By Michelle C. Danda and Corey Ranger
On August 18, 2022, B.C. attorney general David Eby shared the following concern with Postmedia News.
“When someone overdoses twice in a day and they show up in the emergency room for the second time…in the same day, the idea that we release that person back out into the street to overdose the third time and die or to have profound brain injury or just to come back to the emergency room again, seems very bizarre.”
He further stated that “currently under our system…the intervention can only come once they’ve been seriously brain injured themselves through an overdose.” The solution that he proposes is involuntary care for people who use drugs “to make sure that they have a chance”.
Eby’s statements are inaccurate from both healthcare and human-rights perspectives.
It is false that healthcare interventions are only made accessible to people who use drugs after an overdose occurs.
Further, Eby’s statement suggests the best opportunity to help people who experience multiple overdoses is through forced treatment. Accessible, safe and supportive healthcare that offers a range of services from harm reduction to voluntary treatment are the best options.
Eby’s solution is problematic from a human-rights perspective. People use drugs for many different reasons and in many different ways. There is a pattern of paternalism and misinformation reflected in his statement that is strongly voiced by many who do not understand or care about people who use drugs.
A contaminated drug supply poses risk for death to all people who are forced to access the unregulated drug supply. But not all people who use drugs want (or need) treatment for their drug use.
And for decades there has been a scarcity of evidence-informed addictions-treatment programs available for people who want help. We continue to treat people who experience overdose differently from people who experience other critical and life-threatening healthcare issues.
Instead of replacing the volatile unregulated drug supply, providing stable housing, and meeting the basic needs of B.C.’s most oppressed and marginalized, future premier Eby wants to implement a one-size-fits-all fix of involuntary treatment.
Let’s be clear, this suggestion is not a humane response to drug poisonings.
The proposed BC Government legislation for involuntary treatment for youth following overdose was recently scrapped after extensive criticism from healthcare providers, families, and legal organizations. So why is this plan proposed as a pathway to treatment for adults?
General statements like creating “better interventions…that could include and should include involuntary care for people to make sure that they at least have a chance” are harmful. The “best chance to survive” for those who do not want treatment is to provide an accessible supply of drugs that are not contaminated with high concentrations of fentanyl, etizolam, and xylazine (among many others).
The Harm Reduction Nurses Association supports the idea that people who use drugs do not lose their human rights. The point of legislation that decriminalizes drugs is to prevent people from being incarcerated for their drug use. Detaining people in hospitals against their will is another means to legitimize prohibition and erodes the necessary trust that healthcare providers must nurture to ethically and safely provide care for people and communities.
Legislation that promotes forced treatment will disproportionately impact people who are already stigmatized and traumatized by the healthcare system, namely Indigenous people and people of colour. The Truth and Reconciliation Commission Call to Action #18 asks us to do better in recognizing the role of coercive policy in creating health inequity among Indigenous people and to align our future actions that uphold Indigenous peoples’ rights.
The intersection of racism in our healthcare system is a strong predictor of future harms if we do not implement clear safeguards for people interacting with the mental-health and substance-use system of care.
An important question that all of us must ask is, "What is the treatment offered within this legislation?" And, in a healthcare system that is currently limiting access to evidence-informed public-health interventions, a system with scarcity of primary-care providers and community-based clinics, and a housing crisis, what is the goal after people receive this involuntary treatment?
Another question that must be answered before charging forward with enacting legislation that enables forced treatment is, "Under what circumstances could forced treatment be beneficial to a person?" Karen Urbanoski, associate professor at the University of Victoria, posed this question in a 2016 blog post. We still don’t have an answer.
As nurses, we know that forced treatment breeds mistrust and decreases the likelihood that the individual will seek care in the future. The evidence demonstrates that relapse is common, and after periods of forced abstinence tolerance wanes. The risk for overdose death is high after discharge from treatment programs. That’s because involuntary detention and forced treatment is traumatic and does not address the root causes of an individual’s drug use.
A better solution might be increased funding for stable housing, accessible safe supply, and integration of comprehensive harm-reduction services within community organizations and healthcare services.
People are dying from drugs made toxic by criminalization and an absence of predictable, regulated drugs. People are dying from untenable living conditions, poverty, and oppression.
More punishment and coercion is not the answer.