When is coercive methadone therapy justified?

Heroin use poses a significant health and economic burden to society, and individuals with heroin dependence are responsible for a significant amount of crime. Owing to its efficacy and cost-effectiveness, methadone maintenance therapy (MMT) is offered as an optional alternative to imprisonment for drug offenders in several jurisdictions. Some object to such 'MMT offers' on the basis that they involve coercion and thus invalidate the offender's consent to MMT. While we find these arguments unpersuasive, we do not attempt to build a case against them here. Instead, we explore whether administration of MMT following acceptance of an MMT offer might be permissible even on the assumption that MMT offers are coercive, and in such a way that the resulting MMT is non-consensual. We argue that non-consensual MMT following an MMT offer is typically permissible. We first offer empirical evidence to demonstrate the substantial benefits to the offender and society of implementing non-consensual MMT in the criminal justice system. We then explore and respond to potential objections to such uses of MMT. These appeal respectively to harm, autonomy, bodily and mental interference, and penal theoretic considerations. Finally, we introduce and dismiss a potential response to our argument that takes a revisionist position, rejecting prevailing incarceration practices.

AI enabled suicide prediction tools: a qualitative narrative review.

Background: Suicide poses a significant health burden worldwide. In many cases, people at risk of suicide do not engage with their doctor or community due to concerns about stigmatisation and forced medical treatment; worse still, people with mental illness (who form a majority of people who die from suicide) may have poor insight into their mental state, and not self-identify as being at risk. These issues are exacerbated by the fact that doctors have difficulty in identifying those at risk of suicide when they do present to medical services. Advances in artificial intelligence (AI) present opportunities for the development of novel tools for predicting suicide.Method: We searched Google Scholar and PubMed for articles relating to suicide prediction using artificial intelligence from 2017 onwards.Conclusions: This paper presents a qualitative narrative review of research focusing on two categories of suicide prediction tools: medical suicide prediction and social suicide prediction. Initial evidence is promising: AI-driven suicide prediction could improve our capacity to identify those at risk of suicide, and, potentially, save lives. Medical suicide prediction may be relatively uncontroversial when it pays respect to ethical and legal principles; however, further research is required to determine the validity of these tools in different contexts. Social suicide prediction offers an exciting opportunity to help identify suicide risk among those who do not engage with traditional health services. Yet, efforts by private companies such as Facebook to use online data for suicide prediction should be the subject of independent review and oversight to confirm safety, effectiveness and ethical permissibility.

The Case against Forced Methadone Detox in the US Prisons.

Methadone maintenance therapy is a cost-effective, evidence-based treatment for heroin dependence. In the USA, a majority of heroin-dependent offenders are forced to detox from methadone when incarcerated. Recent research published in The Lancet has demonstrated the negative health and economic outcomes associated with such policies (Rich, J. D., McKenzie, M., Larney, S., Wong, J. B., Tran, L., Clarke, J. et al. (2015). Methadone Continuation Versus Forced Withdrawal on Incarceration in a Combined US Prison and Jail: A Randomised, Open Label Trial. The Lancet, 386, 350-359). This novel evidence raises questions as to the justification for current policies of forced detox in American prisons. Opponents of methadone provision in prisons might offer arguments from retributivism, resource allocation and curative effectiveness to justify their position. This article contends that these arguments do not stand up to ethical scrutiny. In light of this, we hold that American policymakers should reform criminal justice policies to allow the initiation and continuation of methadone treatment in correctional settings. This would be consistent with both international recommendations and the example set by a number of other Western countries.