If a person is using drugs, should the government force them to accept treatment?

The recently re-elected premier of British Columbia, David Eby, thinks so. So does Alberta Premier Danielle Smith, who has made forced treatment a centerpiece of her party’s approach to the province’s growing mental health and addiction crisis. Even federal Conservative Party leader Pierre Poilievre has come out in support of involuntary treatment in some form.

All across the country our political leaders are getting behind coercive intervention as the best possible response to the ongoing opioid epidemic. We are meant to believe that this is a bold, commonsense approach set to change everything.

But forced treatment is not new in Canada. It’s already an integral and growing part of our health care systems. Last year there were nearly 30,000 involuntary admissions under the Mental Health Act in BC alone, a staggering increase of 150 percent from 2005. Recent investigations point to similar increases across the country. Statistical analyses suggest that around one in five people attending services for addiction are obligated to be there by various juridical injunctions.

The question of forced treatment’s efficacy is already settled; despite its broad application it is having no discernable impact on the number of people living with and dying from addiction. By expanding the practice Canadian politicians are doubling down on a failing policy the rest of the world is leaving behind.

Coercive interventions have been the preferred response to substance use in many countries. When evaluated, these programs are documented to have success rates lower than four percent. Beyond their marginal benefits, forced treatment programs come with their own downsides, including heightened risk of fatal drug poisonings.

In Massachusetts, where involuntary treatment has been the law of the land since 2018, the state public health department found that the risk of fatal overdose was twice as likely compared to post-voluntary treatment.

Such findings have prompted China, Vietnam and Malaysia to begin moving toward voluntary programs and harm reduction services after years-long experiments with involuntary treatment.

A joint statement by regional World Health Organization offices and a collection of United Nations entities is clear on the matter:

There is no evidence that compulsory drug detention and rehabilitation centres are beneficial. […] Compulsory drug detention and rehabilitation centres need to be closed. Instead, voluntary, evidence-informed and rights-based health and social services must be implemented in the community.

Despite clear evidence and impassioned calls from public health experts, at least a few provinces are likely to move forward with some form of involuntary treatment. While proposals for a Canadian model of forced treatment remain poorly defined, we can get a pretty clear picture of our future by looking at the present.

It is fair to assume that wherever involuntary treatment comes into effect, new treatment resources will be needed. Existing investments in addictions infrastructure suggest that any forced treatment initiative will rely on an expansion of existing private health care resources to meet the legislated demand.

Addictions care has long been on the cutting edge of privatized health care. While national-level data on addiction services is hard to come by, regional information is telling. All nine safe use sites in Vancouver are operated by NGOs. Of the 12 residential treatment centres in Winnipeg, three are owned by private companies, seven are run by religious organizations or NGOs, and two are government operated health care facilities. In Edmonton, half of all medically supported detox beds are privately operated.

Churches and NGOs may not be anyone’s idea of big, scary, American-style private health care, but there are bigger fish in this pond. In Alberta, where forced treatment proposals have come the closest to becoming law, the province has been investing heavily in private treatment infrastructure. This has translated to eight-figure contracts between the provincial government and massive for-profit corporations.

A case in point: last year the Red Deer Recovery Community opened its doors. The provincially funded 75-bed treatment centre is managed by Edgewood Health Network, a for-profit health care company which operates 11 similar sites across Canada. For Edgewood’s services in Red Deer, the province has found itself dishing out $13 million a year.

With so much profit to be made, Bay Street has rushed to insert itself into the equation. Expecting huge returns, Peloton Capital Management (PCM), a billion-dollar Toronto-based private equity firm, began financing Edgewood Health Network’s expansion 2021.

While PCM investors collect interest payments, medical professionals are sounding the alarm on patient care. The privatization of Alberta’s addiction services, including the outsourcing of its data collection, has led to serious concerns about efficacy of the province’s treatment infrastructure.

Projecting these trends forward, forced treatment could mutate Canada’s addiction care systems into something like Mexico’s, where the vast majority of voluntary and involuntary clients find themselves locked away in facilities operating with little government oversight. These centres are described as “hybrid institutions composed of a 12-step approach, mental asylum, prison and church.” Studies found this privately operated, forced treatment system “not only did not translate into less drug use, but it inflicted violence and its deleterious consequences were still suffered even a year after the event.”

Decades of failed coercive rehabilitation programs and thousands of pages of scientific literature stand arrayed against the notion that involuntary treatment will ameliorate the addiction crisis. Ultimately, these programs do not work because they are focused on the symptom and not the disease. Addiction is a social sickness and forced treatment is an ineffective analgesic. Coercing drug users into private health care facilities does nothing to address the cause of widespread addiction and is incapable of stopping it.

To effectively respond to this crisis we must understand its roots. Societies turn to intoxicants when there is suffering without hope; when living conditions deteriorate and the conviction that things can improve becomes untenable. If we want to end this epidemic we must work to improve our material conditions. We must build a society that is able to provide for the basic needs of its people—inclusive of meaning, belonging, dignity, and hope.

Forced treatment will do little to benefit those who are struggling with substance use, and even less to prevent vulnerable people from falling into addiction. It is, however, poised to do a great deal for billion-dollar investment firms, multi-million dollar health care corporations, and shady treatment providers.

For Canadian politicians, that might just be enough.

James Hardwick is a writer and community advocate. He has over ten years experience serving adults experiencing poverty and houselessness with various NGOs across the country.