Skip to main content

Kate Colizza is an internal medicine and addiction medicine physician working in acute care in Alberta. Cheryl Mack is an anesthesiologist and paediatric palliative care physician, the former chair of clinical ethics at the University of Alberta Hospital and an adjunct at the John Dossetor Health Ethics Centre. Angie Staines is the founder of 4B Harm Reduction Society and a member of Moms Stop the Harm.

On April 18, The Globe and Mail through an access-to-information request reported a troubling potential change to the Mental Health Act by the Alberta government. It would make it easier for police, among others, to force people with addiction into treatment programs without consent and against their will.

Alberta Public Safety Minister Mike Ellis subsequently took to the podium in St. Albert to announce community-led policing initiatives. He invoked the government’s “responsibility to uphold and preserve the safety and well-being of our communities.” After his announcements, he was asked about involuntary addiction treatment facilities and whether he supported this approach. He responded that he “would be looking at involuntary treatment options” and that “all options are on the table.”

Since that statement, Premier Danielle Smith has attempted to quell concerns by stating it will be an instrument of last resort. On May 15, the United Conservative Party announced involuntary treatment as part of its platform – pledging that if re-elected, it would develop and pass the so-called compassionate intervention act.

Alberta looks to Portugal for treatment model. But what is it?

As health care providers, front-line workers and family members caring for people who use substances, we still have grave concerns. Our work tells us that coercive, involuntary addiction treatment is dangerous and counterproductive.

The current Mental Health Act already allows family and police to bring patients to hospital for assessment by medical and mental-health professionals if serious concerns exist about safety. The Globe’s report of the obtained records indicate, however, that “drug users could be forced into treatment after committing non-violent criminal or statutory offences ‘primarily as a result of a substance use disorder.’ ”

The Mental Health Act is a framework for protecting patient safety in exceptional circumstances. Transforming it into a tool to punish people for minor offences, often committed out of necessity, represents a clear violation of rights and freedoms, with the potential to cause irreparable harm.

Involuntary addiction treatment is fraught with ethical, legal and practical limitations. It has been shown consistently to increase both social and health harms by contributing to increased overdose risk, loss of housing and employment, and future care avoidance.

This is not trauma-informed care. Rather, the experience of involuntary treatment and detention could serve to magnify trauma and play a role in worsening mental health. Forcing people into treatment programs fractures relationships, erodes trust and further traumatizes and isolates people already facing systemic barriers and colonial violence – including disproportionate harm in Indigenous communities.

Importantly, involuntary treatment doesn’t work: It does not reduce rates of addiction or drug use.

As an example, people who use opioids are at very high risk of injury or death after involuntary detention of any kind. The current supply of street-obtained opioids, often referred to as “fentanyl” or “down,” is made up of a mixture of synthetic opioids of varying potencies, along with non-opioid chemicals such as benzodiazepines. The composition of each dose can vary significantly, making it impossible to predict how the person using the drug will be affected with each dose.

Because the drug supply is poisoned and unpredictable, the rates of overdose and death remain devastatingly high across Canada. People who stop or reduce opioid use lose their tolerance quickly. As tolerance to a medication wanes, people become more sensitive to the effects of that medication. People are much more likely to overdose and die if they are exposed to opioids after they have “detoxed.” This risk is so immense that Canadian guidelines on the treatment of opioid use disorder explicitly recommend against this practice.

People with opioid addiction recently released from jail, for example, have been shown to be at up to a staggering 56 times higher risk of overdose death in the first two weeks after release compared with the general population. Forcing an individual into involuntary treatment, where they may be expected to reduce or stop opioid use against their will, puts them at an unacceptably increased risk of harm.

Involuntary treatment further establishes the health system as a coercive environment and erodes trust in health care not just among people who use drugs, but much more broadly. It erodes trust between patients and health care providers, and will magnify moral distress amongst providers, as it forces us to act in ways that are the opposite to our professional ethics and values.

Instead of promoting ineffective and dangerous involuntary treatment programs, we urge the Alberta government to consult with patients, families and experts on the front lines. People who use substances deserve access to a wide range of safe and effective services. Forcing patients into treatment against their will may push many further away from seeking help, concerned they may be forced into programs that do not align with their goals.

While we support increased access to residential treatment programs and therapeutic communities, these programs should always be voluntary and supported by best practices. More support for supervised consumption sites, safe alternatives to street drugs and low-barrier opioid agonist therapies are also essential. When these options are not readily available, the most compassionate way to address the drug poisoning crisis is to increase access and acceptability of treatment, not resort to involuntary “care.”

As Albertans head to the polls, this disturbing proposal should highlight serious concerns in the current government’s approach to addiction and mental health care. If the government is truly committed to “safety and well-being,” involuntary treatment should be decisively taken off the table.

Our Morning Update and Evening Update newsletters are written by Globe editors, giving you a concise summary of the day’s most important headlines. Sign up today.

Interact with The Globe