The Georgian government has recently proposed forced treatment as an “alternative” for people who were previously engaged in private opioid agonist therapy (OAT), following its crackdown on these programmes. While details are still missing from this proposal, as someone who has followed these developments closely, I find this approach deeply troubling. Decades of research and my own experiences working in clinical and policy settings demonstrate that coercive treatment is not only ineffective in treating addiction, but it also violates human rights and undermines the principles of public health and social justice. Addiction is a health condition that demands a flexible continuum of care, not a one-size-fits-all that’s coercing people into treatment not to improve their condition, but to avoid punitive sentences.
Ending evidence-based treatment
This summer, the ruling Georgian Dream party closed all private opioid agonist treatment centres, claiming these clinics enabled “legal” drug use, contributing to drug diversion and increased crime. For years, officials have used diversion as an excuse to criminalise people who use drugs, instead of expanding healthcare solutions.
I’ll never forget a morning at the clinic when a patient, visibly anxious, looked over his shoulder after picking up his medication, knowing police might be waiting just outside to arrest him. I have seen first-hand how these heavy-handed interventions treat addiction as a criminal problem, when it is a healthcare issue that deserves evidence-based support and compassion.
Even though Georgia has made important drug-related progress compared to other Eastern European countries, particularly around ensuring treatment coverage for the population, drug policy remains rooted in the punitive legacy of the Soviet era. Today, harsh penalties for possession still remain in place, with police surveillance and public drug testing being commonplace. Although legal thresholds and mandatory minimum sentences have been slightly reformed by the Georgian Dream party, the system still prioritises policing over care. By favouring forced treatment over voluntary, evidence-based services, Georgia maintains a coercive path that will harm thousands of people in the long run.
Coercion is ineffective
Involuntary treatment is not only ineffective, but it also violates fundamental human rights. Compulsory treatment does not reduce substance use. Instead, it increases the risk of abuses of power, as well as a person’s return to problematic use, overdose, and even death in some cases. Addiction is caused by a complex interplay of bio-psycho-social factors. Effective care must reflect this complexity, which includes meeting people where they are, whether they continue using substances or choose abstinence. Services that work include but are not limited to addressing social determinants of health, such as housing and employment, and tackling the root causes of issues like trauma. A 2012 UN report noted that compulsory treatment is “ineffective in the treatment of drug dependence and a violation of the right to health.”
Another deeply troubling government initiative is the relocation of treatment centres to isolated areas, supposedly to “protect” communities from so-called “criminals.” This is the implementation of “Not in My Backyard” (NIMBY) battles over where people who use drugs are allowed to exist – a common challenge people face across the world. From my own work in in the US, I saw how from the 1970s onwards, residents fought fiercely to keep treatment facilities out of their neighbourhoods, fearing lower property values and an influx of “unwanted people.” Pushing treatment out of reach not only increases overdoses in surrounding areas, but it also drives support networks to the margins, further fuelling the stigma that people who use drugs are not welcome members of society. As Johann Hari has put it, “the opposite of addiction is connection” – and disconnecting people from their surrounding communities does little to change problematic or addictive behaviours. This is the case in Georgia as it is anywhere.
Even though the Georgian government somewhat acknowledges addiction as a healthcare issue in their rhetoric, the response they offer is not person-centred. The government targets are outdated, undermine public health and human right principles and are not based on updated global evidence and research.
A more effective response must focus on addressing the bio-psycho-social determinants of health such as poverty, unemployment, trauma and genetic predisposition to substance use due to Georgia’s exposure to civil and interstate wars.
That’s why I believe it’s crucial for human rights defenders to step up, raising awareness of non-punitive based treatment, advocate for inclusion, and challenging stigma wherever it appears. If we stay silent, these policies will only do more harm and deepen old prejudices.
Decriminalisation as a solution
There is a better way, with many nations like Portugal, Spain and others offering a clear alternative. In the late 1990s, Portugal faced one of Europe’s worst heroin crises. Initially, authorities relied heavily on coercion and punitive measures, but these strategies failed: HIV infections soared, overdose deaths spiked, and public trust in the health system eroded. In 2001, Portugal decriminalised drug possession and invested in voluntary, community-based treatment and harm reduction. The results were dramatic: The European Union Drugs Agency (EUDA) research illustrates how drug-related deaths fell, and new HIV infections among people who inject drugs dropped by around 80%. By removing coercion, Portugal fostered trust, engagement, and sustained recovery, outcomes that forced treatment in Georgia cannot hope to achieve.
The evidence could not be clearer: involuntary treatment just doesn’t help people recover. Research and a collective experience of those living with addiction prove that forced treatment leads to return to use, more deaths, and wasted public money. On the other hand, voluntary, person-centred care really works, because it respects people’s choices, builds genuine trust, and addresses the full spectrum of health and social needs. Methadone and buprenorphine programmes, for instance, have been shown to reduce overdose deaths by over 50% and slash HIV transmission rates. Yet, Georgia continues to underfund these life-saving services, choosing instead to pour resources into punitive measures that do nothing to help people recover.
Georgia stands at a crossroads. The government can continue its current path, reinforcing stigma, isolation, and coercion, or it can invest in science-based, rights-centred care. Communities don’t benefit by pushing treatment centres out of touch and sight; people using drugs must not be criminalised and instead given the free option to enter treatment when and if needed – this is crucial to reducing addiction and drug-related harms. Human rights-based, person-centred progress in public health happens when we make services accessible, voluntary, and connected to healthcare, social support, and harm reduction for all.
To me, the right path is clear. If Georgia doesn’t learn from the success and the failures of other countries, it risks pulling thousands of its own people back into the harsh, punitive legacy of its Soviet past.
