Would Mandatory Treatment Work?

Mandatory Treatment – Would That Work?

When it comes to the toxic drug crisis in British Columbia, mandatory treatment might sound like a silver bullet – a simple, straightforward solution to a complex and devastating problem. Like trying to fix a leaky faucet with a simple pipe wrench, it seems like a no-brainer. But, as with many things in life, the reality is much more complicated. In Canada, our Charter of Rights and Freedoms is like a sturdy umbrella, designed to protect us from the storm of overreach and ensure our autonomy. The idea of mandatory treatment rubs against the grain of these protections. It begs the question: Can we, or should we, force someone into treatment against their will?

The Ethical Quagmire

First, let's wade through the ethical muck. Imagine someone is swimming in a river. Do you have the right to yank them out just because you think it’s unsafe? We could stand by and watch in case they needed our help. We might even post a sign to swimmers to be careful. We could rope off a safe area or even have life-saving equipment nearby. Maybe even hire a lifeguard. All great harm reduction strategies. However “yanking” would be decidedly a bad idea,

Forcibly pulling them from the water would most likely get us an assault charge. If they started to obviously call for help, then we could act. Now you are probably thinking, “But people with serious opioid addictions are drowning.” - Perhaps, in your opinion, however, the critical factor here is: Are they mentally incompetent to make choices for themselves? Are they aware of their choices, no matter how destructive we think they might be?

Mandatory treatment raises similar ethical dilemmas. Forcing someone into treatment can feel like stripping away their dignity and autonomy – fundamental elements of personhood. It's akin to saying, "We know what's best for you, better than you do." The moral waters get murkier when we consider the potential trauma that can arise from such forceful interventions. People struggling with addiction often have deep-seated issues already, and the abrupt compulsion to undergo treatment will worsen their trauma, rather than heal it. Relapse is almost inevitable, so we need to seriously think about what will be achieved when we consider mandatory options.

If you can understand your situation, your right to choose health treatment is a fundamental right in Canada. No different than if you decided to stop taking your heart medication or insulin. You might even choose to keep on smoking after a serious heart attack. Probably not seen as the brightest choice in the minds of those around you, however, it is your right, your choice.

The BC Mental Health Act

Some may point to the BC Mental Health Act and argue that we already have mandatory treatment for individuals with severe mental health issues, so why not extend this to those with substance use disorders? However, the situations are fundamentally different. The BC Mental Health Act is designed to intervene when an individual's mental state poses an imminent risk to themselves or others, often due to severe psychiatric conditions such as schizophrenia or severe psychosis disorders. This act is a last resort, used only when someone's ability to make decisions is SEVERELY impaired.

You might be still thinking “Well, yeah, I get the mental health mandatory options are specific to people not in touch with reality, but aren’t people with substance disorders the same?” Substance use disorders, while serious and sometimes life-threatening, do not typically render people unable to make decisions in the same way severe mental illnesses can. Addiction often involves complex, conscious behaviours and choices, even if those choices are heavily influenced by dependency. Obviously, using the same framework for mandatory treatment in addiction cases would lead to overreach and misapplication, failing to respect the nuanced nature of substance use disorders.

The Legal Labyrinth

Legally, the Canadian Charter of Rights and Freedoms stands as a formidable guardian of individual choice. Section 7 of the Charter states that everyone has the right to life, liberty, and security of the person. Forcing someone into treatment without their consent can be seen as a direct violation of these rights. It's like trying to navigate a labyrinth where the walls are made of legal precedents and human rights. Those walls are there for a reason. Our rights in Canada protect all of us and are not to be changed or trifled with lightly.

Would It Work Anyway? – The Science

While it might seem like a good idea to make treatment for substance use disorders mandatory, research shows that it doesn't work well anyway. When treatment is forced, it can create a negative relationship between the person and their healthcare providers. This can make the person less likely to actively participate in treatment and more likely to drop out or relapse. Studies have shown that people who are forced into treatment do far worse than those who choose to go on their own. This means that it's important to focus on treatments that people want to participate in and that are based on evidence. By addressing the underlying issues that contribute to substance use and offering accessible and voluntary treatment options, we can improve outcomes and help people achieve long-term recovery.

Alternative Solutions

So, if mandatory treatment is a rocky road, what are our alternatives?

1. Harm Reduction: Think of harm reduction as giving someone a life jacket instead of forcing them to swim to shore. This approach doesn't demand sobriety but focuses on minimizing the negative consequences of drug use. Supervised consumption sites, needle exchange programs, and providing safe supply are vital components of this strategy. These programs keep people alive until they are ready to choose recovery.
2. Peer Support: Sometimes, the best lifeguards are those who have been in the water themselves. Peer support programs leverage the experiences of those who have overcome addiction to help others navigate their recovery journey. This creates a sense of community and understanding that can be incredibly powerful.
3. Voluntary Treatment Programs: Making treatment accessible and appealing is crucial. The biggest problem we have in BC today is the lack of timely access to detox and recovery. When a person with a substance disorder is ready, access to detox/recovery has to be in hours, - not weeks or months. We need voluntary programs that offer a range of services – from detox to long-term rehabilitation – and emphasize patient choice can be more effective. It's like offering someone a map and compass, rather than dragging them along the path.
4. Mental Health Support: Often, addiction is intertwined with mental health issues. Providing comprehensive mental health care can address underlying issues that contribute to substance use. This holistic approach can help individuals find stability and purpose, much like building a solid foundation for a house.
5. Social Support and Housing: Stable housing and social support can act as a safety net, preventing people from falling deeper into addiction. Programs that provide affordable housing, job training, and social services can help individuals rebuild their lives, brick by brick.

Wrapping Up

In the end, addressing the toxic drug crisis in BC isn't about finding a quick fix. It's about understanding the complexity of addiction and respecting the rights and dignity of those affected. Mandatory treatment might seem like a straightforward solution, but it's a path fraught with ethical, legal, and practical obstacles.

Let’s not put the cart before the horse – even if we decided on mandatory treatment, the problem is we don’t have enough timely detox/recovery resources as it is. Where would we send those mandated people? It’s by far better to put in place timely detox/recovery resources and offer people easy access when they’re ready. Let’s try that first!

Let’s focus on creating a compassionate and comprehensive support system that empowers individuals to seek help on their own terms. By doing so, we can offer a hand-up, rather than a handcuff, to those struggling with addiction.

The Author: Ron Merk – Ron advocates for people and families experiencing concurrent disorders.