Canada seeks to treat more drug users against their will

With illicit drug use, homelessness and untreated mental illness reaching a crisis in parts of Canada, the governments of at least three provinces want to treat more people against their will, even as some health experts warn involuntary care for drug use can be ineffective and harmful.

This month, British Columbia's premier, whose party is in a tight race for reelection in the province, said his government would expand involuntary treatment for people dealing with mental illness combined with addiction and brain injuries due to overdose. Some would be held in a repurposed jail.

The Alberta government is preparing legislation that would allow a family member, police officer or medical professional to petition to force treatment when a person is deemed an imminent danger to themselves or others because of addiction or drug use.

And New Brunswick has said it wants to allow involuntary treatment of people with substance use disorders, although it, too, has yet to propose legislation. A spokesperson for the governing Progressive Conservative party, which is also running for reelection, called this "compassionate intervention".

Involuntary care already exists in Canada – it is used when people with mental illness are deemed a risk to themselves or others, or in some cases when they are seen at risk of substantial deterioration due to a mental disorder.

Data shows its use has risen in all three provinces proposing an expansion. In British Columbia (BC), a study found, its increase was especially steep for substance use disorders.

These provinces already have thousands and, in some cases, tens of thousands of involuntary hospital admissions a year. The psychiatrist spearheading British Columbia's initiative told local media the number of additional people affected by these changes would likely be in the hundreds. He did not respond to an interview request from Reuters.

The parties and officials have not made clear what the involuntary addiction treatment would involve.

The latest push comes amid a growing fear among Canadians that substance use is to blame for public disorder and violent crime. An opioid crisis has already killed more than 47,000 Canadians through overdoses since 2016, according to the federal government.

Mental illness plays a role in about 3% of violent crime, and substance use problems in about 7%, according to the Canadian Mental Health Association.

And this push coincides with a backlash against harm reduction measures — programmes that prioritise keeping drug users alive without curbing drug use.

Critics say expanding involuntary care could put people at risk of subsequent overdoses and scare people away from seeking help, while a civil liberties group warns it could violate constitutional rights.

BC premier David Eby told reporters last week his proposal is necessary to protect sick people and the broader community. "For people with these three overlapping conditions, we know that the current response that we offer is not adequate," he said.

"We need to make sure that people who are sick get the care that they need, that they are looked after and that our broader community is safe for everybody."

Legal director of BC advocacy group Health Justice, Laura Johnston, said people are being used as a "political football" in these debates, which can stigmatise them.

"There are real people on the other end of these conversations that are being deeply harmed by the political rhetoric of the moment," Johnston said.

High-profile reports of violence allegedly involving mentally ill people — such as an attack in Vancouver this month that left one man dead and another maimed — can spur political leaders into action, said David Gratzer, a psychiatrist at the Centre for Addiction and Mental Health in Toronto.

Some health experts and advocates say evidence justifying coercive addiction treatment is mixed, and it makes little sense to expand involuntary care when voluntary care is often unavailable.

"Involuntary treatment is being presented as a relatively simple solution to quite a complex problem," said Elaine Hyshka, associate professor at the University of Alberta's School of Public Health and Canada Research Chair in Health Systems Innovation.

She said it ignores issues such as poverty, a lack of housing and a lack of effective, accessible, voluntary treatment.

Robert Tanguay, an addictions psychiatrist and clinical assistant professor at the University of Calgary, supports involuntary care under certain conditions but also stressed more voluntary treatment options are needed.

Reuters