FELICELLA: Involuntary care — another buzzword that won't solve the toxic drug crisis

If you pay attention to election cycles, you’ll see patterns emerge. Without fail, the low-hanging fruit of public safety gets picked immediately, in one form or another.

It’s so easy! Who would ever argue against public safety? And for the upcoming municipal vote in BC, the issue is paired with a new catchphrase: involuntary care.

Unfortunately, when it comes to public safety, involuntary care is unlikely to succeed beyond its utility as a political buzzword.

I spent decades living with active addiction, and I can tell you first-hand that while you can force someone into treatment, you can’t force them into recovery. That’s why I’m disheartened by the growing belief that involuntary care is an answer to the toxic drug crisis and the problems we see on Vancouver’s Downtown Eastside.

I understand why people are demanding action. Families see people they love disappear into addiction. Communities are dealing with very real challenges, including increased open drug use and crime. Front-line workers are exhausted. We all want to see more done to address these problems, but we have to distinguish between doing something and doing something that works.

There’s very little evidence supporting forced treatment for substance use; in fact, it can put people at greater risk. When a person leaves a period of forced abstinence, their drug tolerance can be dramatically lower. If they return to the same toxic drug supply — as many inevitably do after leaving involuntary care — the consequences can be deadly.

Even if involuntary care were an effective treatment for some people, it could only ever reach a very small minority of people who use drugs. In a country where we’re lucky enough to have our human rights protected, it’s a serious matter to hold a person against their will.

BC's Mental Health Act sets out stringent criteria for involuntary care related to severe mental impairment, the need for psychiatric treatment and an urgent need for supervision to protect themself or others.

The vast majority of people with substance-use disorders will never meet these criteria. We can add as many involuntary care beds as we want in Vancouver, and it’s never going to lead to a visible change on the streets of the Downtown Eastside, no matter how compelling the idea may sound during an election campaign.

We also can’t pretend the Downtown Eastside’s problems are caused by addiction alone. Homelessness, poverty, untreated mental illness, trauma, acquired brain injuries, inadequate housing and a poisoned drug supply all intersect there. Moving people somewhere else — or temporarily taking them off the street — doesn’t make those problems disappear.

There is a place for involuntary intervention in genuine emergencies, particularly when someone is experiencing severe mental illness and cannot keep themself safe. But we should be extremely careful about turning an exceptional tool into our addiction strategy.

I’m living proof that recovery is possible. But without housing, stability, connection and ongoing voluntary support, people leaving treatment will return to the exact same conditions they were struggling in before. We need a system that gives people a real pathway to recovery: rapid access to evidence-based treatment, long-term care, housing, mental-health services, trauma care and recovery supports that continue long after detox.

I hate to be the bearer of bad news, but there are no easy solutions to this crisis. “Involuntary care” might sound great on the campaign trail, but it won’t result in lasting improvements to public safety.

Guy Felicella is a peer clinical adviser, and harm reduction and recovery advocate.