Eric Adams is right — we need involuntary treatment to solve the public drug scourge
Mayor Eric Adams aims to try: On Thursday, he called on the state Legislature to allow clinicians and judges to compel people into treatment when their drug use is hurting them and the city.
'We must help those struggling finally get treatment, whether they recognize the need for it or not,' Adams said at an event hosted by the Manhattan Institute (where I work).
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'Addiction doesn't just harm individual users; it tears apart lives, families and entire communities, and we must change the system to keep all New Yorkers safer.'
Adams' proposed state law, the Compassionate Interventions Act, may face an uphill battle in Albany, as 'harm reduction' advocates assail it as coercive and dangerous.
But involuntary treatment should be a tool in New York's arsenal for dealing with the public drug use that has plagued it for years.
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There's no doubt the city has a problem.
Last year it reported nearly 4,000 homeless residents with a history of chronic substance use — probably an undercount, as such people are less likely to be identified by the city's annual late-night census.
Regardless, it's not hard to find people shooting up on New York's streets — just visit the Hub in The Bronx or Washington Square Park in Manhattan.
Such behavior makes whole swaths of the city unlivable.
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Public drug use hurts both users — there were more than 2,100 overdose deaths in the five boroughs last year — and the places where they use.
It deters commerce, and creates environments conducive to more serious crime.
Too often the city has responded to these situations with benign neglect, exemplified by its two 'supervised consumption sites,' which give people a place to use with Narcan-wielding staff standing by.
These sites continue to operate, in spite of the fact that they don't work and violate federal law.
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Leaving people free to abuse drugs, it turns out, doesn't save lives.
Involuntary treatment, by contrast, tries to correct the behavior that drives drug users to hurt both themselves and others.
That's why 37 other states already permit it — and why New York under Adams' plan would join them.
Critics will insist that involuntary drug treatment doesn't work, and that people have to want to change.
But the balance of the evidence suggests that involuntary treatment performs as well as voluntary treatment.
That's backed up both by older research on California's involuntary-treatment scheme, and by strong indications that drug courts, which route drug offenders into treatment instead of prison, can reduce recidivism.
Opponents will also say that it's immoral to compel people to get treatment they don't want, and that it violates their 'bodily autonomy.'
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But there's no right to shoot up in public spaces, or to ruin your body with fentanyl. And New Yorkers should have the right to expect their public spaces to be free from disorder, including public drug use.
The biggest challenge for Adams, though, may be the state's limited treatment capacity.
New York state as a whole has only 134 long-term residential treatment facilities.
As of 2023, the most recent available data, they were serving 2,935 clients — fewer than the city's tallied homeless drug-addict population.
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Implementing the Compassionate Interventions Act will almost certainly require more funding for treatment beds, much as Adams' previous efforts to institutionalize the seriously mentally ill did. That will have to be part of any ask in Albany.
But the mayor's proposal will also allow diversion to outpatient treatment programs, including a new $27 million investment in contingency management therapy — an evidence-based intervention that has been shown to help treat drug addiction.
What happens if Albany says no to Adams' proposal? Or if Adams is out of the mayoralty come the next legislative session?
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The NYPD can still work to clear encampments. And the city can still try to divert drug users into its drug-courts system, which, while useful, faces administrative problems and lacks transparency.
But actually getting drug users the help they need, rather than just cycling them through the city's jails, will be hard — much as the administration struggled to handle the seriously mentally ill before it had the power to compel them into treatment.
The success of Adams' initiative to assist the mentally ill homeless — over 3,500 people moved from the subways and streets to housing, according to the mayor's office — is a sign that such strategies can work elsewhere.
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Expanding the approach to public drug use is the next logical step. Albany should get on board.
Charles Fain Lehman is a fellow at the Manhattan Institute and senior editor of City Journal.
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