How should the state respond to people who commit low-level criminal offenses that stem from an untreated substance-use disorder? The issue has taken on a heightened importance amidst an ongoing national addiction crisis that has destabilized many U.S. communities and led to a myriad of harms. I offer a qualified defense for the use of legal mandates that require participation in drug treatment in lieu of jail time as one possible tool for reducing the public harms associated with chronic addiction. I argue that mandated treatment is effective, though less effective than many proponents argue. Beyond the effectiveness question, opponents contend that mandated treatment exacerbates structural inequalities, including the overpolicing of marginalized communities and underinvestment in voluntary treatment. Drawing on an egalitarian theory of justice, I argue that these structural inequalities present a compelling reason to constrain the use of mandates, but that they should be counterbalanced by a mixture of paternalistic and public safety concerns that make mandates one of several instruments in drug policy for addressing the pervasive harms from severe substance-use disorders.
Brendan Saloner (2026) studied this question.