The Government of Alberta has introduced through Bill 53, the Compassionate Intervention Act, the first-in-Canada legislation to force drug users into treatment and recovery programs.

The aim of the legislation is to ensure that prolific drug users who have a demonstrated risk of causing harm to themselves or others, are placed into either secure or community recovery programs.

“In the past 10 years, over 50,000 Canadian lives have been lost to drug overdoses. They are not just numbers. They are mothers, fathers, sons, daughters, nieces, nephews, aunts and uncles, people who have been consumed by a wretched and unforgiving disease. A disease that seeks to inflict as much suffering as possible to both those afflicted and to their loved ones,” said Alberta Premier Danielle Smith.

“The Compassionate Intervention Act creates an opportunity for families, guardians, healthcare professionals, police or peace officers, to take action when someone’s addiction or substance use has made them a danger to themselves or others.”

She said that the legislation was not being created to act as sweeping legislation applying to all drug users facing addiction, but rather a tool to address what the government considers the most serious cases.

“It is only for the most serious cases where all other options have failed. It’s important to remember that the people in the clutches of addiction are unable to help themselves,” Premier Smith said.

“It isn’t a lifestyle choice, it’s a treatable illness. To families with loved ones suffering from addiction, compassionate intervention offers new hope, hope that their loved ones can get the help that they need to break their addiction, connect with their families and manage their life in recovery.”

In supporting the bill, Premier Smith used an outlier case of a single individual overdosing 186 times in one year as an example of how drug addiction robbed individuals of the ability to make medical choices for themselves.

“When we were drafting our Alberta Bill of Rights, we made it clear in the language, you have to be of sound mind,” she said.

“If you’re of sound mind, able to make your own independent decisions, you have the right to choose your medical intervention. If you’re causing harm to yourself or others, then we’re going to try this different pathway.”

Government officials said that Alberta’s Mental Health Act has been used as a model for the legislation, and that safeguards have been put into place to balance the health needs of patients placed into forced care, and their rights under the Canadian Charter of Rights and Freedoms.

Those safeguards include those stemming from the 2019 legal case JH vs. Alberta Health Services, which saw changes to the Mental Health Act.

In that case, the Mental Health Act was used to detain a man for more than nine months involuntarily after he sought hospital treatment in after being struck by a car. A judge found that act unconstitutional in 2020 as a result of that case.

Minister says bill allows for indefinite detention of individuals under care

Under the new legislation, a three-person Compassionate Care Commission will be formed to hear applications brought forward by family members, police officers, or peace officers to place individuals into forced treatment.

Applications for confinement under the act would be submitted and reviewed, with apprehension orders then carried out by police or peace officers.

Among the criteria that the government said would need to be met for apprehension orders would be harm to self through serious substance use that presents a history of self-harming behaviour that has led to physical or mental health deterioration, or harm to others, including negative impacts to community safety.

Individuals apprehended by Calgary Police would then be brought into a Calgary mandatory addiction treatment facility, where they would be assessed by medical staff and provided with withdrawal and medical support for up to 72 hours before being given a hearing before the commission.

Patients will be given the option to refuse treatment, but under Bill 53, cannot refuse to be observed or monitored by a treatment team, receive clinical advice from medical professionals, or take medication related to their substance abuse that has been prescribed by a medical professional.

Government officials acknowledged that patients may be forced to take medication against their will, prior to a hearing before the quasi-judicial commission ruled on the eligibility and appropriateness of their case.

Minister of Mental Health and Addictions Dan Williams stressed that the detention of individuals under the bill was for healthcare, and not because of criminality.

“It’s not as though it has some sort of criminal justice limitation, etc. So, if somebody is a danger to themselves or others as a result of their serious addiction issue. Then there is a possibility of being re-admitted if you meet that standard, and then treatment,” Minister Williams said.

Individuals detained under secure care could be held for up to three months for forced treatment before being readmitted, while individuals placed into the community could be readmitted after six months.

“We drafted legislation with the intention of being compliant, and we want it to, of course, be constitutional and to balance all the different aspects that we have to deal with,” said Minister Williams.

“We believe that this is balanced, that this is thoughtful, and this is fundamentally a question that needs to be answered by the public and our legislature that represents the public to say, ‘is there some constitutional right to 187 overdoses causing death on the street,’ and harms cards within your own life, leading to death and public disorder as well.”

Government says forced treatment is based on evidence

Minister Williams said that Bill 53 was based on evidence, including the data collected by the province’s Recovery Advisory Panel.

“With this legislation today, there are certain activists that will tell us that mandatory treatment is less effective. However, that is not the truth. What we must compare is truly between the options that we have on the table,” he said.

“It is not fair to compare between voluntary and mandatory treatment for those in addiction, but rather, the real option on the table is whether or not we should provide addiction treatment for those suffering—that 186 overdose individual in the province, or leave them.”

That sentiment was echoed by Chief Cody Thomas of the Enoch Cree Nation, who said that doing nothing was no longer an option.

“This legislation will be met with questions, and it should be. There are real concerns about rights, about fairness and about the long-term success of involuntary care, but when we look at the addiction, I see people who want help,” Thomas said.

“I see families desperate for intervention, but forced to wait until tragedy strikes. Drugs are changing, and so must our efforts.”

Dr. Rob Tanguay, the interim senior medical lead of compassionate intervention for Recovery Alberta, and set to become the medical director should Bill 53 pass the legislature, defended the evidence, including his own paper published in the Canadian Journal of Addiction Medicine.

“That shows there’s no evidence to indicate that this won’t work when it comes to addiction treatment,” he said.

“There is no data that would confirm that it would not work. I was one of the authors of the study that was mentioned. The data clearly shows in cases of multidisciplinary treatment, which is what we will be doing here in Alberta, is that individuals who are involuntarily treated often are equal in outcomes to those who are voluntary, and if not, show improvement. But maybe not to the same extent as those who are voluntary.”

The conclusion of that paper, published in 2023, was that there “is a lack of high-quality evidence to support or refute involuntary treatment for [substance use disorder].”

Critics of forced treatment programs, including those in the Global South and in European nations, have pointed to other studies that have found negative outcomes.

A study in Sweden found that compulsory care in that nation saw older men forced into treatment for alcohol saw increased deaths post-treatment, while younger individuals and females forced into treatment for drug use led to increases in deaths post-release from programs.

The authors writing in that paper said that “although compulsory care is often advocated as a life-saving intervention, our findings do not provide strong support for this claim. On the contrary, our findings show that admission to compulsory care is associated with a higher risk of substance use-related mortality.”

The use of forced drug treatment has also been condemned by the United Nations, especially for its problematic use in countries like China and Myanmar.