The British Columbia government is moving towards a regime of involuntary treatment for people who use drugs who have both “severe” mental illness and head injuries from overdoses. The program’s first beds in non-criminal cases are slated to open in a local jail.
It’s a move advocates say ignores the actual causes of the overdose crisis and rising homelessness in the province—issues that overlap but are often conflated by government—and instead opts to sweep the problem under the rug in a highly unethical way. Involuntary or coerced drug treatment is also ineffective, evidence shows.
After heavy political pressure from the BC Conservatives, the governing BC New Democratic Party (NDP) announced the change on September 15, offering scant details on the legislation involved. The move comes ahead of the October provincial election, and Premier David Eby said the legislation will be introduced after the election if the BC NDP wins.
“This is basically mass internment.”
In a press conference, Eby broke the announcement down into three components:
* Secure treatment facilities that would be set up around the province for “secure, safe and compassionate treatment”
* Secure treatment in provincial jails for people either on remand or those who have been sentenced
* Creating 140 new beds and upgrading 280 existing “outdated” beds in hospitals for both voluntary and involuntary treatment
The first facility to be set up under the first component would be in the Alouette Correctional Centre, a women’s jail in a Vancouver suburb.
“This is basically mass internment,” Karen Ward, a drug policy analyst in Vancouver’s Downtown Eastside, told Filter.
“It does not address the deaths. It deliberately evades addressing the emergency itself,” she continued. “There’s no housing. And that’s the crux of it. We’re refusing, adamantly refusing, to address the problem. It’s fucking disgusting, is what it is.”
Ward said the use of a jail for involuntary treatment contradicts the provincial government’s claim that it views drug policy as a health issue.
The province has been facing calls to reopen the Riverview psychiatric hospital, which gradually closed beginning in the 1980s, and fully shuttered in 2012. Some efforts have been made to reopen the building, but while there is currently some treatment onsite, the property is subject to a land claim by the local kʷikʷəƛ̓əm (Kwikwetlem) First Nation.
Eby told reporters the province couldn’t wait for Riverview negotiations to be completed to expand involuntary treatment in BC.
The expansion of confinement of people who use drugs, Ward said, proves the resources have always been there for programs with more evidence behind them.
BC already has involuntary treatment under the Mental Health Act, with an evaluation of two doctors—in fact, it is the subject of an ongoing lawsuit. And it’s a practice that has grown 162 percent for children and youth in the province over the course of a decade, according to BC’s Office of the Representative for Children and Youth.
Ward questioned where the resources for this new move are coming from. The province has been slow to expand its voluntary treatment programs—and inflating what is available. Recent analysis by the Investigative Journalism Foundation noted that a third of the claimed “treatment beds” aren’t treatment beds at all, but low-barrier housing.
The expansion of confinement of people who use drugs, Ward said, proves the resources have always been there for programs with more evidence behind them, including voluntary treatment, safe supply and overdose prevention sites.
But there remains a question of how the facilities will be staffed, as BC, along with most provinces in Canada, faces a severe staffing shortage in health care.
Ward also expressed concern about the province’s treatment industry in the province, noting there could be lobbying to privatize these services. “Are they calling it treatment? Is it under that rubric? Because that’s not regulated,” she said.
If these moves are intended to appease the right, it doesn’t appear to be working.
The announcement came just over a month before the provincial election, in which the BC NDP is neck-and-neck with the BC Conservatives.
The NDP has spent the last several months acquiescing to right-wing attacks on harm reduction—including pausing a mail-order harm reduction supplies initiative and suspending a program with machines dispensing harm reduction supplies outside hospitals, following outcry generated by the BC Conservatives. The BC NDP also cut funding from the Drug User Liberation Front prior to the Vancouver Police Department raiding the group, rolled back its limited decriminalization pilot project and repeatedly refused calls from within government to introduce non-medical safe supply.
But if these moves are intended to appease the right, it doesn’t appear to be working.
Prominent right-wingers who had been calling for the BC NDP to expand involuntary treatment called Eby out for “flip-flopping” on the issue, and said he couldn’t be trusted to carry out the legislation after the election. They also noted that the province has introduced legislation on involuntary treatment in the past, only to retreat.
“[Former premier John] Horgan & Eby promised involuntary care. Both broke that promise,” tweeted BC Conservative mental health and addictions critic Elenore Sturko, who has largely led the charge against harm reduction in the provincial legislature. “Eby’s new promise for involuntary care is not about saving lives – it’s about his own political survival.”
Members of the BC NDP’s base, meanwhile, have described feeling increasingly alienated by the party.
One BC labor activist tweeted that the shift “won’t make conservatives suddenly vote for the NDP, but it will make the NDP base stay home on Election Day.” Another contrasted the recent policy moves with claims by the “hold your nose and vote NDP” faction of the left that the NDP is a harm reduction vote.
Ward said that the public safety framing of the new announcement—the notion of making streets safer by confining certain people—is divisive and contrary to the social democratic values the NDP has typically claimed. People who will be confined by these policies, she said, are also members of the community—who will be made less safe.
Eby and Dr. Daniel Vigo, a psychiatrist and UBC associate professor who was appointed earlier this year as BC’s chief scientific advisor for psychiatry, toxic drugs and concurrent disorders, characterized the move as following evidence-based policy.
Experts widely view the practice of involuntary treatment as damaging to people who use drugs.
But the evidence generally doesn’t support involuntary treatment. Experts widely view the practice as damaging to people who use drugs.
One study in Mexico found an association between involuntary treatment and subsequent non-fatal overdoses, while another paper called Massachusetts’ experience with involuntary treatment a “cautionary tale.” There, involuntary treatment patients were at 2.2 times the risk of overdose after release compared to those leaving voluntary treatment.
Even to say it does more harm than good may be generous, as researchers have been hard-pressed to find good to balance against the harms.
One study in Malaysia found those committed to involuntary treatment are “significantly more likely to relapse to opioid use after release, and sooner, than those treated with evidence-based treatment.”
And a 2018 commentary in the Canadian Medical Association Journal cited a systematic review of court-mandated treatment that found “forced treatment did not improve outcomes for substance use. Instead, findings showed higher levels of mental duress, homelessness, relapse and overdose among adults after discharge from mandated treatment.”
The government’s move “has nothing to do with actual evidence,” Ward said. “It’s complete caving and pandering to fear, and refusing to actually be honest about what’s happening.”
Representatives of Pivot Legal Society, a legal advocacy organization with which Eby once practised as a lawyer, weren’t available for an interview, but a spokesperson pointed to a position paper Pivot released in March 2023. It called not only for involuntary treatment to not be expanded, but for the practice to be eliminated altogether.
“All voluntary options should be available immediately upon request and accessible.”
That paper called for an investment in “robust access to voluntary treatment options, including primary care, detox, treatment programs that have strict regulatory oversight, harm reduction programming, safe supply, family programming, culturally affirming options, and treatment modalities that reflect the intersecting identities of people who use drugs.”
“All voluntary options should be available immediately upon request and accessible across inner-city, rural, and remote areas,” it continued.
The paper, issued in response to talk by Eby in his 2022 BC NDP leadership bid of expanding involuntary treatment, noted that approaches to the overdose crisis couched as public health measures “are championed as … a more progressive approach” but that “their attendant policies and practises are frequently rooted in the same institutionalized stigma, racism, and anti-drug sentiment as drug prohibition … to justify similar ends.”
Pivot also wrote that using law enforcement tools for involuntary treatment admission is a dangerous combination, when police “are not only ill-equipped and untrained to deal with mental health events … but also have a demonstrated history of escalating mental health events,” including police killings of individuals during “wellness checks.”
Photograph of Alouette Correctional Centre for Women via BC government
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