I am a physician working on the front lines of this toxic drug crisis. Let’s talk about involuntary care.
When politicians have the power to guide the tools and resources I have access to as a physician, it is of the utmost importance to me that they have the data and evidence to make informed decisions. As a medical expert in this field, it is part of my job to ensure that our communities have accurate and fact-driven representation by our political leaders.
There is zero evidence from any high-quality study that involuntary care decreases rates of substance use, decreases harms or deaths from overdose, or reduces rates of homelessness or public drug use. In fact, the evidence shows definitely that the opposite of each of these is true. As well, we know that Indigenous peoples are disproportionately affected by substance use (they are six times more likely to die in B.C. from overdose compared to the general population), and nine times more likely to be incarcerated. If involuntary treatment for substance use were to be implemented in B.C., what we would see is our Indigenous peoples disproportionately having their freedoms taken away and being physically locked in forced systems of care. This is systemic racism. Have we not learned from the mistakes of our past? Are we prepared to deal with the ramifications of creating another cycle of intergenerational trauma, when we are still reconciling for the actions of our past?
Involuntary care is an ideologic solution based on stigma and avoidance. Stigmatization of any medical illness worsens outcome. Currently, 55 per cent of fatal toxic drug poisonings occur from people using within their own private homes. Stigmatization prevents people who are using behind closed doors from asking for help.
Sadly, we are currently devastatingly inadequate at meeting the needs of those who want help. When a patient comes to me requesting treatment, they will wait months for a treatment bed, if they gain access at all. In the meantime, they are left without access to supports to stop using substances, in the midst of unprecedented poisoning and contamination of the illicit supply. This is why the organization Doctors for Safer Drug Policy is asking for overdose prevention sites at hospitals, among other tools they need to save lives. We are demanding every single evidence-based harm reduction intervention available at our disposal.
Fifty percent of people who died of overdoses had a co-occurring mental health diagnosis, according to the B.C. Coroners Service, and yet wait times for psychiatry in my community can be years. Many people have no access to primary care. We have inadequate numbers of low-income and supportive housing to serve our ever-growing unhoused population. We have unprecedented numbers of people accessing food banks. Let’s talk, first, about the basic determinants of health that our government is currently failing to support for our most vulnerable community members. Those are the things we know as physicians have the absolute greatest impact on one’s health and recovery. Let’s talk about the inability of our current system to help the people who are desperate for it.
Involuntary care is a solution of convenience to those who would prefer to not have the ‘eyesore’ of those suffering on our sidewalks. It is a solution of putting your head in the sand so as not to have to see the ways the government continues to fail those who need us. Is that the kind of solution that you stand for?
Let’s talk. But more importantly, let’s act. My patients continue to die avoidable deaths while our government systems do nothing.
Dr. Jessica Wilder works in family and addictions medicine.
