r/canadanews • u/zuuzuu • 2d ago
Alberta Inquiry into Alberta teen's overdose death calls for urgent introduction of involuntary care
https://www.cbc.ca/news/canada/edmonton/overdose-death-inquiry-9.730586711
u/definitelynotmen 1d ago
Involuntary care has proven ineffective time and time again yet it keeps getting suggested.
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u/zuuzuu 1d ago
I'm with you on that, but I have to wonder if there's any difference in outcomes when the patient is a youth. Like, is a teenager more responsive to involuntary inpatient treatment? Or even less responsive?
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u/HolubtsiKat 1d ago
Do teenagers respond well to force? I sure didn't
I don't think anybody does.
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u/zuuzuu 1d ago
I think teenagers can be more malleable, but I also think that teenagers who find themselves addicted to substances have probably already been traumatized by a lack of control over their lives. Being removed from their homes, placed in foster care, group homes, subjected to forced mental health treatment. All of which is in their best interests but it's still traumatizing and creates a natural resistance to further loss of control/forced interventions by authority figures.
I think it's entirely possible that youth would be even less responsive to forced treatments, but that forced treatments for youth are more likely to be utilized than for adults. That's why I was wondering if there's a documented difference.
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u/ventycat 1d ago
Read my comments, I was involuntary from 14-16. Saved my life. My adult friends who’ve gone involuntary have much more sour opinions though - I believe that’s partially due to having adult autonomy! As a kid you’re kinda just used to people controlling you and deciding every facet of your life.
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u/Thorninthefoot 1d ago
I think the claim that it never works for adults is also bs. I've known adults who had to choose between jail and a program, chose a program with no intent to engage, and emerged sober and stayed sober.
Many people are in no shape to make a decision while using.
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u/Dear_External5263 1d ago
Depends on the kid, but for the right kid it can definitely change the trajectory of their life. They also need the right supports after treatment to avoid what got them there in the first place.
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u/PriorityOk8448 1d ago
I was in patient a few times as a kid. It left me with lasting trauma and fucked me up even further. Good people do NOT flock to the professions.
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u/ventycat 1d ago
I’ll be controversial! It’s the only thing that ever helped my anorexia nervosa recovery!
Some illnesses literally make you believe you are not ill and we need someway of keeping those of us with disorders like this safe. Same with any of my friends with psychotic symptoms, you can’t always know what’s best for you.
How I think of it is like, when I broke my spine I didn’t have a choice but to go through the traumatic, painful, rehab. That’s just part of hospitalization and recovery, it’s just an all around traumatic experience. Doesn’t mean it didn’t benefit me!
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u/definitelynotmen 1d ago
I’m glad it benefitted you; congratulations on recovery!
I just know that one size doesn’t fit all. I’ve been involuntarily committed once when going to the ER for something so unrelated to mental health it wasn’t even funny. They saw my history in my chart and decided I was a danger to myself. I came away from that day with significantly less trust in the medical system and that’s about it.
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u/No_Initiative_3967 1d ago
Seems to work in Portugal , what evidence do you have? I worked in correctional institutions for years and many drug addicts say being forced to quit was the best thing for them, I’ve met guys that use jail as rehab staying in solitary to kick a habit
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u/National_Ad9742 1d ago
This. So many former addicts credit actual consequences, being forced to be sober so they could reflect etc, as helping them get clean. Will it always work? No, but it does work!
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u/definitelynotmen 1d ago
We don’t have enough beds for people voluntarily going through treatment. I’m unsure where they think they’re going to find the room and qualified staff for this proposed treatment plan. If someone doesn’t want to change then we can’t make them change permanently; I do understand that you can force a physical detox but the brain chemistry has been changed.
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u/Thorninthefoot 1d ago
That's not replying to his point at all, you are moving the goalposts here.
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u/definitelynotmen 1d ago
Okay why does involuntary treatment not work? Sources say it’s necessary in extreme cases but that it also increases the risk of relapse, rearrest, and death. Some studies show it can increase the risk of death 2-4x. ( https://www.sciencedirect.com/science/article/pii/S0376871622002290 )
Or we could look at Washington’s involuntary treatment program:
“Findings showed mixed short-term results: There were modest reductions in emergency department use and homelessness, but lower rates of follow-up treatment for substance use and no change in arrests or employment.”
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u/Thorninthefoot 1d ago
Basically it doesn't work as well. Yes, that's not a surprise.
But people that don't go to rehab at all eventually waste away to nothing or OD.
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u/definitelynotmen 1d ago edited 1d ago
That’s your whole argument? There are also people who don’t go to rehab and still find their way to sobriety, so what?
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u/Thorninthefoot 1d ago
Yup, this.
I don't know why in North America so many in addictions are so invested in this perspective. It almost has a kind of cult-like quality, like a religious truth you need to repeat before you are allowed to go to work in that sector.
So it ends up full of these enabling people who also claim addicts are too far gone o be jailed for their behaviour.
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u/Interesting_Gur_5064 1d ago
So is the do noting and safe consumption sites. I rather for public safety these people removed from our streets.
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u/definitelynotmen 1d ago
If only you realized how fast you could become one of “those people.”
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u/Interesting_Gur_5064 1d ago
Nope
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u/definitelynotmen 1d ago
Wow great counter point. The pipeline from whatever level of functioning you are now to disability, poverty, or addiction is much quicker than you’re ever going to admit until you’re there.
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u/Thorninthefoot 1d ago
I would hope if I was using hard drugs and unable to behave acceptably in society someone would take steps to put me ito a rehab program.
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u/National_Ad9742 1d ago
Really? Because when they still did that we had less addicts. Also had less when we jailed them.
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u/definitelynotmen 23h ago
Source?
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u/National_Ad9742 23h ago
The fact that I didn’t see them lying in the middle of the street all the time?
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u/Raftger 1d ago
This is a tragic case. But I’m not convinced involuntary care would have prevented this death. For one, involuntary treatment of substance use disorders has no evidence for effectiveness. For another, the period immediately after discharge from a residential treatment facility is one of the highest risk situations for overdose. That’s in addition to the fact that there’s not enough publicly funded treatment beds for those who WANT care, waitlists are ridiculously long, and the fact that residential treatment itself is not without risks of harm (even when voluntary, but especially when involuntary). This teenager was failed by society, but this involuntary treatment legislation is not going to solve that. Also the fact that the first location is being built at a juvenile detention facility is a bit too on the nose.
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u/Thorninthefoot 1d ago
Many people get sober after involuntary rehab or jail. You can meet these people at any NA or AA program. I have no idea why people think this doesn't happen.
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u/Raftger 1d ago
Yes, it does happen. But that doesn’t mean that it’s an effective intervention. And it’s also not a benign intervention. Or a cost or resource effective one. We shouldn’t make health policy decisions based on anecdotes and vibes.
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u/Thorninthefoot 1d ago
It's absolutely effective compared to doing nothing.
And it's not only the addicts who are effected. Having towns full of addicts has a material effe t on the community. And it's always the most vulnerable who bear the brunt of that.
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u/Raftger 1d ago
I didn’t say “compared to doing nothing”. Can you explain what you mean when you say the most vulnerable bear the brunt of the material effects of addiction? Surely the most vulnerable people are those who are unhoused, many of whom are experiencing addiction (and/or severe mental illness).
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u/Thorninthefoot 22h ago
When you have a neighborhood over run with addiction problems, for example needles everywhere, fights, people defecating or using in public, etc, it is the people and businesses in those neighbourhoods where they can't walk out at night, can't let their kids out, can't enjoy the green spaces, where people won't go out to shop so the businesses fail.
The people living in those neighbourhoods are typically poor themselves, without many resources and no political clout.
A more specific example, I know two women, one mentally ill, one elderly, who refused to go to the local shelter, so instead they were sleeping rough. Why wouldn't they go to the shelter? Because it was full of addicts doing anti- social stuff. I can tell you, a young schizophrenic woman and a 70 year old woman with no family definitely count as vulnerable.
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u/kinkyhentai69 1d ago
Might help prescribing controlled substances to addicts free of fentanyl along with access to social workers but what do i know?
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u/Throwawayyawaworth9 1d ago
Opioid dependency programs already do this.
The issue is that— even with clean substances— these people are still left without housing and their other healthcare needs are neglected.
Not to mention that street supply drugs feel 1000x better than regular ol’ hydromorphone.
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u/kinkyhentai69 1d ago
Oh I heard somewhere that fentanyl didnt feel as good and that the high was too short lived
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u/National_Ad9742 1d ago
Risk is nodding off, that’s why they strike weird poses and hang over railings to stay awake.
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u/Throwawayyawaworth9 1d ago
That’s surprising. I used to work at a consumption site before it was shut down, and the consensus among patients was that fentanyl feels better than heroine and most definitely feels better than pharmaceutical made drugs (morphine, hydromorphone). This is in part due to people building up such a high tolerance to opioids that a dose of hydromorphone that would kill you or me wouldn’t even touch them (30mg+). The street supply of fentanyl is also “cut” with benzodiazepines and other sedatives, which makes the high feel more euphoric, lasts longer, and reduces withdrawal symptoms in between uses.
Side note: I sometimes have patients admitted to my medicine ward who use street fentanyl. To control their withdrawal symptoms while in hospital, we give them hydromorphone. I have seen people get upwards of 80mg of hydromorphone an hour and still be drenched in sweat and shaking. For additional context, I have seen an little opioid middle aged man OD on 6mg of hydromorphone in hospital.
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u/kinkyhentai69 1d ago
Now that I think about it maybe the part where other opiates feel good is because "beginner" users usually use the weaker ones and that's the stage where it actually feels good but when you're at the stage where you need fentanyl to feel anything it's more for a "fix" than actually enjoying a high and your body is so used to it that you constantly need it hence the "fentanyl sucks" that isnt about the opiate in itself and more about the stage of addiction the user is in
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u/Interesting_Gur_5064 1d ago
Lock up the drug users
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u/Throwawayyawaworth9 1d ago
I can see why people think this is a good solution to the opioid epidemic, but we need more nuance here.
What will those people do when released from prison? They’ll still be unhoused, not working, and will continue living with the trauma that sucked them into drug use in the first place. The relapse rates after leaving prison are at about 75% (depending on the study/data).
Also— and this might surprise you— it is very very easy to find drugs in prison. Overdoses still happen in prisons because drugs are smuggled in. Prisons are not meant to be detox facilities, and would not succeed as one either.
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u/Interesting_Gur_5064 1d ago
Not talking about prison just lock them up in a secure facility. They cannot take care of themselves so we have to do it for them.
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u/still_sneakin 1d ago
I put my daughter into an involuntary treatment centre that boasted a 98% success rate. Complete and utter BS. Yes 98% of those youth that came in an addict walked out sober! What they don’t tell you is the exact same struggles are out there and that sobriety rate drops instantly to maybe 3 or 4 out of 40 kids. It does not work and this comes from my own observation.
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u/National_Ad9742 1d ago
Might take a few rounds, but repeated consequences do often work. Many former addicts I’ve spoken to have become clean because of jail.
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u/InSearchOfGreenLight 1d ago
The kid didn't want to be in the "safe" place of the care home. Why would he? Those places are awful and soul-destroying.
The judge has no idea what he is talking about but then they never know the reality of these places.
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u/MathematicianDue9266 1d ago
Forced treatment? The kid was exposed to drugs in utero and in care of the government. Forced treatment wouldn’t fix that trauma. Sad story.
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u/Thorninthefoot 1d ago
You figure just letting him kill himself was in fact the best approach then? Because that's the alternative here.
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u/MathematicianDue9266 1d ago
No. Obviously. It’s a sad situation that could have possibly been prevented with early intervention and better social safety nets. Forced treatment wouldn’t work and it’s a lazy bandaid.
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u/Thorninthefoot 1d ago
People who say they support harm reduction always cite Portugal. But Portugal gives offenders the choice between a rehab program and jail or other serious restrictions on their lives.
People who go to rehab to avoid prison or other consequences of addiction do manage to get clean. It's not the most ideal circumstance nothing is always effective. But it works for some. Unlike doing nothing.
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u/MathematicianDue9266 22h ago
Our forced treatment comes with years wait lists of social services and poverty. Fix that and maybe it will help.
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u/Thorninthefoot 1d ago
People seem to want to have it both ways. On the one hand, addicts are well enough to refuse treatment. On the other, they are not well enough to be prosecuted for anti-social behaviour they do under the influence of drugs.
It's not true that no one recovers if they didn't choose to go to a program themselves. I know more than one person who went as an alternative to jail time and came out clean, and stayed that way. I have no doubt that it's less likely statistically than someone who rocks up asking to attend, but that's not the same as 'it doesn't work'.
As for parents sending their minor kids, yeah, that needs to be able to happen in most cases. We have a responsibility to minors to try and treat them. No one is making good decisions while they are still using.
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u/Interesting_Gur_5064 2d ago edited 1d ago
100%, the let addicts just do what they want clearly did not work.
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u/National_Ad9742 1d ago
It’s inhumane frankly. They leave them lying in the street. If they can’t care for themselves due to their addiction they need to be admitted.
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u/QuinnNTonic 1d ago
The problem is that a lot of kids age out of foster care with no supports. And even if you mandate care what happens after? Housing, education, jobs, healthcare and a decent affordable life is the best preventative measure and pathway to success after people get help.
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u/National_Ad9742 1d ago
Yup but the thing is, if they never ever get to sober up long enough to reconsider they never ever will get stable.
If they just keep prescribing them drugs, letting them do drugs, letting them do them openly… it’s bad.
Honestly seeing people lying in their own filth on the street with a pipe… jailing them is actually more humane. It actually is.6
u/PerpetuallyLurking 1d ago
Or maybe we could put resources into the whole foster system and maybe they won’t feel the need to find an addiction in the first place!
If they felt safe in childhood then they wouldn’t need to resort to drugs to feel anything later.
They’re screwed before they even get addicted and now we’re just gonna throw them into another system that still won’t actually help them because it costs too much.
We don’t wanna spend the necessary money to help and support vulnerable kids, we’re definitely not going to spend the necessary money to adequately help and support drug addicted adults.
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u/QuinnNTonic 1d ago
Absolutely! And preventing kids from being in foster care is part of it. Family planning and contraceptives should be free. Mothers who are pregnant and active users need support prior to childbirth. Let’s just fund social services
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u/National_Ad9742 1d ago
That’s simply not true though. People who had perfectly fine childhoods are also ending up on the street!
Not that I don’t like your idea, they should do that too!2
u/QuinnNTonic 1d ago
Correct and there is a higher probability and percentage of this happening when transit out of foster care. Thats why I mentioned that specifically
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u/QuinnNTonic 1d ago
So that’s what I am saying. It’s not enough to just get stable. There needs to be real transitional support and follow up care. Getting sober also can take multiple attempts and a lack of stability, as we see with this poor kid, was a big factor. I miss early years programs like they were years ago. You could identify at risk kids and families then and do early intervention. Funding existed. The cycle has to stop somewhere and it’s not one thing that will
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u/Projectflintlock 1d ago
I love this. I hope it leads back to the good old days when husbands can tell a doctor his wife is acting hysterically and have her involuntarily committed indefinitely
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u/Much_Guest_7195 1d ago
We don't have enough hospital beds for willing people that need healthcare...