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Guy Felicella is the peer clinical adviser for the British Columbia Centre for Substance Use

S. Monty Ghosh is an addiction physician and assistant professor at the University of Alberta and University of Calgary

British Columbia recently suggested new policy for involuntary mental-health treatment. It is a large pivot on its previous stance but it does not end there.

In Premier David Eby’s examination of the Mental Health Act for involuntary treatment, he is considering expanding to mandate treatment for substance-use disorders.

With the drug poisoning crisis showing no demonstrable end, other provinces are examining similar regulations. Indeed, Mr. Eby’s policy has stirred up much conversation among clinicians, policymakers and politicians in conservative provinces across the country, including Alberta and Ontario, around the potential utility and impact of these mandates.

Recovery, however, works by attraction, not by promotion or force. As such, mandates won’t inspire change but rather will inspire contempt.

Forced and involuntary treatment puts into question personal autonomy and health liberty. While this is warranted in extreme cases, what if we as a society chose a different path? Instead of forcing treatment, what if we incentivized it? Offering a basic stipend to those who enter treatment for their substance addictions can be persuasive. It could be similar to income assistance of $20 a day.

Incentives would be focused on people who do not have the means to afford treatment. It allows us to use the narrative of the carrot instead of the stick – maintaining personal choice and autonomy, while encouraging personal accountability. This concept isn’t far-fetched. As a society we already provide income assistance for various reasons.

Incentivization could be cost-saving. Substance use costs related to justice and crime, housing, loss of productivity and extreme health care utilization add up to a sum of $46-billion a year in Canada. The cost of enforcing treatment through court orders, apprehension and consequences for non-compliance are found to be exorbitant.

Incentivization could conceivably be much cheaper, with potential for continuing reductions in societal and health costs. It would also be much more acceptable for thousands of Canadians with substance-use disorders.

Incentives are already used to treat addiction and motivate marginalized populations. Contingency management is a well-known, incentive-based treatment that has shown the best outcomes for treating problematic methamphetamine use. Financial incentives given to pregnant mothers to quit smoking improve abstinence from cigarettes by three times. Incentives were helpful in improving vaccination rates in both Vancouver’s East Side and the homeless population in Alberta.

Incentives are a reliable and demonstrable strategy.

Forced treatment, on the other hand, has demonstrated little efficacy. A systematic review found that forced treatment showed no improvement in drug use or criminal recidivism.

Forced treatment has been tried in Asia with compulsory drug detention and rehabilitation centres. These have only reinforced the stigma against substance use. Institutionalization already leads individuals to avoid seeking help for their medical needs for fear of “detention.”

Additionally, forced treatment centres lead to higher rates of relapse compared to voluntary treatment. These facilities have also led to inappropriate detention of individuals suspected of drug use, and have been used as political tools against unwanted parts of the population, prompting the United Nations to advocate for the closing of these facilities. It pushes the narrative of criminalization of substance use, instead of treating it like a health issue.

The thought of paying individuals to enter treatment for substance use might be repugnant to some parts of society. They might say taxpayers shouldn’t pay for treatment, but taxpayers are already paying for the consequences of substance use through the effects on the justice, social and health care systems.

They might say we are rewarding people for their chronic drug use, but really, we’re offering a more appealing opportunity for individuals to reach recovery, especially in comparison to powerful euphoric substances that motivate people to continue to use rather than seek treatment.

Imagine a world where someone leaves treatment knowing they will not be homeless and will have immediate access to income, food and security. This appealing notion shifts thinking, inspiring genuine autonomous change and encourages continued engagement with treatment services.

Forced treatment instead would have many watching the clock to get out. Incentivizing changes the narrative to where the problem no longer is getting people to treatment, but rather how to manage them afterward.

As British Columbia and possibly other provinces move to create policies to enforce involuntary treatment, we ask both federal and provincial governments to consider a more compassionate than punitive philosophy. We ask that if governments have the ability, resources and funding to force treatment, then they should equally be able to pay people to voluntarily enter treatment and seek recovery.

Involuntary treatment sets a dangerous precedence that is not in line with our true Canadian values of autonomy, empathy and compassion.