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A recent opinion column in the Calgary Herald, Compassionate intervention for addiction saves lives, discussed how decision-makers may be able to use the legal system for behaviour change for people with addictions. 

The column asserts the evidence for “compassionate intervention is clear”, but the reality is not so black and white. The column presents some significant gaps in terms of application and summary of the evidence. 

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The column references a 24/7 sobriety program as evidence for the efficacy of “compassionate interventions” or mandatory treatment. It refers to this program, which mainly focuses on people who have committed crimes related to alcohol including domestic violence and drunk driving, and applies it to a separate population – individuals who use recreational drugs who may or may not have committed additional crimes. Trying to draw conclusions from this program to the current issue is like comparing apples to oranges. Outside of the completely different population, the authors only state the program “might have some public health benefits” and is thus far from clear.

Looking at the academic literature on involuntary treatment (compassionate intervention) shows limited, short-term gains at the cost of long-term harm. Data from similar policy implementation in Massachusetts suggests that individuals who are placed in involuntarily treatment are 2.2 times more likely to experience a drug poisoning event or ‘overdose’ after release. In the most recent study out of the United States, all patients who received involuntary treatment had returned to substance use after release and had at least one emergency department visit. All this to say this critically undermines the argument that involuntary treatment is a form of “compassionate” care. 

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In addition, the piece makes the argument that efforts against the will of people who use drugs to help them is an ethical response. The column states that “the proper response to someone dying of an opioid overdose would be to ignore them, because an unconscious person cannot consent to a life-saving dose of an overdose-reversal drug.” This argument presents a fatal flaw which is that people who use drugs would want to die from their overdose and thus naloxone administration is against the will of individuals. In contrast to the implication, people who use drugs can make their own informed decisions regarding their health.

While they are considered “compassionate” interventions, the proposed strategy violates the rights of Albertans and Canadians and perpetuates systemic racism within both the carceral and health-care systems. For many reasons, including but not limited to intergenerational trauma from the legacy of residential schools, First Nations people are at disproportionately higher risk of fatal drug poisoning. Therefore, not only would involuntary treatment bear a resemblance to the involuntary institutionalization of Indigenous peoples within residential schools in addition to the child welfare system, but it would also contribute to the continued systemic racism which disproportionately impacts this community. Mandatory treatment undermines individuals’ autonomy, dignity and fundamental right to make decisions regarding their health. 

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Lastly, the argument is made that without these interventions we are “leaving Canadians who are addicted to die on the streets from drug overdose.” This disregards the hard work of public health officials regarding interventions – backed by scientific evidence – for people who use drugs, namely housing-first initiatives, evidence-based voluntary addiction treatment and harm reduction programs. One program which encourages people who use drugs to access treatment is contingency management, or incentivized treatment, which has continued to demonstrate positive results.

Undoubtedly, more needs to be done to combat the rising death toll of Albertans and Canadians, and doing so in an ethical and evidence-based manner is key to addressing this crisis.

William Rioux is a medical student at the University of Alberta and a drug policy advocate.

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