Canadian provinces want to treat more drug users against their will

By Anna Mehler Paperny and Nia Williams

TORONTO (Reuters) – As illicit drug use, homelessness and untreated mental illness reach crisis levels in parts of Canada, governments in at least three provinces are moving to treat even more people against their will, even as some health experts warn that involuntary treatment of drug addicts can be ineffective and harmful.

This month, the premier of British Columbia, whose party is seeking re-election in the province, announced that his government would expand compulsory treatment for people with mental illness combined with addiction and brain damage resulting from overdoses, some of whom would be housed in a converted prison.

The Alberta government is preparing legislation that would allow family members, police officers or doctors to request involuntary treatment if a person is deemed an imminent danger to themselves or others due to addiction or drug use.

And New Brunswick has announced it will allow compulsory treatment for people with substance abuse disorders, although no bill has been introduced there either. A spokesman for the ruling Progressive Conservative Party, which is also seeking re-election, called it a “compassionate intervention.”

Compulsory commitment already exists in Canada. It is used when mentally ill people are considered a danger to themselves or others or, in some cases, when their condition is at risk of significant deterioration due to a mental disorder.

Data shows that use has increased in all three provinces proposing expansion. In British Columbia, one study found, the increase in substance use disorders was particularly sharp.

These provinces already see thousands and in some cases tens of thousands of involuntary hospitalizations each year. The psychiatrist leading the initiative in British Columbia told local media that the number of additional people affected by the changes would likely be in the hundreds. He did not respond to a Reuters request for an interview.

Neither the parties nor the authorities have clarified what involuntary addiction treatment would entail.

The latest push comes amid growing fear among Canadians that drug use is responsible for public unrest and violent crime. According to the Canadian federal government, more than 47,000 Canadians have died from overdoses since 2016 amid an opioid crisis.

According to the Canadian Mental Health Association, mental illness plays a role in about three percent of violent crimes, and drug problems play a role in about seven percent.

And that push comes with a backlash against harm reduction policies – programs whose top priority is to keep drug users alive without restricting drug use.

Critics say expanding forced treatment could put people at risk of further overdoses and discourage them from seeking help. A civil rights group also warns that it could be a violation of constitutional rights.

British Columbia Premier David Eby told reporters last week his proposal was necessary to protect sick people and the broader community.

“We know that the measures we currently offer are not enough for people with these three overlapping conditions,” he said.

“We need to make sure that sick people get the care they need, that they are taken care of and that our community is safe for everyone.”

“POLITICAL FOOTBALL”

Laura Johnston, legal director of the advocacy group Health Justice in British Columbia, said people in these debates are being used as a “political football,” which can lead to their stigmatization.

“On the other end of these conversations are real people who are deeply harmed by current political rhetoric,” Johnston said.

High-profile reports of violence involving people with mental illness – such as an attack in Vancouver this month that left one man dead and another maimed – can prompt policymakers to act, says David Gratzer, a psychiatrist at the Centre for Addiction and Mental Health in Toronto.

In British Columbia, Eby faces an October election in which drug policy is a top issue. His Conservative opponent, John Rustad, has also promised to expand voluntary care if elected.

“Basically, they are trying to rebalance patient rights in light of what they perceive as societal security,” Gratzer said.

“We have such cases of violence and governments are happy to respond to them,” he said. “I'm afraid it's not that simple.”

NO EASY SOLUTIONS

Some health experts and advocates say there is incomplete evidence to justify compulsory treatment for addicts and that there is little point in expanding involuntary treatment when voluntary treatment is often not available.

“Involuntary treatment is presented as a relatively simple solution to a fairly complex problem,” says 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 problems such as poverty, housing shortages and a lack of effective, accessible and voluntary treatment.

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

Tanguay was a member of Alberta's Recovery Expert Advisory Panel, which helped shape government policy on addiction and mental health care, and said there were mixed opinions about the effectiveness of involuntary commitment.

“Everyone agreed that this must be done with compassion and in the health system, not in the penitentiary system,” Tanguay said. “We cannot simply lock up drug users.”

Traci Letts, board president of the advocacy group Moms Stop the Harm, lost her 31-year-old son, Michael, to an overdose in February.

She said that compulsory admission would not have helped her son, but a regulated supply of medication would have helped him because he would know what he was taking and could choose the right dose: “There were times when he tried to get detoxification and treatment on his own, and the wait time was astronomically long.”

(Reporting by Anna Mehler Paperny in Toronto and Nia Williams in British Columbia; Editing by Frank McGurty and Deepa Babington)