B.C. Premier David Eby faced a media scrum on July 10 to announce something that just a few short years ago would have been unthinkable — the province would soon be opening two new involuntary care facilities, one in Prince George (72 beds) and the other in Surrey (60 beds), for people suffering from mental health disorders, serious addiction issues and the brain injuries these addictions often cause.
This triad of afflictions — which has exploded across the country during the illegal fentanyl crisis — is also being addressed by the Alberta government through a similar involuntary initiative, last year’s Compassionate Intervention Act.
In late June, the provincially funded Canadian Centre of Recovery Excellence (CoRE), a Calgary-based research organization, announced the establishment of its Compassionate Intervention Expert Group, which includes 11 “renowned world-class experts in addiction medicine, psychiatry, law, public policy, Indigenous health, recovery science and evaluation from leading institutions across Canada, the United States and the United Kingdom,” who will help guide how the act is applied.
Predictably, organizations that advocated for the decriminalization of street drugs and the proliferation of injection sites are none too happy about the growing push to replace “safe consumption” sites with a modern version of quasi-institutional involuntary care.
In December, for example, the Canadian Drug Policy Coalition released a policy statement opposing the “widespread use” of involuntary treatment claiming “There is limited evidence to suggest that involuntary substance use treatment is safe or effective.”
Nevertheless, there is a growing chorus of voices — even on the left — that are clearly not paying much heed to the Canadian Drug Policy Coalition.
In April, Larry Campbell, the former mayor of Vancouver who was recently appointed by David Eby’s NDP government as an advisor to address the mounting despair that is Vancouver’s notorious Downtown Eastside, said in a Global News interview that not only is he seeking more accountability from existing service providers for the mentally ill, addicted and brain damaged, but also that he didn’t understand why “everyone lights their hair on fire” when the prospect of involuntary care is raised.
Campbell, during his term as mayor, was a harm reduction advocate who oversaw the opening of Canada’s first injection site in Vancouver’s Downtown Eastside in 2003. It’s remarkable that he now openly states his admiration for the voluntary treatment facilities in Alberta, which has coincided with the closure of some injection sites. Campbell wants the Downtown Eastside to follow suit with facilities where those needing care aren’t entering what he calls “One Flew Over the Cuckoo’s Nest.”
Also in April, Louis Hugo Francescutti, an emergency doctor in Edmonton, and a former president of both the Canadian Medical Association and Royal College of Physicians and Surgeons of Canada, appeared as a witness before the parliamentary health committee. Francescutti described for the committee the “moral distress” emergency physicians suffer when they are repeatedly discharging overdose patients back into the streets — what he called “treat’em and street’em” — knowing that the pattern was almost certain to continue.
Francescutti added that if lawmakers wanted to know what they could do to improve things, a good place to start would be passing a law that would prohibit any homeless patient in Canada from being discharged from a hospital into homelessness.
But even if hospitals could keep patients from returning to a life of addiction and mental illness in the streets, many of these institutions are currently unsure about what to do with them. Several emergency department doctors in downtown Toronto I’ve spoken to tell me that when they send patients with both mental health and opioid use disorders (which is the rule, they say, not the exception) for psychiatric assessment, they are typically returned with a memo that says, “Please bring this patient back once their addiction issue is addressed.”
The idea put forward by the Canadian Drug Policy Coalition that there is “limited evidence to suggest that involuntary substance use treatment is safe or effective” has also been scrutinized.
Last October, the Canadaland podcast interviewed Alison Ritter, a professor at University of New South Wales in Australia, which has had success with involuntary care. Ritter, who has 35 years of experience in the field of addiction, explained that the problem with studies on involuntary treatment is that they include findings from very different forms of forced treatment around the world: individuals placed labour camps in south-east Asia and those being treated against their will in American prisons are lumped together with individuals treated involuntarily in other countries. In contrast, in Australia, Ritter says patients are only treated involuntarily as a result of what’s called “civil commitment,” which is determined by a healthcare practitioner and reviewed within 48 hours “from a human rights angle by an independent magistrate.”
“If you just review the civil commitment literature only,” said Ritter, “and you take into account the quality of the care that’s provided, every study shows it’s as effective as voluntary treatment.”
Another bogeyman the Canadian Drug Policy Coalition trots out about involuntary care is that it’s going to be used to “clear large encampments ” and place vulnerable people in large-scale institutions.
Well, that’s not true, either.
Dr. Nathaniel Day, CoRE’s Chief Scientific Officer, said in an email interview that “among the severely impaired population living in entrenched encampments,” the proportion who would be candidates for involuntary treatment “may plausibly fall in the 5-per cent-to-15-per cent range, but we do not currently have adequate linked clinical and administrative data to establish that figure with confidence.”
One of the eleven experts Day has pulled together to advise on Alberta’s Compassionate Intervention initiative is Dr. Daniel Vigo, who was appointed in 2024 as B.C.’s first chief scientific adviser for psychiatry, toxic drugs and concurrent disorders. Vigo was present at Eby’s side when he announced the forthcoming involuntary beds.
Newly-appointed Vigo has come to symbolize the very sharp turn B.C. took away from its extremely liberal approach to the fentanyl crisis to the formulation of a response to the triad of very lethal conditions that has led to thousands of deaths in this country.
The first major forum I’m aware of at which Vigo articulated his ideas was on Dec. 3, 2024, before a parliamentary subcommittee formed by the health committee during the previous government because the opioid crisis had grown so dire that it warranted its own dedicated committee. It’s hard to view this appearance as anything less than a seminal pivot in this crisis.
When pressed on whether B.C. would be pursuing recommended initiatives involving government-supplied drugs such as heroin, cocaine and meth, Vigo flatly stated that “the premier has made it very clear that there will be no expansion of those initiatives that make drugs available.” Instead, the government would only expand “services that are within the context of treatment.” The current priority, Vigo explained, was to find “the sweet spot” in which the use of illegal drugs wasn’t criminalized while, at the same time, laws weren’t being disregarded to the detriment of everyone else.
Vigo also emphasized the need for more Assertive Community Treatment (ACT) teams in addition to long-term psychiatric rehabilitation beds and “de-centralized” housing options for people “who require intensive services” as part of a continuum of care. In case it wasn’t clear, Vigo spelled out that treating addiction, mental health disorders and brain injuries all at the same time meant creating services “that don’t exist.”
He also cut many critics off at the pass by emphasizing that involuntary care should only expand proportionally as options for voluntary care also increase.
At the end of the hearing, Gord Johns, an NDP member of parliament from Vancouver Island, raised yet another, oft-used knock against involuntary care — that it is associated with increased risk of overdose after release.
Vigo wasn’t having it.
“It’s only if the involuntary treatment is inappropriate,” he responded, “that someone would have increased risk of overdose or death afterwards.”
As Day pointed out in the interview, “Existing interventions have not produced the desired outcomes for a small but highly vulnerable (and visible) group, so higher-intensity options are now being considered.”
And those unfolding options at this point, as Vigo explained to the committee, include a combination of anti-psychotic medication and opiate agonist treatment.
“The objective should be to create a realistic opportunity for recovery wherever possible,” Day said, “while providing safe, dignified and continuing care for those who are no longer able to care adequately for themselves.”
National Post
