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opinion

As the poison drug crisis grows more lethal and visible, hence becoming more politically and socially untenable, politicians and policy-makers are grasping for new solutions.

Both B.C. and Alberta, for example, are promising to expand involuntary treatment – essentially forcing some drug users into treatment, whether they want it or not.

This get-tough approach has obvious appeal.

It is born of frustration – a desire to clear the streets of the growing legions of encampments of homeless and drug-addled people, where social disorder, petty crime and violence flourish.

It also involves an element of compassion – the recognition that a life lived in the clutches of addiction, often in fear and in squalor, is no life at all.

Any parent with a loved one struggling with severe mental illness or addiction will tell you that trampling a bit on constitutional freedoms seems a fair trade-off for giving people back some dignity and agency, and that it’s cruel to not try everything to rescue them.

There are conflicting rights at play. But is being sick really a right? What about the right to be well?

As well-intentioned as expanding involuntary treatment may be, the proposals put forward by B.C. Premier David Eby and his Alberta counterpart, Premier Danielle Smith, raise many questions that need to be answered before we start a wave of coercive care and pre-electoral roundups of people living with addiction.

First of all: is this jail by another name?

Neither province has actually tabled new legislation, so the proposals remain vague at best, free of the devilish details that ultimately matter.

But the suggestion seems to be that those targeted will be people who commit non-violent offences primarily as a result of substance use disorder. New laws would allow police, family members or guardians to request involuntary treatment for a drug user, and a panel would decide if it’s warranted. Finally, a health professional would also have to decide if forced treatment is ethical.

But who, exactly, would be targeted with this new approach? People who shoplift? Urinate in public? Trespass or camp out on sidewalks?

The Red Fish Healing Centre has been cited as a model for involuntary treatment facilities. But their clients are repeat, violent offenders. That’s a different kettle of fish.

We already have forensic psychiatric facilities to house those who were once called the “criminally insane.”

Diverting treatable people who suffer from substance use disorder and/or mental illness from prisons to treatment facilities is a great approach. It’s a form of alternative sentencing, where an element of choice remains – a criminal offender can choose treatment or accept their prison sentence.

Forcing someone who has committed no crime into treatment involuntarily is much more problematic. Still, we already have legislation that allows this, mostly for people in mental health crises.

In B.C. alone, more than 20,000 people a year are involuntarily hospitalized, usually because of a psychotic episode that poses a danger to themselves or others.

Most undergo a 48-hour hold in order to be stabilized, and then they are released. It’s a bit of a revolving door.

Mr. Eby has said he wants to expand the Mental Health Act to provide “clearer options,” meaning longer stays for adults in some cases. That’s defensible. The law already allows protective orders for up to 15 days for minors for assessment, detoxification and stabilization.

Earlier in its term, the B.C. government had proposed mandatory treatment for everyone who overdosed, but dropped that plan after an outcry from activists. With about 120 overdoses officially recorded every day (and seven overdose deaths daily), there is no way that treatment could be provided.

The most problematic aspect of the involuntary treatment approach for drug users is that there is really no good evidence that it’s effective, or that it’s more effective than voluntary treatment.

Addiction is powerful and, when they’re released from treatment facilities (or prison), many drug users will consume substances again. Those who do have a much higher rate of overdose death.

Another practical reality is that a lot of drug users do want to get treatment, but there is a crying lack of rehab beds. With limited resources, are we going to prioritize involuntary treatment over voluntary treatment?

It can’t be repeated enough that the toxic drug crisis requires a response on many fronts: prevention, harm reduction, enforcement, and treatment.

Involuntary treatment will be, at best, a small element of the overall treatment response, and one that must only be used as a last resort. It must be treated judiciously – and not used as a tool to score political points with a frustrated public.

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