More elected officials consider forced detoxification to stem the opioid crisis

More and more provincial and municipal governments across Canada are considering implementing legal measures to force drug addicts to receive treatment for their addictions. However, this idea does not gain consensus among experts. Some point out the lack of data on the effectiveness of involuntary treatments.

The question arose in particular during the provincial election campaign in New Brunswick. Former Prime Minister Blaine Higgs, who was then trying to run for a third term, reiterated his intention to introduce a bill to this effect if he won the election.

At the other end of the country, in British Columbia, the government of David Eby affirmed this fall that it wanted to modify the Mental Health Act to provide involuntary mental health care to people experiencing serious addictions and mental health issues.

The Prime Minister of British Columbia described this approach as a new phase in [sa] response to addiction crises.

This initiative inspired the mayor of the city of Brampton, Ontario, who is calling for a provincial pilot project to establish a policy for the involuntary treatment of drug addicts. The city of Windsor followed suit by also showing interest.

The government of Danielle Smith, in Alberta, for its part, expressed its interest last year in implementing a bill to this effect.

Forced detoxification treatments would particularly target individuals struggling with addiction, mental health and brain injury problems.

Soon a project on the federal scene?

The leader of the Conservative Party of Canada (PCC), Pierre Poilievre, for his part said he was in favor of such an approach with people incapable of making decisions for themselves, citing children as an example.

This approach nevertheless seems to be in opposition to that of harm reduction, which has been widely advocated in recent years in order to stem the overdose crisis. The first Canadian supervised injection center opened its doors in 2003 and, since then, dozens of such establishments have emerged across Canada.

However, this type of center in many cases creates friction with their neighbors. There is no easy solution to ensure good coexistence between the residents of a neighborhood and the services offered to the homeless or to drug addicts, experts say.

Difficult cohabitation led Ontario to order this summer the closure of ten supervised consumption centers, including five in Toronto, even though an expert report commissioned by the provincial government instead recommended that the Ministry of Health increase the offer of this type of service in the province.

Despite efforts to reduce the overdose crisis, according to the most recent data published by the federal government, since 2016, more than 47,000 deaths in the country have been linked to opioid poisoning.

Lack of data on involuntary treatment

The use of involuntary treatments as a solution to the opioid crisis is questioned by some experts who point to the lack of evidence regarding their effectiveness.

These addiction specialists caution against viewing forced detoxification as an easy answer to a complex health and social problem.

I think this is a response to a problem that people perceive as having no real solutionsays Dr. Anita Srivastava, medical director of spending for the hospital network Unity Health in Toronto. According to her, this solution will not work.

It’s a response to the pain and suffering you see in front of you, and you say, “I don’t want to have to see that, so let’s make sure it doesn’t happen.” .

A report from the Canadian Medical Society on addiction published in 2023 concluded, after analyzing 42 studies published around the world, that a lack of high-quality evidence to support or refute involuntary treatment for [les troubles liés à l’utilisation de substances].

More research is needed to guide public health policiesunderlines the report.

The study also notes the difficulty of drawing conclusions about functional treatments, since the quality and types of treatments offered vary widely from coast to coast.

Limited access to voluntary treatments

Scientific evidence for the effectiveness of involuntary treatment simply does not existassures the executive director of the Center for Drug Policy Evaluation of the hospital St Michael’s de Toronto, Dan Werb.

According to him, governments should instead invest as a priority in voluntary treatment programs. He believes that Ottawa does not devote enough resources to these programs.

There is a huge disparity between the number of people referred for treatment and the capacity of the system to meet this demand.

Dr. Katie Dorman, a physician at the health center Sumac Creek of Toronto, agrees. The woman who has worked in the addiction field for much of her career believes there are too many barriers to voluntary treatment, such as long waits and restrictive criteria.

The average wait time in Ontario for an assessment is 16 days, followed by 72 days for admission to voluntary drug treatment, according to data from the Ontario Ministry of Health. In comparison, in Alberta, the average wait time to begin such treatment would be between 20 and 37 days.

I think it’s absurd to talk about involuntary treatment when there are so many people who want care and simply can’t access it.

One more lever to manage the crisis

Others, like the professor of psychiatry at Stanford University in Palo Alto, California, Keith Humphreys, are more moderate. The man who chaired an advisory group of Alberta experts on addiction recovery believes that forced detoxification must be part of the solutions considered to counter the opioid crisis.

We need to be realistic that addiction is a chronic disorder.

When we talk about forcing people into treatment, we should remember that there aren’t many people who spontaneously wake up in a tent and say, “I never want to use fentanyl again.” he says.

A solution to detention?

In addition to scientific considerations, various legislative changes would be necessary for involuntary detoxification treatments to be part of the tools to manage the crisis.

At the Canadian level, under the Penal Code, courts cannot force an individual to undergo drug treatment. They can nevertheless, in certain cases, offer it as an alternative to a prison sentence: if the person does not adequately follow their treatment, they will receive a prison sentence.

Provincial mental health legislation generally authorizes involuntary psychiatric treatment when a doctor believes that a person represents a danger to themselves or others.

One thing is certain, before seeing the country’s drug addicts forced to go through withdrawal, the provinces will have to modify their respective laws on consent to health care.

With reporting from Mike Crawley of CBC News and The Canadian Press