NYC Pushes Forced Treatment: Legal Issues and Implications of Adams’s Proposal

New York City Mayor Eric Adams recently announced a controversial proposal to change state law to allow involuntary treatment for people with substance use disorders. The plan—part of his broader “End the Culture of Anything Goes” campaign—would give clinicians and judges authority to mandate treatment for individuals who refuse it, if they pose a danger to themselves or others due to drug or alcohol addiction. Gothamist

Here’s a breakdown of what Mayor Adams is proposing, the potential legal and ethical risks, and what providers and advocacy organizations should be watching closely.

What Adams Is Proposing

• Legislation to allow involuntary commitment for substance use disorder, even when someone doesn’t consent, if they’re determined to be a danger to themselves or others. Gothamist

• Expansion of criteria similar to what was recently passed for mental health involuntary hospitalization: people unable to care for themselves and showing signs of mental illness can be involuntarily transported to hospital. The new proposal would extend that framework to include substance or alcohol use. Gothamist

• Investments accompanying the proposal:• $27 million to expand access to treatment programs in NYC, including new strategies to keep people engaged in care. Gothamist• $2 million to provide cell phones to participants in the Relay program (which follows up after an overdose) to improve care retention. Gothamist

Legal, Ethical, and Practical Concerns

1. Civil Liberties & Autonomy Forcing someone into treatment raises serious concerns about individual autonomy and the right to refuse medical care. Laws that allow for involuntary commitment must carefully balance public safety and individual rights under both state constitutional guarantees and federal constitutional protections.

2. Due Process Protections Any law enabling involuntary commitment will likely need clear due process safeguards:

   • A judicial hearing or review before commitment;

   • Criteria that are specific, objectively measurable, and not overly vague;

   • Legal representation for the person being committed;

   • The ability to challenge the commitment and request periodic review.

3. Burden of Proof & Standard of Evidence Determining when someone “poses a danger to themselves or others” can be subjective. The law will need to define the standard of proof (e.g. “clear and convincing evidence,” “preponderance of evidence,” etc.) to avoid arbitrary or unjust commitments.

4. Medical & Clinical Concerns

   • Evidence shows that voluntary treatment programs tend to have better outcomes. Forced treatment can lead to relapse, higher risk (for example, after detox when tolerance is lowered), and even harm. Gothamist

   • Ensuring there is enough treatment infrastructure, qualified staff, adequate beds, continuity of care, and follow-up support is essential. Mandated treatment without support risks failure.

5. Stigma & Trust Policymaking that emphasizes compulsion can worsen stigma. Some individuals may avoid seeking help if they fear they might be forced into treatment. As many advocates have noted, it may erode trust between providers, communities, and government agencies. Gothamist

6. Potential for Discriminatory or Disproportionate Impact Historically, forced treatment and commitment laws have been applied unevenly—often affecting marginalized communities, people experiencing homelessness, or people of color more heavily. Safeguards must be included to mitigate discriminatory application.

What Providers, Advocates, and Agencies Should Do

• Review Existing State Law: Understand how New York’s current laws on involuntary hospitalization (for mental illness) are structured. What procedural protections, criteria, and burdens exist now? What is likely to change?

• Monitor Legislative Drafts Carefully: When Adams submits the legislative language (likely in 2026), providers and legal advisors should scrutinize definitions (e.g. “danger to self or others,” “severe substance use disorder”), proof standards, duration of commitment, and remedies for persons deprived of liberty.

• Advocate for Strong Due Process: Push for inclusion of rights such as counsel, ability to appeal, periodic review, limitation on duration, and clear criteria to avoid overreach.

• Ensure Capacity & Clinical Standards: If legislation passes, treatment providers will need to be ready—adequate staffing, best clinical practices, continuity of care, safe detox, withdrawal management, and aftercare.

• Evaluate Ethical Guidelines & Risk Management: Clinics, hospitals, and public health agencies implementing involuntary treatment should adopt ethical guidelines, oversight mechanisms, policies to minimize harm, and procedures to document decisions and protect rights.

Lynne Legal’s Takeaway

Mayor Adams’s proposal underscores a growing trend among U.S. cities to lean more heavily on mandated treatment as part of responses to public disorder, addiction, and homelessness. While the goals of reducing overdose deaths, improving public safety, and offering help to people with severe substance use disorders are compelling, the legal risks are substantial.

At Lynne Legal, we work with behavioral health clients to anticipate legal perils, design compliant policies, and stay ahead of changing laws—especially in volatile areas like involuntary commitment. If your organization is in New York (or any state considering similar legislative shifts), now is the time to review your procedures, advocacy strategy, and risk exposure.