With illicit drug use, homelessness and untreated mental illness reaching a crisis in parts of Canada, the governments of at least three provinces want to treat more people against their will, even as some health experts warn involuntary care for drug use can be ineffective and harmful.
This month, British Columbia’s premier, whose party is in a tight race for reelection in the province, said his government would expand involuntary treatment for people dealing with mental illness combined with addiction and brain injuries due to overdose. Some would be held in a repurposed jail.
The Alberta government is preparing legislation that would allow a family member, police officer or medical professional to petition to force treatment when a person is deemed an imminent danger to themselves or others because of addiction or drug use.
And New Brunswick has said it wants to allow involuntary treatment of people with substance use disorders, although it, too, has yet to propose legislation. A spokesperson for the governing Progressive Conservative party, which is also running for reelection, called this “compassionate intervention.”
Robert Tanguay, an addictions psychiatrist and clinical assistant professor at the University of Calgary, supports involuntary care under certain conditions but also stressed more voluntary treatment options are needed.
Tanguay was a member of Alberta’s Recovery Expert Advisory Panel that helped shape government policy on addiction and mental health care, and said opinions about the efficacy of involuntary care varied.
“The one thing that was all agreed upon is it has to be done compassionately and in the healthcare system, not in the penal system,” Tanguay said. “We can’t just incarcerate people using drugs.”
This makes sense to me.
There’s a risk that police will weaponize an ability to commit someone to involuntary rehab. There’s a risk that overdoses might go unreported because people want to avoid being committed to a facility. The question is if these risks will be outweighed by any benefits. I think it’s unfortunate that these programs aren’t being discussed by political parties in practical terms. There’s just a lot of handwaving about whether or not it will ‘work’, and no real discussion of the objectives and expected outcomes.
The cause of addiction is not drugs. Programs like guaranteed minimum income would have far more impact on the actual causes of addiction. But let’s just imprison people until they stop being sick, that’ll work.
The cause of addiction is not drugs.
This is a very strange take.
It was a strange take in the 1980s when the disease model was the best we had. Today it is well accepted that most drugs alone don’t typically produce addiction. Just not by conservative voters, who still act like addiction is a moral failing, because people choose to do drugs “the first time,” and then become “chemically addicted”.
Please see, for example:
The concept of physical dependence implies a deterministic outlook which limits seriously any therapeutic hope. It predicts that once a user has taken a dangerous drug he or she will be hooked, with little chance to gain control. It also implies a social policy advocating total prohibition, since the drug itself is seen as the cause of addiction. The person is seen as passive and helpless in front of the pernicious substance. Alexander and Hadway [20] have called such a view the exposure orientation on addiction. They contrast it with an adaptive view of addiction which suggests that drug use is an attempt to reduce the distress that existed before it was first taken. Opiate users thus are at risk of addiction only under special circumstances, that is, when they are confronting difficult situations and trying to cope by turning to drugs. The problem lies in the persons’s psychological deficiencies and not in the drug itself. Thus, drug prohibition would be of no effect since the individual would still have to confront his or her stress and deal with it. In this view, the user has the choice of finding alternatives, searching for help and ultimately abandoning his or her dangerous habit.
A number of facts show that there is no universal and exclusive connection between such drugs as opiates and physical addiction. Any person using drugs does not necessarily become an addict. The effects of psychoactive substances are extremely variable from person to person and are relative to a number of factors among which are prior history of drug use, genetic susceptibility, cognitive factors, such as expectancy and attributions, environmental stresses, personality and opportunities for exposure [22]. People who have come to use drugs by accident, such as hospital residents who were given regular doses of morphine for pain relief, have not demonstrated an irresistible craving for such substances after release. It is estimated that about one quarter of the American soldiers in Viet Nam took heroin. Most of them, once back home, were able to quit without major difficulties. Similar observations hold for the period of the American Civil War. The case of controlled users, of which physicians are the best known group, shows that regular intakes of opiates over decades do not lead to tolerance or to withdrawal symptoms during abstinence. Heroin can be used on a regular but infrequent basis without dependence or catastrophic consequence [23]. It has also been found that former heroin addicts can completely stop using it or shift to casual use. Epidemiological studies have established that many heroin users are adolescents who grow out of their addiction and become abstinent later in life. People can experience withdrawal symptoms from much milder substances than opiates, such as sedatives, tranquillizers, laxatives, nicotine and caffeine. This evidence shows that no deterministic physiological mechanism can explain physical addiction exclusively.
I understand the view that in rehabilitation from addiction, drugs are not the only factor to consider. But they are absolutely a factor that needs to be considered. Ask anyone who has tried to quit smoking, drinking, or using any drug.
If someone overdoses and almost dies, or harms someone else, I think the state has a responsibility to get that person help that they may not have the ability, knowledge, or desire to seek, as opposed to turning them back out onto the street and waiting for it to happen again. The situation right now where I live is that businesses and homes are stocked with naloxone kits, and citizens are administering lifesaving healthcare to people on death’s door, on the sidewalk. Everyone I know who lives downtown has seen a dead body on the street in the past year. That’s not good, and practical solutions are needed immediately. I’m not convinced that a Swiss bulletin from 1999 which tents its argument on examples from the Vietnam War and the American Civil War really gets to the heart of the current issue and set of circumstances.
Ok. There are hundreds of overdoses EVERY DAY in shelters in my town. Have fun with that.
You can’t just lock people in a room until they are out of physical withdrawal and call them cured. They are still addicts. The causes of the addiction still exist. They will continue to seek drugs to help cope with life. This makes things worse.
But it takes resources away from people who want to get better. In my town, there are two to FIVE YEAR waiting lists for resources. But go ahead, institutionalize every person who a shelter worker has to shoot with Naloxone. You can fuck them and people trying to get better at the same time. Hurting all the right people, perhaps.
You are arguing from a place of ignorance, and that’s exactly what these politicians are counting on. You’re arguing from the needs of people who don’t want to see overdoses in the street, not from the needs of people with addiction. That’s the point of this entire program; addressing the relatively unimportant desires of non-addicts who vote.
You’re making personal assumptions about me, and the internal mental states of others that I think are unfair.
I don’t want to see overdoses in the street, nobody should. Not because I want it to happen in private, but because I don’t want it to happen. For the record, and not that you asked, but, I’ve also never said that I’m an advocate for mandatory rehab, or that it’s some kind of magical cure-all. I’m not here carrying water for these initiatives. All I’m saying is that there’s a serious problem, and a need for solutions and sincere discussion. I don’t think anything is gained for any position by browbeating others and fabulating their inner thoughts.
This was course material to a post grad university course on the subject of addiction and recovery taught THIS MONTH. It discusses the entire history of opiods.
Interesting. Can you link the course? I’d be curious to see the syllabus and learn more.
I’m not convinced that a Swiss bulletin from 1999 which tents its argument on examples from the Vietnam War and the American Civil War really gets to the heart of the current issue and set of circumstances.
This was course material to a post grad university course on the subject of addiction and recovery taught THIS MONTH. It discusses the entire history of opiods.
I think we should both be able to agree that it is more informed than you are.
Nobody gets clean while sleeping rough.
https://homelesshub.ca/collection/programs-that-work/housing-first/
https://endhomelessness.org/resource/data-visualization-the-evidence-on-housing-first/
And here is a podcast by and about drug users where people speak about their experiences with the system in BC and elsewhere as is has been, is, and is becoming: https://www.crackdownpod.com/ Includes interviews with researchers and doctors.
I have found it extremely worthwhile and necessary listening, but it is heartwrenching.
Nothing about them without them.
The problem with the current program is that we did a “half Portugal” where we stopped with enforcement because it was cheaper, and also didn’t put in funding for support and treatment because because they (the goverment) thought is was cheaper.
The problem with this, knowing that our government is cheap. They’ll talk about enforcement, but will be super cheap about it. I’d actually be more worried about this endeavour if I thought they were going to fund it adequately.
The intention of the politicians expounding this isn’t even to improve outcomes, it’s to improve election performance, and they don’t care who has to be thrown under the bus to accomplish it. They don’t care whether or not it improves outcomes as long as it engages their voters. And right now, their voters want to see the right people get hurt.
What evidence do you have for this?
This is such a ridiculous proposition. The people who want treatment can’t get it. Are we going to take the overworked doctors away from patients in order to forcibly treat drug addicts?
A few years ago I would’ve been pretty disgusted with this, but now with frequent contact with entrenched homeless I think it’s needed.
There are those few that just seem to be stuck in addiction and anti-social behavior and permanent incarceration or exile are about the only other options. You’d need some robust safeguards though so that it’s only used as that last resort after exhausting other options.
Or Canada could fix its social issues to slow down the flow of destitute people.
Or Canada could fix
Surely you mean “and”? I may not have been clear in my previous comment but my point is there is a very small minority that can’t be helped in the other ways. That doesn’t mean you shouldn’t also do all the other things since it’s just a very small group that can’t be helped that way and that’d be silly.
The state will do anything but fix the root cause IMHO.
Hence why I don’t never shill remedial programs. The regime caused these problems and now using taxpayer money to be the “good” guy.
This scheme here specifically is fucking abominations. Literally recipe for abuse. Nobody will be helped but many people will absued by the system. This is regime 101.
This doesn’t help the people already stuck. On these drugs, homeless, and dealing with the mental health issues that come with that is a huge burden, even if we fixed the issuess that push people into these addictions, they may not be able to get out of these situations on their own. Things like getting housed or employed become increasingly difficult when homeless and addicted. Ideally these involuntary treatments include housing treated people and assisting them in getting their own housing and employment.
This doesn’t help the people already stuck.
Neither will arresting them! We know that forced treatment does not have good outcomes for addiction! This is not science based policy, this is sheer populism, and it is going to further harm vulnerable people.
The idea that coercive power of the state can fix or even help is beyond naive.
Boomer brainrot
“Ideally these involuntary treatments include housing treated people and assisting them in getting their own housing and employment.”
…yeah but they won’t, will they?
allow a family member, police officer or medical professional to petition to force treatment when a person is deemed an imminent danger to themselves or others because of addiction or drug use
As long as there are some seriously strict requirements that need to be met then it’s better than what we have at the moment.
There absolutely will not be.
The intent is to be able to go out, round up the homeless in vans, and toss them into a ‘treatment’ centre. Taking street drugs is inherently dangerous, and so if you’re using, you’re eligible. If it turns out that you’re clean but have untreated mental health issues, then you’ll get held against your will for the safety of those around you.
I mean, they might as well start tracking these people by tattooing them - maybe with a bar code on their wrist.
I’m not sure how these are different from already existing psych holds?
