Characteristics and experiences of people who use drugs with involuntary civil commitment (Section 35) histories in Massachusetts: 2017 to 2022.

Massachusetts law permits involuntary civil commitment (ICC) of people who use drugs (PWUD) into drug treatment. We sought to characterize experiences of PWUD with and without ICC histories by exploring the associations of one or more ICC experiences by sociodemographics, substance use, and subsequent health outcomes. We analyzed survey data of 714 PWUD, collected from multiple mixed-methods rapid assessments conducted between 2017 and 2022, with further examination of the 209 (29.3 %) participants who reported experiencing ICC and have since returned to use. We computed univariate and bivariate statistics by ICC experience-none versus at least one ICC experience and one versus multiple ICC experiences. Putative associations were also explored between recent ICC experience and subsequent overdose risk, response, and preventive behaviors. Among participants who reported ICC experience(s), most identified as men, White, housed, co-using opioids and stimulants, and having been civilly committed by a family member and most recently in 2015 or beyond. Overdose experiences, both personal (χ2 = 16.2, p < .001) and witnessed (χ2 = 6.7, p < .01), were more common among participants reporting one or more ICC experiences than those with no ICC. 35.1 % of participants with ICC experience(s) in the past year had subsequently experienced an overdose, while 20.3 % experienced incarceration following their ICC. Naloxone administration at last witnessed overdose was higher with versus without a history of ICC (χ2 = 6.45, p < .05). To mitigate future health and social harms among PWUD, the current study's findings underscore the need for consideration of the aforementioned risk factors when tailoring future ICC policy.