Forced treatment for addiction can undermine trust and leave youth at risk of overdosing, B.C. researchers warn

No one can fault parents for making every attempt imaginable to help a child who has become addicted to drugs, but some efforts have a risk of unintended consequences, a new paper cautions

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      Several times during my reporting on B.C.'s opioid epidemic, parents have told me that they would forcibly restrain their child if they thought it could save them from a fatal overdose.

      No one can fault parents for making every attempt imaginable to help a child who has become addicted to dangerous drugs like cocaine or heroin. Parents' feelings of desperation are completely understandable, especially since the arrival of the synthetic-opioid fentanyl significantly heightened the risks of using drugs purchased on the streets.

      But should parents be allowed to force a child into treatment for an addiction to drugs? Should B.C. allow the use of physical coercion and restraint to ensure that someone under the age of 18 attends and remains in a drug-treatment facility?

      There is coherent logic behind the suggestion. Children under the age of 18 are still the legal responsibility of their parents. And by forcing a child addicted to drugs into treatment, it is likely they will stop using drugs in such a facility, at least for as long as they remain there. Parents could therefore reduce the risk of their child suffering a fatal overdose if they could be allowed to force them into a treatment facility, one would think. And, regardless of the child's initial willingness to stop using drugs, perhaps during the time they spend in forced treatment, they might come to change their mind and decide they are ready to stop using drugs.

      With 1,452 fatal overdoses in B.C. last year, these are very important questions. Unfortunately, a paper published in the Canadian Medical Association Journal (CMAJ) yesterday (October 15) suggests there are no easy answers and, if treatment is going to work over the long term, an individual addicted to drugs has to want it.

      "In response to the ongoing overdose crisis and its effect on young people, British Columbia has been considering following the lead of other provinces and implementing secure care legislation, which would permit the apprehension, detention and forced treatment of youth who are engaged in high-risk substance use," it begins.

      “In a systematic review of studies on court-mandated treatment, authors found that 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."

      Titled "Secure care: more harm than good," the report was coauthored by Dr. Perry Kendall, who served as B.C.'s provincial health officer from 1999 to January 2018, and a trio of researchers with the B.C. Centre on Substance Use and Simon Fraser University. It warns that forcing youth into treatment can actually increase the likelihood that they will suffer a drug overdose.

      "Restricting the liberties of youth to protect them from overdose and other drug-associated harms is a flawed approach and may have unintended consequences," the report reads.

      "Existing evidence suggests that mandatory addiction treatment does not lead to significant improvements in substance use outcomes and can be destabilizing, increasing the risk of subsequent overdose," it continues.

      "Coercive approaches to substance use risks undermining trust and our ability to connect youth who live with intergenerational, childhood or institutional trauma with the health and social services they need most."


      As an alternative, Kendall and his coauthors—Andreas Pilarinos, Danya Fast, and Kora DeBeck—stress the importance of trust and relationships with children using drugs.

      "Instead of resorting to coercive measures, providing coordinated addiction treatment services across a continuum of care would better combat the current overdose crisis and drug-related harms," the report reads.

      "Until we restructure our institutions and make the necessary investments in early interventions so that all families and youth have the emotional, social and material supports needed to flourish, secure care should not proceed," it continues. "In the short term, investing in accessible, evidence-driven interventions and building meaningful connections with youth will serve to protect their health and safety better than will the belief that legislated coercion can be used to 'fix' them."