Opinion: Evidence lacking for involuntary addiction treatment success

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Involuntary treatment for individuals with substance use disorders is becoming increasingly considered and implemented across Canada.

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British Columbia has already implemented such legislation, and the government of Alberta announced its plans for involuntary treatment, which they are coining “compassionate intervention.”

Since 2016, opioid-related harms alone have resulted in over 47,000 deaths in Canada, and use of other substances have resulted in substantial hospitalizations, deaths, criminal incidents and economic costs.

Given the significant harms and costs related to substance use, involuntarily ordering individuals at high risk seems like a logical solution, right?

Before you decide, it is crucial to see what the research says. Does involuntary treatment work any better than voluntary treatment? If it works, is it worth violating someone’s inherent human rights?

At first glance, the logic behind involuntary treatment appears sound: if a person’s substance use poses a risk to themselves or others, forcing treatment seems like a necessary intervention.

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Advocates for involuntary treatment certainly argue that it is a necessary last resort for those who do not address the severity of their condition.

Yet, several studies argue that before involuntary treatment is utilized, voluntary treatment options must first be offered and prioritized, be readily available and accessible in the community, and provide wrap-around supports that address other factors such as poverty and housing.

Canada’s current voluntary system of care is already struggling to support those actively seeking addiction treatment, which highlights its lack of sufficient infrastructure. As a result, expanding involuntary treatment could create further strain on our resources, exacerbating our current public health crisis.

This raises a practical concern: are we prioritizing forced treatment over strengthening the very system that could support people before they reach a crisis point?

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Another striking theme of findings across several studies show that involuntary treatment can increase the risk of overdose following treatment, due to lowered drug tolerance levels.

Furthermore, some involuntary programs do not provide supports for evidence-based aftercare, such as medication assisted treatments (i.e. methadone and suboxone programs). This highlights a lack of evidence-based approaches and inconsistent treatment practices within such programs.

This raises an urgent question: are we prioritizing appearances of action over effective solutions that are evidence based?

Beyond its practical limitations, involuntary treatment raises serious ethical and human rights concerns. It fundamentally challenges autonomy — the right of individuals to make decisions about their own health care — protected under the Canadian Charter of Rights and Freedoms.

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If we don’t force individuals to undergo treatment for other health concerns, should we really expect someone to undergo addiction treatment, effectively criminalizing a health condition?

Moreover, research shows that challenges to autonomy increases resistance to change, which may increase one’s risk to return to substance use and erode trust in the health-care system. Rather than alleviating the crisis, involuntary treatment may drive people further from the support they need.

Almost 20 organizations in B.C. have raised concern or advocate against involuntary treatment for substance abuse, including the Canadian Mental Health Association and B.C. Association of Social Workers. Critics suggest that such policies risk disproportionately targeting and harming marginalized communities.

Some have even drawn a parallel between colonialism and the expansion of involuntary treatment in Canada. People who are most vulnerable are at an increased risk of experiencing involuntary treatment, which raises concerns about discrimination under the guise of public health.

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So where does that leave us? Addressing the harms of substance use and addictions requires thoughtful, evidence-based responses. Involuntary treatment, while politically appealing, carries significant risks and pitfalls.

Rather than doubling down on coercion, policymakers should focus on expanding voluntary, accessible and culturally responsive care. If we are serious about addressing the harms of substance use, we must be equally serious about respecting the rights and realities of those most affected.

Involuntary treatment may offer the illusion of control, but true progress lies in policies that prioritize compassion, choice and evidence. Anything less risks worsening the very crisis we seek to resolve.

Sarah Seebach is a registered social worker, a certified Canadian addiction counsellor and an instructor for the Mental Health and Addictions Counselling Program with Saskatchewan Polytechnic.

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