David Eby proposes involuntary drug treatment to combat overdose crisis

Could involuntary treatment help the overdose crisis? David Eby pitches controversial idea

How do you help those on BC’s streets who are suffering such severe mental health and addictions crises that they can’t help themselves?

It’s a question provincial politicians have been dancing around for years, as they fiddle at the edges of a treatment system filled with so many silos, gaps and wait times as to be functionally useless for people with the most complex issues, who end up unhoused and visibility in distress in areas like Vancouver’s Downtown Eastside.

But the discussion fundamentally changed this week, after BC NDP leadership candidate David Eby proposed forcing addictions and mental health treatment upon those who repeatedly overdose or suffer untreated crises on the street.

David Eby pitches involuntary treatment

“There are folks who will overdose two or three times in a day and end up in hospital, and it’s not until they profoundly injure their brains that the government says okay, we’ll care for you for the rest of your life,” Eby said in an interview.

“And I just think we can do better.”

The debate comes as Vancouver wrestles with removing tents at an East Hastings Street encampment. There, the province is confronted by the dual issues of insufficient housing, as well as people with trauma, addictions and mental health concerns who don’t necessarily want to access the treatment options the province currently provides.

The government can currently force people into health care, but only if they are deemed a risk to themselves.

Multiple overdoses on toxic drugs should qualify as that risk, said Eby.

“I just feel like if you were harming yourself in any other way, our response would be different and we wouldn’t send you back out into the street to die,” he said.

“And that’s what we’re doing right now.”

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Mixed reaction to the idea

The idea was met with strong reaction on both sides, including those who say forcing people into drug treatment against their will leaves them at a higher risk of future overdoses due to a reduced drug tolerance, can create fear and stigma that will prevent people from calling for help, and is also a fundamental breach of a person’s rights.

“Compulsory treatment and forced treatment, it’s pretty clear, especially in the short term, that it’s ineffective at best and can actually do significant harm in a number of ways,” said Dr. Paxton Bach, an addiction medicine physician at St. Paul’s Hospital in Vancouver.

“I can’t in good conscience even consider that, when we also think about the fact that voluntary treatment right now in this province is incredibly inaccessible. There’s up to a three-month waitlist for voluntary treatment.”

But Dr. Bill MacEwan, the former head of psychiatry at St. Paul’s and a longtime Downtown Eastside advocate, said Eby’s proposal is kick-starting a valuable discussion.

“The major thing I was very happy David did was start the conversation — the idea of what to do, what we do, when a person’s life is needing to be saved,” he said.

“This isn’t for the average anyone who is using drugs, but for the person coming in with not one, but two overdoses in a short period of time.

“What do you do in the moment, is what he’s trying to highlight. It’s really a good thing to do because it brings to the question of how do we broaden our approach.”

The current system is not working

More than 10,000 people have died from overdosing on BC’s poisoned street drug supply since 2016, and the province is on its way to another record year of deaths in 2022, according to the chief coroner.

Both MacEwan and Bach admit the current treatment and addictions system is not working.

But Bach said forcing people into treatment against their will is “short-sighted and more likely to do harm than good,” he added.

“For us to even start the debate around involuntary treatment, when I’m seeing patients overdosing in hospital actually seeking treatment and I can’t connect them with that — I think that not only is this not a solution, but also the focus is in the wrong place,” said Dr. Bach, who is also the co-medical director for the BC Centre on Substance Use.

MacEwan credits the NDP government for funding new detox and treatment beds, but says the province is still failing to put them all together into a working system where people know what’s available when needed.

“(Mental Health Minister) Sheila Malcolmson announced 132 new beds recently,” said MacEwan. “I have no clue whether they’ve been delivered, and no clue as a practitioner where they are or whether they are being utilized.”

Eby admitted the current system needs to be changed to a “seamless run” from detox, into treatment and then supportive housing.

But he argued the province has “done well” on safe supply initiatives and a decriminalization pilot project from Health Canada, though critics of both say the initiatives fall short on the drug types, thresholds and accessibility needed to make an actual difference amongst users.

The politics of involuntary care

Eby is one of two candidates in the BC NDP leadership race, which is set for a vote on Dec. 3.

His rival, climate activist Anjali Appadurai, said she’s heard from organizations and directly-affected people that “it’s simply not a policy that produces good outcomes.”

“This is a policy that’s from the old way, which is taking away choice,” said Appadurai, adding the current government’s decisions have made the toxic drug crisis worse.

“There are lots of things that the evidence does support that produces better outcomes than involuntary care.”

Politically, Eby has an unlikely ally in his proposal: BC Liberal leader Kevin Falcon.

Falcon has said he supports expanded involuntary treatment for addictions and mental health crises, going so far as to admit that previous governments — including the BC Liberals in which he served as a minister — failed to invest in enough community care to compensate for closing BC’s main psychiatric detainment facility, Riverview Hospital, in the 1990s.

“We have to tackle it head on and have to recognize there are some folks who through no fault of their own are incapable of making decisions in their best interests,” said Falcon.

Involuntary care would be far better than “warehousing” people suffering severe addictions and mental health issues in substandard single-room occupancy buildings in the Downtown Eastside, as well as motels the government has purchased at inflated rates, said Falcon.

The return of Riverview?

In discussing his involuntary confinement idea, Eby has at times referenced the Riverview hospital, which when it closed more than two decades ago faced allegations of mistreatment and archaic care.

Eby said any new involuntary care would not resemble Riverview, but would be modern. He’s proposed to convene experts and people with lived experience to craft appropriate guidelines on when to intervene.

Indigenous leaders would also be involved, to ensure culturally-appropriate care is provided to a group often over-represented in addictions and homelessness, he said.

Eby to tackle criticism

Eby said he’s willing to debate critics of his idea, and admits some will wonder how he can champion such a proposal given his past work with groups like the BC Civil Liberties Association.

“I do think we need to respect autonomy and people’s choices, but when you’re poisoning yourself two or three times in a day, I just think it’s unacceptable to leave someone to die in the street because they’re poisoning themselves with fentanyl instead of with some other kind of poison,” said Eby.

“We do need to intervene. And people can disagree with me about that, that’s fine. But I would like to hear their solutions to the serious problem of police, fire and ambulance picking up people over and over again, and then that person ultimately dying in the streets alone, because I think that’s completely unacceptable.”

Rob is Daily Hive’s Political Columnist, tackling the biggest political stories in BC. You can catch him on CHEK News as their on-air Political Correspondent.