There is little question that child protective services can mandate persons who have custody over children to seek evaluation and treatment for drug dependence and successfully complete treatment as a condition of retaining custody of children. Those who fail to comply with treatment requirements and who are found, after due process, to be negligent or abusive may have parental rights terminated. Nothing in the case law sets limits on the specific treatment modality that can be mandated, although basic fairness would require that an immunotherapy or sustained-release formulation be deemed safe and effective before being imposed.

Decisions about the coerced use of immunotherapies must also take into consideration the potential stigmatization of both the individuals who are required to participate in the treatment and the treatment itself. There is a risk that an individual who has been actively immunized can be identified through the use of a blood test for a long time. That information might then be used to adversely affect employment, insurance, and other necessities of life. While discrimination on the basis of a past drug history is currently prohibited under the Americans with Disabilities Act and some state disability discrimination statutes, the scope of those protections for persons with disabilities has been limited by the courts. Care must be taken in imposing a treatment that could result in potential negative consequences long after an individual has stopped drug use.

It is also important to ask whether the coerced use of immunotherapies could cast a shadow on this new therapy that, if found to be effective and safe, might significantly change the face of drug treatment. Such a stigma might deter individuals from accessing a potentially useful treatment and further inhibit the mainstreaming of drug dependence treatment into general medical practice.

Recommendation 9 The National Institute on Drug Abuse should support studies to determine the standards to be applied when immunotherapy medications are considered for use in the criminal justice and child welfare systems, including due process protections when there is a government-imposed treatment requirement.

Recommendation 10 The National Institute on Drug Abuse should support studies to carefully articulate the behavioral, ethical, and social risks associated with treatment of pregnant women and their fetuses and protective therapy in minors and to develop clinical practice guidelines for such use or discouragement of such use.



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