question. More importantly, we must ask why would your family want to pursue legal action with Marchman if you are doing well? If you are not impaired and you are stable, without any current substance abuse issues, why in the world would they pay an attorney to have you get an involuntary assessment and have you committed to involuntary mental health services for substance abuse impairment? There are a some possible explanations.
Some family members misunderstand how medication assisted treatment works.
They may believe that Suboxone treatment is simply trading one addiction for another. If this is their belief, you can imagine how they think you are still impaired, even if you are functioning well without any problems. The fact is that if you are doing well on a medication such as Suboxone, ZubSolv or Sublocade, and you are clean from all other substances, you are considered to be clean and in recovery. To help educate your family members on this point, you may want to recommend the book, Overcoming Opioid Addiction by Adam Bisaga, M.D. You can download my interview with Dr. Bisaga here. His book includes a chapter for family members and another chapter for healthcare workers to explain these points. So, if you are legally forced to get an assessment and examination for substance abuse and you are following your MAT plan with your doctor successfully, do not be concerned. If you are clean and not impaired, you are safe from the Marchman Act. While you may have to submit to involuntary assessment, they cannot make you give up your life at home and work to go away to rehab for up to six months.
The importance of staying clean and following MAT protocols.
When patients get started in MAT (medication assisted treatment), they sometimes feel as if they have been cured of opioid addiction. The treatment can work so well, it feels like a cure. Unfortunately, there is no cure for addiction. Opioid use disorder is a chronic medical condition that can be treated, but not cured. But, because it gives the patient clarity of thought and peace of mind so quickly, sometimes patients are quick to take matters into their own hands. They may start altering their medical treatment plan without discussing it with their doctor. This is not a good idea. You should not change how you take Suboxone or similar medications without approval from your doctor. And, you must attend therapy as ordered by your doctor. Following the program is important. It will give you the best chance for success and it will protect you in maintaining your life without interruption.
Harm reduction vs The Marchman Act.
There are people who believe we should have safe injection sites everywhere. These sites would be locations where heroin users could use heroin safely. Services would be provided such as testing the heroin to be sure it is not contaminated with fentanyl or other poisons. Other services might include providing clean needles and syringes as well as education on available treatment options to quit heroin. Most importantly, an attendant would be standing by to provide emergency resuscitation with Narcan in the case of an opioid overdose. Some people believe that safe injection sites are enabling and that they encourage ongoing heroin use. Why would a heroin user seek treatment to quit if they can just go to the safe injection site every day? Would it not make more sense to force all recreational opioid users into involuntary long-term mental health treatment? Why not just get them all off of the street and into a safe place? While the Marchman Act is a good idea for many heroin users and it does save lives, it is not going to work for everyone. People are all different and it is important to provide harm reduction and services to meet the needs of different people and different life situations. There is a place in the world for harm reduction, such as safe injection sites and also for The Marchman Act.