Dear Members,
The government has introduced Bill 53 Compassionate Intervention Act for mandatory addiction treatment. This is enabling legislation, with regulations intended to define the details. Government has committed $180M and has announced plans for a 150-bed compassionate intervention facility in both Edmonton and Calgary. Implementation of the legislation is expected in 18 months or more. It should be noted that government believes it will apply only to a very small population and in extreme circumstances.
While this remains to be seen, the AMA is consulting with our sections of Addiction Medicine and General Psychiatry. This letter reflects our initial thoughts on the bill.
As leaders and counsel in the Ministry of Mental Health and Addiction and Recovery Alberta develop the regulations, we have offered them an opportunity to work with medical experts. We hope to involve other sections in the months ahead such as rural, emergency, pediatrics and family medicine.
This bill presents challenges for physicians and patients. The current evidence does not support that the benefits of involuntary treatment outweigh the risks and costs. In addition, there are questions around medical ethics, human rights, social justice, the role of lawyers as gatekeepers to care and potential harms. Many individuals who use substances have experienced significant trauma, and involuntary treatment carries a real risk of re-traumatization.
Our future discussions with government will explore other key questions raised by the legislation. This includes:
- How will ‘substantial harm’ be interpreted?
- What will be the role of physicians, in and out of treatment facilities?
- How will health care workers be protected from moral distress?
- What care – medical and withdrawal management – will be provided at compassionate intervention facilities?
- What is the maximum total duration of involuntary care?
- Will comprehensive after-care be available after treatment?
- How will social factors like housing and income be addressed?
- How will legal safeguards for patients be ensured, including fair, timely and accurate assessments?
- With police involvement in apprehension, how will concerns be addressed about racialized surveillance and the risk of furthering the disproportionate harms already experienced by First Nations, Inuit and Métis individuals?
- Under what circumstances will forced medication administration be considered?
- To prevent harm or risk to those in care, what protections, including legal and ethical safeguards, will be used to ensure the sharing of identifiable health information with various external parties, as outlined in the Act?
The potential long-term consequences of mandatory care call for a balanced, rights-based approach to ensure ethical and effective addiction treatment. We are committed to working with government to explore these issues and inform the implementation of this bill. We appreciate the openness to ongoing dialogue that has been expressed to us.
One thing is very clear. The stated key tenet of the legislation is to support the timely treatment of individuals with severe substance use or addiction while minimizing negative impacts on rights and freedoms and protecting dignity. The best intervention would be to invest in robust voluntary treatment and social supports to help prevent individuals from travelling a road where others might deem involuntary treatment to be necessary.
Sincerely,
Shelley Duggan, MD, FRCPC
President, Alberta Medical Association
This will cause more trauma! Suicide rates will rise, people do not want to be forced into institutionalized settings. These are people, they have rights and this will cause way more harm than good.
The fact that they don\'t understand that addictions stem almost entirely from trauma is horrifying. Their policy is entirely about the privatized delivery (and profit) using public money. If this were not the case, their delivery of care in prisons would be significantly better, not "maybe if we can, we might." This government has no interest in public health. Their only interest is in using public money to enrich themselves and their friends.
I am completely against forcing people into treatment. I think it\'s cruel & against one\'s human rights. And I don\'t think it works. Individual have to want to recover in order for treatment to work, and even in that type of situation, recovery may be short lived. I really hope you stand up to Premier Smith & tell her this is not the way to go!
This Bill definitely needs more collaboration. Listen to the experts before waisting time.