Forcing people into drug treatment is on the political agenda. Here's what the evidence says

As the toxic drug crisis continues to claim thousands of lives each year — fuelling perceptions that existing measures are failing — the notion of involuntary treatment is gaining political traction. 

Across Canada, there's a growing number of political leaders proposing to force people into treatment for drug addiction, even though a recent research review found inconclusive evidence about whether it's effective. 

Some experts in addiction medicine warn against seizing on forced treatment as an easy answer to a complex health and social problem. 

"It's a response to seeing pain and suffering in front of you and saying, 'I don't want to have to see this, so let's just make sure that this is out of the way,'" said Dr. Anita Srivastava, medical director of addiction medicine for Unity Health in Toronto. 

"I think it's a frustrated response to a problem that [people] perceive as having no real solution," said Srivastava in an interview. "I don't think it will work, but I can understand where it might be coming from." 

Others think involuntary treatment needs to be one of the available options, given the urgency of the crisis. More than 47,000 Canadians have died from toxic opioids since 2016, according to the latest federal figures published in September.

A task force created by the Canadian Society of Addiction Medicine recently reviewed worldwide research into the effectiveness of involuntary treatment. The task force looked at 42 studies from around the globe and published its report in 2023 in the Canadian Journal of Addiction.

Of the 22 studies it found that compared involuntary to voluntary treatments, 10 reported negative outcomes from involuntary treatments, five found no significant differences, and seven found improvements, mainly in retention in treatment. Only one of those seven found a post-treatment reduction in substance use, and that was not sustained long-term.

"There is a lack of high-quality evidence to support or refute involuntary treatment for [substance use disorders]," the report concluded. "More research is needed to inform health policy."

The review also noted the difficulty drawing conclusions about what worked, since the quality and types of treatments offered — mostly in U.S., China and Canada — varied widely. 

Despite that lack of evidence and the call for more research, there is no shortage of politicians suggesting involuntary treatment as a policy option. 

Forcing people into addiction treatment was floated by various parties in the recent British Columbia and New Brunswick provincial election campaigns. 

In Ontario, the mayor of Brampton, Patrick Brown, is calling on the provincial government to launch a pilot project that would allow for involuntary treatment of drug addiction in his community. 

The province that's closest to moving ahead on forced treatment is Alberta, where the government of Premier Danielle Smith has promised legislation.