As the toxic drug crisis continues to claim thousands of lives each year – fueling the perception that existing measures are failing – the notion of involuntary treatment is gaining political traction.

In Canada, there is a growing number of political leaders who are proposing to force people into drug addiction treatment, even though a recent research review found inconclusive evidence about its effectiveness.

Some addiction medicine experts caution against resorting to forced treatment as an easy answer to a complex health and social problem.

“It’s a response to seeing the pain and suffering in front of you and saying, ‘I don’t want to have to see this, so let’s make sure this is out of the way,'” said Dr. Anita Srivastava, MD . director of addiction medicine for Unity Health in Toronto.

“I think it’s a frustrated response to a problem that (people) perceive as having no real solution,” Srivastava said in an interview. “I don’t think it will work, but I can understand where it might come from.”

Others believe that involuntary treatment must be one of the available options given the urgency of the crisis. More than 47,000 Canadians died from toxic opioids in 2016, according to latest federal report figures published in September.

CLOCK | Can forcing people into addiction treatment help solve Canada’s drug crisis?

Is forcing people into drug treatment the right way to go?

As Canadian cities grapple with an addiction crisis, a growing number of politicians are proposing involuntary drug treatment as a solution, but as CBC’s Mike Crawley explains, the evidence is far from clear that forced care is the right way.

“More research is needed”

A task force created by the Canadian Society of Addiction Medicine recently reviewed worldwide research on the effectiveness of involuntary treatment. The task force reviewed 42 studies from around the globe and published them report in 2023 in the Canadian Journal of Addiction.

Of the 22 studies it found comparing involuntary versus voluntary treatments, 10 reported negative outcomes of involuntary treatments, five found no significant differences, and seven found improvements, mostly in treatment retention . Only one of the seven found a reduction in substance use after treatment, and this was not sustained over the long term.

“There is a lack of high-quality evidence to support or refute involuntary treatment for (substance use disorders),” the report concluded. “More research is needed to inform health policy.”

The review also noted the difficulty in drawing conclusions about what worked because the quality and types of treatments offered – especially in the US, China and Canada – varied widely.

Despite this lack of evidence and the call for more research, there is no shortage of politicians suggesting involuntary treatment as a policy option.

Forcing people to undergo addiction treatment has recently been floated by various parties British Columbia and New Brunswick provincial electoral campaigns.

In OntarioBrampton Mayor Patrick Brown is calling on the provincial government to launch a pilot project to allow involuntary drug addiction treatment in his community.

The province that is closest to moving forward with forced treatment is Albertawhere has Premier Danielle Smith’s government promise legislation.

It requires a change in legislation

Under Criminal Codecourts cannot compel anyone into drug treatment, but they may offer it in certain cases as an alternative to a prison sentence, with the threat of jail time if the person fails to complete treatment.

Provincial mental health legislation across Canada allows for involuntary psychiatric treatment if a doctor believes a person is a danger to themselves or others. Forcing people to seek addiction treatment would require a province to amend its health care consent legislation.

Keith Humphreys, a professor of psychiatry at Stanford University in Palo Alto, California, who chaired the Alberta expert advisory panel on addiction recovery, believes that involuntary treatment must be part of the drug crisis response arsenal.

“We have to be realistic about the fact that addiction is a chronic disorder,” Humphreys said in an interview.

“When we talk (about) forcing people into treatment, we should remember that there really aren’t many people who would spontaneously wake up in a tent and say, ‘I don’t want to ever use fentanyl again.’

Calls for forced treatment are gaining momentum, in part, because of the perception that the current harm-reduction approach to the drug crisis is failing.

There is not enough voluntary treatment available

However, opponents of forced treatment argue that what is really to blame is the increasing potency and toxicity of the illicit drug supply – drugs have become stronger, more addictive and more deadly than when heroin dominated the street trade.

Dan Werb, executive director of the Center for Drug Policy Evaluation at St. Michael of Toronto, says those who advocate for forced treatment assume that the person who is addicted is to blame.

“The scientific evidence to support (involuntary treatment) as an effective approach is simply not there,” he said in an interview.

Werb was the lead author of a 2015 review of research on the effectiveness of mandatory drug treatment, published in International Journal of Drug Policy. Of the nine studies reviewed at the time, only two showed that mandatory treatment had a positive impact on relapse and drug use.

Werb and his co-authors concluded that policymakers should prioritize investment in voluntary treatment programs. However, he says Canadian governments are not putting enough resources into such programs.

“We have this massive gap between the number of people being referred for treatment and the ability of the treatment system to meet that demand,” he said.

Dr. Katie Dorman, a family physician at Sumac Creek Health Center in Toronto who has worked in addiction medicine for much of her career, says there are far too many barriers to voluntary treatment, including long waits and restrictive criteria.

“I think it’s absurd that we’re talking about involuntary treatment when there are so many people who want care who can’t access it,” Dorman said in an interview.

Alberta’s wait time is much shorter than Ontario’s

For intensive residential treatment programs – designed for people with chronic substance use – statistics provided by the Ontario Ministry of Health show the average wait time is 16 days for assessment, then another 72 days for admission.

In Alberta, the comparable wait time to begin residential treatment ranges from 20 to 37 days, according to figures from the province’s Ministry of Mental Health and Addictions.

The Alberta government has dramatically increased its publicly funded drug treatment program since 2019, adding 7,700 detox spaces and over 2,700 residential treatment and recovery beds, an increase in total capacity of over 55%.

“Everything about the Alberta model is really about getting people off drugs,” said Marshall Smith, a former (but unrelated) chief of staff to the premier, in an interview in October at a newly opened recovery facility in Gunn, Other. , about 90 kilometers northwest of Edmonton.

While Smith says it’s critical that voluntary drug treatment is readily available, he also believes there is a role in forcing people into treatment.

“Is it better to have involuntary care or to let someone languish in a tent by shooting fentanyl down their throat under an overpass with the threat of death?” Smith said. “I’d say it’s more effective than that any day of the week.”

His perspective is informed by personal experience. Smith has spoken publicly about how he spent four years homeless in Vancouver, addicted to methamphetamines. He traces his recovery to an ultimatum received from the police.

“They basically told me, ‘Go to treatment or go to jail,'” he said in his interview with CBC News. “I chose treatment and haven’t looked back since.”