The British Columbia government is doubling down on involuntary treatment for people who use drugs, fast-tracking a law to skirt a constitutional challenge and giving doctors permission to force medications on youth.
It’s doing so under the guise of “increasing access” to treatment, phrasing described by one opponent as “Orwellian.”
“It’s a classic example of governments using words to not mean what they actually mean—in fact, it kind of means the opposite,” Dr. Ryan Herriot, an addiction medicine specialist and co-founder of Doctors for Safer Drug Policy, told Filter.
As of December, doctors can force long-acting buprenorphine on youth admitted involuntarily at their parents’ request.
In one announcement on December 5, the BC New Democratic Party government said it was clarifying in guidelines that health care workers can force long-acting buprenorphine on youth at their parents’ request.
Dr. Daniel Vigo, the BC government’s advisor on psychiatry, toxic drugs and concurrent disorders, said in a press conference that there were previously different interpretations of what the province’s Mental Health Act permitted around forced medications.
But as of December, he said, the official interpretation of the government is that doctors can force long-acting buprenorphine on youth when they are admitted involuntarily at the request of their parents.
“It’s considered voluntary if the parents request it and the kid meets criteria,” he said.
Vigo summed up those criteria as a child deemed to have developed a dependence on opioids and to be at risk of death or brain damage.
Previously, on November 24, the BC government had announced a bill to exclude health workers who impose involuntary treatment on patients from legal liability and to remove the Mental Health Act’s phrasing around “deemed consent,” which has been facing a constitutional challenge.
That amendment bill passed the legislature the following week, and is now law. Arguments on the constitutional challenge have ended, but a decision is still pending. It remains up in the air how the legislation will impact the court case.
“I think it’s shaping up to be an unmitigated disaster for substance use care in this province. I don’t know how else to put it.”
Prior to the amendment, the Mental Health Act stipulated that “treatment authorized by the director is deemed to be given with the consent” of patients admitted involuntarily.
Typically, if a person is considered incapable of consenting to treatment, then a family member or personal supporter would make the decision instead. The “deemed consent” provision in the Mental Health Act effectively circumvented that.
But while the new bill erased the language around “deemed consent,” it didn’t remove the substance of the act that allows forced treatment.
“I think it’s shaping up to be an unmitigated disaster for substance use care in this province,” Herriot said of the two announcements. “I don’t know how else to put it.”
“We have scads of research on involuntary treatment for substance use disorders, and we know that this is not an effective intervention, or at least there’s no evidence that it’s an effective intervention,” he continued. Many experts condemn involuntary treatment on ethical grounds alone.
The BC NDP government has previously attempted to introduce involuntary substance use disorder treatment for youth, before backing down in the face of significant pressure.
Asked in the December 5 press conference what led to the province deciding to push ahead after previous hesitancy, BC Premier David Eby said he’s following Vigo’s research.
“In their announcements, I’ve heard what I would personally call moral panic.”
But Thea Sheridan-Jonah, co-chair of Canadian Students for Sensible Drug Policy, said she didn’t hear evidence presented for involuntary treatment.
“In their announcements, I’ve heard more what I would personally call moral panic,” Sheridan-Jonah told Filter.
On the contrary, Herriot said, there’s “significant research” showing the harms of forced treatment, including increased risk of overdose after discharge, as well as the trauma it causes patients.
“If you talk to the patients themselves who have been through this kind of thing, particularly for substance use disorder, the absolute trauma of this, and the breakdown of future trust in health care, health care interventions and professionals is difficult to quantify, but it’s significant,” Herriot said.
In fact, Vigo himself has recently published academic literature to this end.
A 2021 study in which Vigo is listed as a co-author asked patients who have undergone forced treatment what it should look like, and those patients said involuntary treatment was inappropriate for substance use.
“Not only is that youth’s trust broken with the health care system, but it’s also broken with the adults in their life who they’ve tried to trust.”
Sheridan-Jonah said she’s concerned about the long-term impacts of forced treatment on that breakdown in trust, as it leaves people less likely to seek medical help when they need it. That breakdown in trust, she noted, can extend to parents or other caregivers who have tried to support the person but also put them into forced treatment.
“So not only is that youth’s trust broken with the health care system, but it’s also broken with the adults in their life who they’ve tried to trust with their care,” Sheridan-Jonah said.
Eby described the use of long-acting buprenorphine, which is sold under the brand name Sublocade and can be effective for about a month after each dose, as giving patients a “window of clarity” to develop longer-term treatment plans because it reduces the ability of a person to get high on opioids.
And Vigo suggested using Sublocade could reduce their time being held involuntarily, as they could continue their treatment in the community.
But Sheridan-Jonah called that a “nefarious” line of reasoning, when resources for youth in the community are still scarce. She said she’s worried youth could have Sublocade forced on them, then be left in the community with little support.
Buprenorphine typically requires some amount of detoxification before being administered. But Herriot said that is changing, and there are ways through microdosing to introduce buprenorphine into the system slowly to avoid withdrawal. That is an off-label use, however, and it’s not clear that would be the standard of practice, meaning the policy could lead to more youth being forced to suffer through withdrawal.
Writing about the policy in the Mainlander, BC harm reduction worker Heather Tunold described a recent three-day withdrawal experience as “torture.”
“I have never wished for death, but in that window I imagined it as a reprieve. And that was with community, support, and love around me—conditions many young people will not have if this is forced on them,” Tunold wrote.
Herriot said he’s also concerned Sublocade could lead to people using street drugs in more chaotic and hazardous ways.
Because it blocks the high of opioids to a certain degree—but not entirely—he said he’s seen people overestimate the amount they need to take to break the Sublocade barrier. That only becomes more risky as the Sublocade leaves the person’s system, Herriot added.
Photograph via PxHere/Public Domain
