The Canadian province of British Columbia has been a widely influential font of libertarian drug policy that decriminalized drug use in private and in public, opposed any formal or social pressure on drug-addicted people to seek treatment, and distributed drugs to addicted individuals for unsupervised use, as I documented in a prior Brookings report. It is thus notable that the liberal premier of the province, David Eby, recently described those policies as a mistake, and he has been trumpeting an expansion of involuntary care capacity for addicted people, particularly for those who are homeless. Similar calls to rethink how to get more people with substance use and other psychiatric disorders into treatment have recently been issued by policymakers as diverse as President Donald Trump, California Governor Gavin Newsom, and the mayors of many cities, including Jacksonville, Florida; San Jose, California; New York, New York; and Salt Lake City, Utah. Accordingly, this article discusses evidence for three strategies that are intended to accomplish this.

To Improve Retention in Addiction Treatment, Improve the Quality and Accessibility of Treatment

If a restaurant chain were struggling to attract customers as much as the addiction treatment industry, its CEO would likely evaluate the quality of the atmosphere, service, and food to see if they might be improved. To continue the analogy, the addiction treatment industry currently comprises some Michelin-starred eateries, some greasy spoon diners that flunked their last health inspection, and many places with quality between those extremes. For example, one secret shopper study showed that a plurality of residential addiction treatment programs do not offer Food and Drug Administration-approved opioid agonist therapy, and about one-fifth actively oppose it. Other enduring quality challenges include a lack of integration with the rest of the health care system and a shortage of well-trained health care professionals. These quality problems likely lower individuals’ willingness to enter and stay in treatment, bolstering retention rates in addiction treatment.

Read the full article about increasing participation in addiction treatment by Keith Humphreys at Brookings.