A Swedish register-based study examines what happened after a 2016 policy change made it possible to initiate and continue opioid agonist therapy during compulsory care for people with severe substance use disorders. The findings show increased treatment uptake alongside lower short-term mortality after discharge.
In Sweden, people with severe substance use disorders can, under certain circumstances, be placed in compulsory care under the Care of Abusers Act (LVM). Mortality following discharge from this type of care is high, particularly from opioid-related causes. Until February 2016, opioid agonist therapy (LARO) was not permitted during LVM care despite being recommended for opioid dependence. A regulatory change subsequently allowed treatment to be initiated or continued during compulsory care.
Using linked Swedish national registers, the researchers followed individuals discharged from compulsory care between 2012 and 2019. They examined participation in LARO during care and mortality during the first 180 days after discharge, comparing the periods before and after the policy change and paying particular attention to individuals likely to be eligible for treatment.
Treatment uptake increased substantially following the reform. Around 3–4% of LVM episodes involved LARO in 2015, compared with more than 15% by 2020. Mortality during the first 180 days after discharge also declined following the policy change, with a larger reduction among individuals eligible for LARO. Among eligible individuals admitted after the reform, participation in LARO during compulsory care was associated with an 85% lower risk of death within 180 days after discharge.
The study also found that individuals receiving LARO during compulsory care were considerably more likely to show evidence of continued treatment after discharge. The findings underline the potential importance of providing evidence-based treatment during compulsory care and ensuring continuity of care during the particularly high-risk transition back to the community.
Read more: 10.1016/j.drugalcdep.2026.113278