Mandatory addiction treatment facilities are coming to Calgary as part of the Alberta government’s response to the toxic drug crisis.

In a statement on Wednesday afternoon, Premier Danielle Smith said the province will be moving forward with its proposed compassionate intervention legislation this year. The act would give police, family members, or legal guardians of drug users the ability to refer adults and youth into involuntary treatment if they pose a risk to themselves or others.

The legislation is expected to be introduced this spring. The Premier tacked the comment on to a statement about the first ministers’ meeting and the handling of the fentanyl drug trade in Canada.

“We will also continue to move forward with our recovery treatment centres and will be moving forward, this year, with promised compassionate intervention legislation and the construction of secured mandatory treatment facilities in Edmonton and Calgary,” Premier Smith wrote in the statement.

The policy would be the first of its kind in Canada if passed. It is part of the United Conservative government’s recovery and treatment model while significantly reducing harm reduction resources like supervised consumption sites. Previously, former premier Jason Kenney announced Calgary’s only supervised consumption site be shut down and replaced by two overdose prevention centres. However, the locations of the two centres have not yet been determined.

Smith’s statement comes as toxic drug deaths continue to surpass pre-pandemic levels. Around 964 people died from toxic drugs between January 2024 and October 2024, according to recent data from the province’s substance use surveillance system. While that is a 38.95 per cent reduction since the same period in 2023, it is still a 77.53 per cent increase when compared with the same period in 2019.

Around 10,963 unique clients accessed Alberta Health Service’s opioid dependency program (ODP) from January to September 2024.

‘The devil’s in the details’: Addiction expert

Dr. Monty Ghosh is an internist and addiction specialist and an assistant professor at the University of Calgary and the University of Alberta.

He said a lot of the details surrounding the Compassionate Intervention Act are still unknown and it’s too early to provide commentary on the legislation. The evidence surrounding involuntary treatment outcomes is also “heterogeneous” because all the studies use different methods, such as intensive therapy sessions or intensive treatment in large community settings (therapeutic communities).

There are also legal and ethical concerns around patients’ rights, Ghosh said.

“There’s a lot of complexity … Are we causing more harm than good to this patient population with those complexities added, especially knowing that a large portion of the population experiencing substance use has a history of trauma,” Ghosh told LWC in an interview on Thursday.

“I worry that we’re reaching a point where we don’t understand the details around the legislation, what it means and will there be poor outcomes.”

Ghosh said the government needs to ensure that successful programs are in place so patients don’t see poor outcomes.

Data about Massachusetts’ CARE Act – which allows the state to involuntarily commit someone with an alcohol or substance use disorder for up to 90 days – suggests that positive outcomes are “especially bleak,” according to a blog published by Harvard University.

The state’s own legislative report even found that people who were involuntarily committed under the act were more than twice as likely to die from toxic drugs compared with those who completed voluntary treatment.

Ghosh added there were no uniform treatment programs for patients who were involuntarily committed into treatment under Massachusett’s model.

“It could go the wrong direction, potentially. There’s evidence to show that this may not work. If the government is planning to implement this, and it sounds like they are, how will they ensure there are safety roads and a successful program where you don’t see poor outcomes?” he said.

A public safety issue?

Hunter Baril, press secretary for the Ministry of Mental Health and Addiction, told LWC in an email the proposed Compassionate Intervention Act will “restore health and community safety” which have been “diminished” by the toxic drug crisis.

Baril did not provide specific details on where the mandatory treatment facility will be built in Calgary.

“For Compassion Intervention to fully restore health and safety in our communities, Alberta will need more recovery and secure treatment capacity. New compassionate intervention facilities will be built to support Albertans struggling with the most damaging cases of addiction. The Compassionate Intervention Act will be one more tool in the Alberta Recovery Model, which is already the most recovery-oriented system of care across North America,” his email statement read.

“We refuse to leave Albertans in perpetual addiction without care and will not stand to see our communities deteriorate from crime, violence, and social disorder.”

Ghosh said involuntary treatment will not solve public safety issues because the benefits from treatment work best for people who have “reasonable cognitive capacity.” The vast majority of individuals that are often cited in public safety disturbances are using substances like crystal meth and are in deep psychosis. Around 20 to 50 per cent of those experiencing homelessness have moderate to severe brain trauma and moderate to severe cognition concerns.

Drug users experiencing homelessness also prefer to use in public spaces due to safety concerns, especially in the winter, he added.

“They use in spaces to stay warm, and they use because they can’t access physical supervised consumption sites because they’re inhaling their substance and there are no inhalational supports,” Ghosh said.

“If people are worried about individuals using the CTrain line, many of them are there because there are cameras so there’s immediate responses to support the overdose event. It’s also a warm space for them to go to.”

What are the solutions?

One potential alternative to involuntary treatment is incentivized treatment, Ghosh said.

“A key predictor of recovery is motivation, and if someone is not motivated to go into treatment, then it may not be very helpful. If you incentivize them into treatment, you increase their motivation,” he said.

“We know that strategies such as contingency management are evidence-based tools that use motivation to get people into a state of wellness and into a state of recovery. This has worked for methamphetamines. It’s worked for cannabis. It’s worked for other substances. I think this would be a route to explore that could end up saving the system much more than the Compassionate Intervention Act.”

The addiction specialist also said more resources like intensive housing opportunities and warming centres are needed in Calgary, especially in the winter. They must also have wraparound support so drug users can access treatment.

“It’s expensive, but it’s probably better for the population in terms of safety, wellness for the client and an overall cost-benefit evaluation for the society as a whole, as opposed to a forced treatment service,” he said.

Ghosh also raised concerns that Indigenous people will be disproportionately represented in forced treatment facilities. Indigenous populations often experience a disproportionate level of racism and discrimination compared to other populations in Canada, he said. They also are disproportionately represented in statistics about homelessness and drug use.

He cited a study in Australia that suggested 90 per cent of individuals who were admitted involuntarily into treatment programs for alcohol use disorders were Aboriginal Australians, to the point where the Australian government had to shut down that program.

“If the government is going to go through with this, they need to develop some safeguards around this. We haven’t heard much from what the safeguards are as of yet. Will they involve Indigenous communities? Will they involve chiefs or Elders? What do they entail? Or would we be at risk of worsening the traumatic experience of this particular population? Would we be reinventing the residential school system?” Ghosh said.