On June 23, the provincial government of British Columbia announced the first reading of Bill 22, a proposed amendment to the province’s Mental Health Act. It would allow people under the age of 19 who had been treated for an overdose to be detained in a hospital for between two and seven days, as a “stabilization period.” Although there are reports from credible sources that the Bill has been put “on pause” as of July 24, it is imperative that it be rejected altogether.
The stated intent of this legislation is to “keep youth safe immediately following an overdose” and support connection to culturally safe community care. This is a noble aim in a province that has just suffered its highest-ever monthly toll of overdose deaths—and also points to the critical need for investment in community-based services to support the needs of young people who use drugs.
But in practice, Bill 22’s proposed “emergency stabilization care” represents another way for British Columbia’s healthcare systems to fail youth—both through the denial of basic rights and the potential to cost lives.
The bill lays out the framework to determine how and when a youth experiencing “severe problematic use” may be detained against their will and submitted to forced treatment, as determined by a physician. The stated criteria for “severe problematic use” are wide open to interpretation—but not to consideration of the youth’s self-evaluation.
Section 47 of the bill states:
“…a youth who uses substances is engaged in severe problematic substance use if:
a. 2 or more of the following indicators are present in relation to the youth’s use of substance:
(i) neuroadaptation to the substance;
(ii) craving for the substance;
(iii) difficulty controlling use of substance;
(iv) use of the substance despite suffering harm in relation to that use, and
b. The youth’s use of the substance is likely to continue and to result in the death or severe disability of the youth.”
The breadth and obvious subjectivity of these indicators place all the power in the physician’s hands, stripping young people of agency.
Kali Sedgemore, an Overdose Prevention Site peer worker and youth outreach worker, and acting executive director of Coalition of Peers Dismantling the Drug War, told Filter of their concern that already-marginalized youth will be disproportionately impacted—“specifically, youth in care and Indigenous youth, who often don’t have any control in what goes on in their life due to social workers that make a lot of choices for them.”
Judy Darcy, BC’s minister of Mental Health and Addictions, lauded the amendment when she announced it, stating: “Experts are telling us this emergency measure is vital to ensure the immediate safety of young people in crisis.”
It is unclear, however, exactly who these experts are, and on what evidence they are basing their recommendations. As youth who advocate for sensible drug policy, this has become a primary concern for us.
“I am concerned there is the potential … for an increase in fatalities.”
Because we do know of a number of experts who have detailed shortcomings of Bill 22—including the current lack of voluntary treatment options for youth, an over-reliance on clinical and controlling settings to provide substance use services, and the lack of legal counsel and recourse planned for youth who are detained.
Lisa Lapointe, chief coroner of the British Columbia Coroners service, stated in a press release, “I am concerned there is the potential for serious unintended consequences as a result of these legislative amendments, including the potential for an increase in fatalities.”
Forcing anyone into detox will put them at great risk of another overdose, perhaps fatal this time, due to the likelihood of resumed use with lowered tolerance. “There is a dramatically heightened risk of withdrawal and fatal overdose following short-term detention,” Caitlin Shane, a drug policy lawyer for Pivot Legal Society, told Filter.
This could be even more the case for youth. “Being detained last time they [overdosed makes it] more likely [they] will be using alone, hiding their drug use, which we already know is problematic and the risk of fatal OD is likely,” Sedgemore pointed out.
With an increasingly toxic drug supply resulting in overdose deaths in British Columbia reaching record high numbers in both May and June, there are grounds to fear that Bill 22’s move to forced treatment would increase, not reduce, the number of overdoses among youth.
Interestingly, one way to reduce this risk was proposed by British Columbia’s child and youth advocate, Dr. Jennifer Charlesworth, in 2018. She recommended the implementation of youth-focused supervised consumption sites. This proposal actually addressed a key question unanswered by Bill 22: How can we strategically focus our resources on ensuring young people do not end up in the emergency room in the first place?
Legislators ignoring the recommendations of harm reduction specialists and substance use researchers with a direct connection to people with lived/living experience of drug use, including youth themselves, is nothing new. Nor is “emergency stabilization care”—a new string of words—really a new idea.
Kendra Milne and Laura Johnston of the BC organization Health Justice have described how this type of legislation has already been proposed and struck down a number of times—the result of opposition from several communities that had not been initially consulted, let alone asked to collaborate and advise.
Why then, for the fifth time since 2000, according to Kendra and Milne, have impacted groups not been consulted in this discussion?
Threat and support are simply not compatible.
If these groups had been consulted, they would have made clear how forced treatment could make bad situations worse for some youth. Sedgemore described one specific risk: “If the youth is street-involved or lives in a violent home, you’re putting the youth at risk for violence because they were gone for [up to] seven days.” In psychological terms, who would think that detaining youth in an unfamiliar place for up to seven days in an unfamiliar place represents “stabilization”?
This year has brought increasingly widespread recognition of the harms of the extent to which the criminal-legal system seeks to control, surveil and police people. But control masquerading as “care” has long characterized the healthcare system, too.
It is critical that we pay attention to the ways in which this system—among others—is structured. This has been apparent during the COVID-19 pandemic, as public health recommendations have turned into increasingly far-reaching power to control and discipline people through enforcement and fines.
During a recent panel co-hosted by Paradigma, an international coalition of youth drug policy organizations, and Canadian Students for Sensible Drug Policy, young people presented accounts of forced detention and the associated harms, which then made them distrustful of mental health services and unlikely to access them again.
Threat and support are simply not compatible. Shane noted that Bill 22 goes completely against the spirit of Canada’s 2017 Good Samaritan Act, a federal Bill passed to encourage people to call 911 without fear of detention or arrest for drug possession. The amendment “will almost certainly have a chilling effect on calls for emergency aid when an overdose does occur,” she said.
Imagine, as a young person, hearing about friends being forcibly detained for a week after an overdose. You might well hesitate to call for help during an overdose for either yourself or your friends.
Unsurprisingly, given this bill’s potential for harm, expressions of resistance aimed at Minister of Health Adrian Dix and Minister Darcy have garnered extensive support and raised awareness, encouraging those who are fighting to block or change it.
“This works counter to approaches that are inclusionary.”
Scott Bernstein, director of policy for the Canadian Drug Policy Coalition, told Filter: “I think the sentiment behind wanting to care for young people is a sincere one, but this legislation is problematic and there really is no evidence that involuntary treatment works.”
Bill 22, he added, “sets a wrong precedent and creates animosity among the public and the state with regards to treatment and services. This works counter to approaches that are inclusionary and work with youth who need help, rather than taking action against them.”
The Union of British Columbia Indian Chiefs, Health Justice, and the British Columbia Civil Liberties Association are hosting a live-streamed July 27 press conference to urge the provincial government to not just put the bill on pause but withdraw it completely.
Their critiques will address concerns such as involuntary detention, including use of restraints, without the consent of a youth or a parent/guardian; lack of comprehensive and meaningful engagement with Indigenous peoples, contrary to the principles of the United Nations Declaration on the Rights of Indigenous Peoples; the harmful impacts of coercive healthcare on youth who use substances during an overdose crisis; and the need to establish a comprehensive, voluntary system of substance use services throughout BC.