“It’s a really simple recipe — the province has to treat addiction faster than it creates it.”
–Marshall Smith
Premier David Eby’s switch to support involuntary care this week has put British Columbia in an unusual position: Both the NDP and Conservatives are now in agreement on a key social issue.
The two parties broadly support developing a new legal framework and system to provide mandatory treatment to those with concurrent severe addictions and mental health disorders. Which means, no matter who wins the election on Oct. 19, the province is moving in this new direction.
For advice on what the next government should consider, British Columbia can look to Alberta, which is blazing a national trail on the issue.
“It’s great both of the parties have committed to moving forward with something like this,” said Marshall Smith, who is chief of staff to Alberta premier Danielle Smith and leading the redevelopment of that province’s addictions treatment system.
“However, the devil is in the details.”
A simple formula for success
In Alberta, reforms are underpinned by a $500-million promise to build 11 large new 75-bed treatment centres and recovery communities. Three are already open, with five more under construction, and five planned in partnership with First Nations. The province also scrapped user fees for beds.
Smith said the new facilities are better environments for recovery, purpose-built for the task, produce the best outcomes, and are cheaper than hospital beds.
The province also pulled support for ‘safe supply’ government drug programs, to refocus its efforts on treatment. That stands in stark contrast to British Columbia, which has the most permissive safe supply programs in the country and is the only province to experiment with decriminalization.
“It’s a really simple recipe — the province has to treat addiction faster than it creates it,” Smith said in an interview, saying he’d “urge jurisdictions to really overbuild” on treatment beds.
“The province has to treat addiction faster than it creates it.”
Marshall Smith
“If you don’t want people pooling up in tents and sidewalks, etc., you have to treat it faster than you make it.”
Treatment ‘the core’ of recovery-oriented system
The initial build up of treatment and recovery services occurred before Alberta announced it will introduce involuntary care legislation next spring, which it calls “compassionate intervention.”
The result, said Smith, has been been a 55 per cent reduction in opioid deaths during the first five months of this year, 41 per cent reduction in methamphetamine deaths, 50 per cent reduction in cocaine deaths and 59 per cent overall reduction in overdose deaths by any substance — all prior to involuntary treatment even landing on the floor of the legislature for a vote.
“Checking into a treatment centre and participating in that process, that will always be the core of what we do in a recovery-orientated system of care. However, we recognize there is a percentage of the population, many of whom are highly-visible in our streets and are on the news every night, who are very, very sick with addiction and multiple co-occurring issues,” said Smith.
“They are not going to wake up in the morning, throw open the drapes and exclaim today is the day I’m going to make a change. It just does not work like that.
“They are sick to the point where they are so dependent on potent drugs and complications they have simply lost the ability to make those rational healthcare choices for themselves. And as a result they are at extreme risk of death. And because of the situation they are in, they are causing tremendous upheaval in the community.”
‘This is for people on death’s door’
Alberta’s compassionate intervention program will involve people’s addiction situation being assessed by a three-person panel of commissioners, in a new quasi-judicial health commission.
“It’s not a courtroom, it looks more like family mediation, a boardroom table where they are going to sit down and have a discussion with the individual and say, ‘Rob, look, what is going on with you? Your family is incredibly concerned. Here’s what’s going on. Did you know you nearly died six times last month? Here’s the evidence. Rob, will you accept treatment today? We are offering it to you right now.’”
People could be referred to the commission by family, friends, police, social workers and other officials.
“This is not a process for people who smoke too much pot and leave their dishes in the sink.”
Marshall Smith
“We’re not building a process where you can just be snatched and just put into treatment,” said Smith.
“There is a mechanism of natural justice that has to apply.” That includes people having a right to independent legal counsel.
Eventually, the commission will give a person an order.
At first, it’s not confinement, said Smith. “They are not locked in there.”
But if a person’s situation worsens, or treatment fails, a person could eventually be ordered confined in a secure facility until they stabilize.
“This is not a process for people who smoke too much pot and leave their dishes in the sink — that’s not who this is for,” said Smith.
“This is for people who are on death’s door, daily, multiple times a day.”
BC NDP propose in-prison and regional treatment
British Columbia’s model has yet to be sketched out fully by either Eby or Conservative leader John Rustad.
Eby has proposed legal changes to allow both new regional community treatment facilities, in-prison secure treatment (which Alberta also has) and measures to confine vulnerable youth who are at risk of severe addiction.
“This is about making sure their safety, as well as the safety of the broader community, is looked after.”
David Eby
The idea has been opposed by some addictions experts. Civil rights advocates on Wednesday called on Eby to abandon the proposal, saying people have a right to refuse unwanted medical treatment and should not be arbitrarily detained against their will.
Eby called that “a fundamentally misleading construction of what we’re doing here.”
“We’ve got people in our streets, mentally ill, brain-injured, they’re addicted to some of the most addictive substances that humans have ever known, synthetic opioids and crystal meth, and they are seriously interfering with the rights of people in our communities through violent attacks, through making them feel unsafe, but also their own rights are profoundly violated if they can’t get the health care that they need,” he said.
“This isn’t about forcing people into a particular treatment. This is about making sure that their safety, as well as the safety of the broader community, is looked after.”
Conservatives support ‘compassionate intervention’
The BC Conservatives also call their involuntary treatment proposal “compassionate intervention,” and MLA Elenore Sturko said that’s by design to mirror the Alberta model.
“There’s far more people in this province right now that would voluntarily go into a therapeutic community and be supported to live and recover than people that would need to receive involuntary care,” said Sturko, a former Opposition addictions critic and the party’s candidate for Surrey-Cloverdale.
“And frankly, those resources do not exist in B.C.”
The Conservatives propose to boost treatment, as well as create secure units across the province.
Sturko said the NDP have had seven years to build out a treatment system, and have already twice proposed and backed away from involuntary care.
Eby dismissed civil liberties arguments by saying “rights and freedoms are balanced” and “it’s not an absolutely no intervention by government, any place, any time” world.
Alberta has been wrestling internally for more than a year with the legal intricacies of designing a compassionate intervention system that fits within people’s charter rights, said Smith. The province is happy to give it away to whomever wins the B.C. election.
“Alberta has put a huge amount of legal resources into designing this and we’re happy to give it away,” he said.
“So any of the things we’re doing in Alberta are available for jurisdictions across Canada.”