Rethinking Mandated Drug Treatment: Why Expanding Freedom Requires Structural Drug Policy Reform.

In this same, May-June 2026, issue of the Hastings Center Report, Brendon Saloner suggests that mandated drug treatment can expand freedom and promote egalitarian social justice so long as three criteria are met. Drawing on our clinical experience in addiction medicine and a critical appraisal of the available evidence, we challenge this claim. We argue that Saloner's three criteria are unlikely to be met within jurisdictions that criminalize drug use and lack supports for people who use drugs. The criterion that mandated treatment be "likely to be beneficial" is undermined by the coercive nature of such interventions and the lack of evidence supporting their effectiveness when compared to voluntary care. Further, the application of mandated treatment risks extending carceral oversight to individuals charged with minor offenses, disproportionately affecting equity-denied populations. Finally, we question whether infringements on liberty through legal oversight can genuinely expand freedom, particularly when such measures exacerbate social instability and undermine the potential for voluntary engagement with care. We contend that meaningful expansion of freedom for people who use drugs is better achieved through voluntary, community-based treatment models supported by robust social infrastructure. A radical reorientation of drug policy-away from coercion and toward supportive, person-centered care-is necessary to achieve the ethical aims of reducing harm, promoting autonomy, and advancing egalitarian social justice.