Involuntary treatment of drug addicts the Alberta election issue the rest of Canada is watching

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Alberta is entering election season, and an unlikely issue could prove crucial: The United Conservative Party’s plan to force chronic drug addicts into treatment, a bold but controversial measure that could have resonance for provinces across the country struggling with street violence and disorder.
The Compassionate Intervention Act — whose existence was first revealed earlier this month through an access to information request — would be Canada’s first legislation laying out a path to push an addict into treatment against their will. Although coerced treatment currently exists for criminal offenders or the severely mentally ill, this would apply specifically to chronic addicts believed to be at immediate risk to themselves or others.This is happening at a time when Alberta’s next door neighbour is championing “safe supply.” British Columbia, conversely, has become the first jurisdiction in Canada to decriminalize personal amounts of hard drugs.

“Addiction is a progressive illness, and there is virtually no addict that makes a change in their life without some measure of intervention,” said Marshall Smith, chief of staff to Alberta Premier Danielle Smith.

And it’s something he says with some experience. After Smith began his career as a staffer for B.C. premier Gordon Campbell, an addiction to cocaine and then meth led him to four years on the streets of Vancouver in the mid-2000s. He’s credited his recovery to a Vancouver Police officer who offered him either jail or a spot in a Maple Ridge treatment centre. That, and his body was deteriorating so rapidly he was having trouble walking down the street.

Addiction is a progressive illness, and there is virtually no addict that makes a change in their life without some measure of intervention

Since 2019, Smith has overseen Alberta’s massive reorientation towards a treatment-centred model of addictions care, an approach that advocates are now calling the “Alberta model.” It’s involved the opening of “recovering communities” all across the province, along with an overarching focus on getting addicts off drugs. In 2021, the Alberta government was saying they had managed to open 8,000 new addiction treatment spaces, and had removed all pre-existing user fees for accessing them.

“For too long, public health policy on addictions has been monopolized on a single-minded approach and that involved in part setting up drug-consumption sites — consumption sites that are at best about managing addiction rather than treating it,” said then Premier Jason Kenney in 2020 when announcing the first tranche of new recovery centres.

Critics have referred to it as “American-style prohibitionism,” but the idea is to measure success in terms of addicts getting clean, rather than on the usual indicators such as overdoses averted or Naloxone kits distributed.

It hasn’t been cheap: Just this year, Alberta earmarked $275 million for addiction and mental health treatment. Safe consumption sites are still there, but they’re more tightly regulated than in B.C., and with a definitive focus on pushing users towards detox and treatment.

Overdose deaths in Alberta are still incredibly high; 1,630 Albertans died of drug poisoning in 2022. But it’s one of the only places in Canada where overdose fatalities are trending downwards. In the first 11 months of 2022, Alberta saw 1,443 drug fatalities. In that same period in 2021, they’d hit an all-time high of 1,842.

In B.C. last year, toxic drug deaths hit 2,272, with no sign of slowing down.

The Compassionate Intervention Act, which wouldn’t be introduced until after the May 29 election, would see the province operate drug courts outside the criminal system to which police could refer an addict. Where the involuntary part comes in is that the courts can be petitioned for a mandatory treatment order by a close relative or official such as a doctor, nurse or child protection officer.

“If they believe you are in imminent danger to yourself or others, they can make a quick application to the drug court to have the individual apprehended and brought before a judge,” said Smith. That judge could then make a treatment order.“We think that this is the most compassionate way to try to address this problem because we’re watching people slowly killing themselves on the street and we’ve got to draw a line and say we’re just not going to let that happen anymore,” is how Premier Danielle Smith described the program this week in an announcement at the Enoch Cree First Nation. She was there to announce $30 million for a 75-bed drug recovery facility build on Enoch land.

“The notion behind it is a last resort,” said the premier.

It would be based largely on the Portuguese model. Portugal’s approach to addiction is known largely for how the country decriminalized all personal-use possession of drugs starting in 2001.

Less known is how Portugal paired this with a strict system of compelled treatment. Anybody caught with drugs is referred to a Commission for the Dissuasion of Drug Addiction, where a panel of health professionals recommends treatment – and can levy fines and other civil consequences in cases of non-cooperation.

The Alberta system would also have a completely parallel version staffed and managed by Indigenous groups. Not only are Alberta First Nations overrepresented among addiction drug users, but the community has a bad history with programs of government compulsion.

In 2019, just before the Canadian addictions crisis soared to all-time highs as a result of COVID-19 lockdowns, an Angus Reid Institute survey found that 85 per cent of respondents were in favour of some form of “compulsory” drug treatment.

Respondents were divided on other issues related to the addictions crisis. Most respondents opposed a blanket “decriminalization” of all drugs, and there were noticeable divides in support for “supervised injection sites.”

But almost everyone backed some move towards forcing addicts into treatment. Even 87 per cent of NDP voters liked the idea. And this wasn’t a group to which addiction was some distant abstraction; roughly one fifth of them reported knowing someone who had been “dependent” on opiates.

It’s a stark contrast to how Canada has largely chosen to run its addictions policy. Starting in Vancouver, the country has leaned into a model of “harm reduction” — the idea of curbing drug deaths by providing clean drugs and a safe place to use them.Officially, B.C. calls its strategy the “four pillar” approach: Attack addiction through a combination of prevention, treatment, enforcement and harm reduction. But in practice, it’s the last pillar that’s gotten most of the attention.

I don’t think you can explain the Downtown Eastside if you think policymakers have been pursuing recovery,

BLAIR GIBBS

And for 20 years, the showcase for the policy has been Vancouver’s Downtown Eastside.

“I don’t think you can explain the Downtown Eastside if you think policymakers have been pursuing recovery,” said Blair Gibbs, a Vancouver-based member of the Stanford Network for Addiction Policy. He’s also a member of Alberta’s Recovery Expert Advisory Panel.

Said Gibbs, “everything about the Downtown Eastside works against that goal.”

A latticework of more than 200 government-funded agencies exist to supply addicts with everything from meals to blankets to pet food. Hundreds of millions of dollars have been put towards low-barrier, single-room housing. The City of Vancouver actively subsidizes a local “street market” well-known as a hub for stolen goods. Sidewalk tent encampments are so entrenched that fires and explosions caused by ill-tended propane tanks were becoming an almost daily threat to nearby businesses.

The neighbourhood even has a reduced speed limit to accommodate the semi-frequent incidents of people darting into traffic.

Gibbs is a transplant from the United Kingdom, where he worked as an advisor to Boris Johnson, the London mayor turned Conservative prime minister. Britain has plenty of neighbourhoods plagued by injection drugs, but not like this. “There is no way that a European city would allow a neighbourhood like this to deteriorate as much as it has,” said Gibbs.

Whenever the harm reduction model has been pitched to lawmakers, it was always argued that it was merely a first step in an addict’s journey of getting clean.

But the implementation has been somewhat different. The treatment numbers have not materialized, if they’re being tracked at all. As noted in a 2012 thesis documenting the experience of nurses at the facility, Insite has had no qualms about helping people administer their first-ever hit of an injectable opioid. “Even though I want to tell them to ‘run out of there! It’s important that I give them a really good experience so that they come back and when they have their crisis … they come to us,” said one nurse after supervising the injection of a young woman who was new to the Downtown Eastside.

Particularly over the last 10 years, B.C. has dramatically expanded the number and scope of sites offering some form of “safe consumption.”  But detox and treatment is a different story. Last August, after a 49-year-old Victoria man died of an overdose in a sidewalk tent, his sisters told the Times Colonist that he had recently sought detox, only to be told there was an 111 day wait.

Earlier this year, while the B.C. government was touting its decriminalization of hard drugs, they admitted that they didn’t actually know how long the wait times were for a treatment bed. “Access to waitlists is something that we, at some point, need to be in a better position to respond to,” Jennifer Whiteside, B.C.’s Mental Health and Addictions Minister, told reporters.

It’s not an accident that Canada’s two competing visions of addiction policy happen to be right next to each other.Alberta and B.C. share many of the same supply lines for illicit drugs, and each has a rate of overdose deaths well beyond anything else seen in Canada. But if Alberta has charted a different course on drugs from its West Coast neighbour, it’s in part because B.C. provides a ready model of how much worse things can get.

“Anywhere that this philosophy has taken hold has been disastrous,” said Smith. “There’s a social libertarian activist view that dominates those services — they don’t believe that they should be speaking to drug users about treatment and recovery, they believe that it’s oppressive,” he added.

I fundamentally disagree with the idea that it is respectful of someone’s liberty and human rights to release them into the street to die of an overdose

DAVID EBY

In the weeks before he was sworn in as B.C. Premier, David Eby made headlines for suggesting that B.C. wouldn’t be able to tame its overdose crisis without some level of “involuntary” treatment for chronic drug users.

“I fundamentally disagree with the idea that it is respectful of someone’s liberty and human rights to release them into the street to die of an overdose,” Eby, a former street-level activist in the Downtown Eastside, told Postmedia in August.

But he’s since softened the proposal amid pushback from drug user advocates. “Involuntary treatment — for any community — is a harmful and degrading intervention at odds with healing, wellness, and best practices,” read a paper by Pivot Legal Society, which happens to be Eby’s former employer.

According to Smith, who has strong feelings on the subject, it’s this entrenched dogma that’s one of the biggest barriers to any kind of innovation when it comes to Canada’s worsening overdose crisis.

When Prime Minister Justin Trudeau visited the province last year, he said Alberta’s drug policy was an affront to “science.” “It’s unfortunate to see Alberta seems to be going in the opposite direction away from a science-based, harm-reduction approach,” he said.

When Alberta hosted an international conference on drug treatment in February, it was met with protesters. “There’s actually people here protesting recovery,” said one delegate from California, former addict Tom Wolf.

Said Smith, “this has spiralled into almost a religion for a growing field of people.”

Involuntary treatment of drug addicts the Alberta election issue the rest of Canada is watching
Involuntary treatment of drug addicts the Alberta election issue the rest of Canada is watching

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