Rep. Colleen Madigan had planned to introduce a bill next year to establish a court process for family members to force loved ones into substance use treatment.

Then she experienced a personal tragedy and decided it couldn’t wait. Madigan’s bill was introduced after the deadline for new bills, and it  prompted an emotional public hearing at the State House Wednesday.

Madigan, a Democrat from Waterville, said her sister died in January from complications associated with alcohol withdrawal. She said her sister had been sober for 15 years, but relapsed after being prescribed opiates to deal with some health problems.

Rep. Colleen Madigan, D-Waterville

Madigan said the last two years of her sister’s life included repeated attempts to detox at home followed by relapses, a process that landed her in the hospital repeatedly. Madigan believes that her sister would still be alive today if Maine had a court process for forcing people into substance use treatment.

“I told Elana about the bill,” said Madigan, who originally intended to introduce the proposal next year. “I told her I would rather she be mad at me for the rest of her life than die. She cried and said do it. She didn’t want to die. She was afraid she was going to die. She asked me to never give up on her. So I am before you today.”

Madigan’s testimony, as well as others who shared tragic stories of family members needing help, drew tears from some members of the Judiciary Committee Wednesday.

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The bill, L.D. 2008, is a bipartisan, bicameral bill with 10 co-sponsors, including House Speaker Ryan Fecteau and Sen. Marianne Moore, R-Calais. It is based on a similar law in Kentucky. But the proposal – and its introduction late in the legislative session – sparked concern from a range of groups, including recovery, mental health and domestic violence advocates, and civil rights groups.

Recovery advocates are divided on the bill, with some opposing the concept and others supporting the idea but expressing concerns about the details. Some pointed to a lack of options for people voluntarily seeking treatment, let alone for those who might be forced into treatment. Others worried about constitutional rights. And the state’s court system questioned whether it could handle the additional caseload.

Courtney Allen, the policy director of Maine Recovery Advocacy Project, was among those calling on lawmakers to slow down the process and form a group to study the idea rather than try to pass a bill at the end of a busy legislative session.

“The recovery community is clearly split on this issue,” Allen said. “It’s important to understand that this is not often the case in our community. That tells us this is a very sensitive topic that deserves a much bigger conversation in our community. We do not want to be pitted against each other. We’re asking your committee to give us time to work out our differences.”

Maine already is one of 37 states that have some laws allowing involuntary commitment of adults suffering from substance use disorder or alcoholism, according to the National Alliance for Model State Drug Laws. However, existing laws typically have strict requirements, such as proof that a person has threatened or attempted to harm themselves or another person or cannot care for themselves, the alliance said.

Madigan’s bill would expand the commitment option under Maine law by allowing a loved one to seek a court order to compel treatment if the substance use presents imminent danger to the user or someone else and two licensed treatment professionals recommend the treatment.

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Dr. Ronald Springel, a retired addiction medicine physician and a member of the state’s overdose review panel, said he supported the bill  because of the ubiquity of fentanyl. The powerful synthetic opioid that is responsible for most fatal overdoses and has changed the calculus of harm reduction strategies, which seek to allow people to use substances safely until they’re ready for treatment.

“Harm reduction is now more like sitting on death row,” Springel said. “We must recognize now is the time for drastic measures.”

CONSTITUTIONAL RIGHTS RAISED

The American Civil Liberties Union of Maine testified against bill, saying it raised concerns about the constitutional rights of people using drugs or alcohol.

“Nobody wants to see their family members in pain,” ACLU Policy Director Meagan Sway said. “But the constitution is there, even when we’re in pain. The right to refuse medical treatment is a constitutional issue.”

Andrea Mancuso, executive director for the Maine Coalition to End Domestic Violence, also opposed the bill. She said she was worried that domestic abusers, including estranged spouses and former partners, would try to exploit the provisions to exert more control over their victims. And the court process would require victims to meet with their abusers, she said.

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“Abusive intimate partners frequently try to portray those they victimize as mentally ill or substance dependent as a way of evading accountability for their own abusive behavior,” she said. “Domestic Violence Resource Center advocates often help survivors whose abusive partners coerced them into using illegal drugs and used that dependency as a means of controlling the survivors, creating complex and devastating barriers to accessing help.”

Others raised practical concerns of implementing the proposal, such as providing legal representation for the person using drugs and paying for treatment and legal costs.

COURTS ALSO RAISE CONCERNS

Julie Finn, legislative analysis for the state judicial branch, said district courts would need additional resources and staffing to handle the increase in caseloads. Finn said courts already are operating at capacity and have a backlog of cases from the pandemic.

“The proposed legislation establishes a significant new court procedure that involves an ex parte hearing, a full hearing within 14 days, contempt hearings, and possibly post-judgment hearings regarding whether to vacate the original order,” she said. “Due to the short amount of time left in the session and the complexity of the bill, the Judicial Branch suggests that a study or stakeholders group be convened to work out some of the problems presented by the bill and come back next session with a new bill.”

Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services, provided neutral testimony on the bill, saying it was too complicated to address this session. She noted that Kentucky’s law was being challenged in court on constitutional grounds.

Shaughnessy said that more treatment beds and outpatient services are needed to meet current demand, let alone future demand if the bill becomes law.

“To mandate treatment, without a full continuum of care to access, seems to be unworkable,” she said. “We need to fill in the holes in our system of care.”

The Judiciary Committee is expected to schedule a work session in the coming days.


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