A commentary by the former chief coroner of British Columbia.
Premier David Eby recently announced plans to open highly secure facilities for people with long-term mental-health and addiction challenges.
The government’s news release states the plan is for individuals to be committed under the authority of the Mental Health Act.
There are also plans to introduce legislative changes to “ensure that people, including youth, can and should ensure care when they are unable to seek it for themselves.”
This announcement is both immensely unsettling and deeply ironic.
As properly observed by the province’s own experts in the report attached to the news release, there is no conclusive evidence for the effectiveness of involuntary care for those experiencing substance use disorders.
It is further acknowledged that such care may, in fact, do more harm than good.
It is concerning that our government is seeking to remove a person’s most basic rights to liberty and security of the person in order to impose care with no evidentiary basis.
More troubling still are plans to expand involuntary care at a time when the voluntary care many are seeking is virtually inaccessible.
The secure facilities will come at immense cost and are to provide involuntary care for 3,000 to 5,000 people annually, while government currently funds only about 3,600 voluntary care beds provincewide.
Confining people involuntarily when they’re unable to access care voluntarily cannot be justified.
Despite recommendations made by a B.C. Coroners Service expert death review panel in 2018, and reinforced by subsequent expert panels into this crisis, including the province’s own Select Standing Committee on Health, there continues to be no provincial regulation of addiction treatment services.
There are no provincial treatment standards, and no provincial requirements for reporting results.
While evidence-based substance use disorder treatment plays a critical role in resolving this public health emergency, treatment outcomes province-wide are unknown.
In fact, it might be that abstinence-based treatment programs contribute to our province’s drug toxicity crisis; a person who uses drugs after a period of abstinence is far more likely to die.
Clearly, the provincial regulation of addiction treatment services and the treatment industry is long overdue.
The reality is that about 225,000 people are using illicit substances in our province. About 100,000 are experiencing substance use disorder.
The majority of those who use drugs do so in private residences and out of the public eye. This is also where they die.
The unregulated drug market is chaotic and unpredictable, and drug toxicity, driven by illicit fentanyl, remains the leading cause of death in B.C. for those ages 10 to 59.
While evidence-based treatment is essential, it is clear that treatment alone is not going to be enough to address a crisis of this magnitude.
Recommendations from subject matter experts have repeatedly emphasized the need for a continuum of care and services in response to the toxic drug crisis.
This includes timely access to medical and mental-health services and supports, and the availability of safer alternatives to the toxic illicit drug market.
Most of the harms associated with illicit drugs are due to the toxicity and volatility of the supply. Ensuring a regulated drug supply would allow our governments to manage the market and remove it from unscrupulous profiteers in much the same way that they approach alcohol.
To be clear, regulation should not be confused with promotion. Clearly there are significant risks with consuming any psychoactive substance, including alcohol, and a provincial prevention and harm reduction strategy, that includes identification and education about harms, is essential.
Vulnerable members of our communities, many of whom are also the most visible on our streets, are experiencing immense challenges.
Too often they are living with long-term illness or injury or disease or trauma, and substance use is often a way to cope.
It is unconscionable to incarcerate those who are suffering when the supports that would have kept them well are inaccessible. The resources necessary to establish involuntary treatment would be far better expended much further upstream.
We must invest in a cohesive, evidence-based system of care and eliminate reliance on the toxic illicit market. The unregulated drug trade is flourishing, and it relies on recruitment of new purchasers.
This crisis is complex, and that complexity requires creation of a comprehensive plan that includes access to medical care, mental health supports, housing stability and drug regulation.
Not only is it indefensible to deprive people of their most fundamental rights when the health measures that would keep them safe are unavailable, it will do nothing to bring this crisis to an end.
