You may have heard that Canada is in the midst of an opioid crisis. In 2021 there were over 7,500 overdose deaths in Canada[i], giving us one of the highest overdose death rates in the world. In 2020 and 2021 opioids were responsible for the loss of an estimated 450,000 years of life, 5x the number of life years lost due to COVID over the same period.[ii]
These deaths are not evenly distributed across Canada. Nearly half of all deaths occurred in Alberta and BC, despite these two provinces accounting for only a quarter of Canada’s population. As COVID-19 recedes, politicians in both provinces are turning their attention to opioid addiction, a subject that has received particular attention from the public because of its ties to social disorder.
For better or for worse, an ideological line has been drawn between Alberta and BC. Alberta is pressing for a recovery-oriented system of care, emphasizing treatment and de-emphasizing harm reduction. BC, in contrast, is leaning into decriminalization and safer supply. For a more thorough examination of this material, I recommend reading the report my colleagues and I wrote for the Stanford Network on Addiction Policy.
It is in this context that Alberta’s United Conservative Party (UCP) are considering the implementation of involuntary treatment for those suffering from addiction in a potential new law referred to internally as the Compassionate Intervention Act.
According to the Globe and Mail, the Act would give police, family members or legal guardians the ability to refer adults and youth into addiction treatment against their will. [iii] Applications would be referred to an administrative panel which would rule on whether an individual should be placed in treatment. Alberta Premier Danielle Smith stated that “the government is looking at evidence from across the globe on involuntary treatment, and is paying particular attention to what is being done in Portugal.”[iv]
There are many discussions that could be had on this subject, but I would like to specifically focus on one issue: the degree to which Alberta’s proposed model resembles the Portuguese Model.
The Portuguese Model
The Portuguese Model, implemented in 2001, consisted of the following elements:
Portugal decriminalized the consumption, acquisition and possession of all illicit drugs for personal use. However, these acts remained an administrative offence.
Each administrative district in Portugal maintained at least one Commission for the Dissuasion of Drug Addiction (CDT), consisting of a legal and two medical professionals. CDTs could implement a variety of sanctions, such as fines, travel restrictions, or requiring users to regularly report to the commission. They could not mandate drug treatment, but they were could use sanctions to encourage or pressure users into treatment.
Referrals to CDTs were primarily made by police officers. When police officers encountered a person using or possessing drugs, they would confiscate the drugs and direct the person to appear before the regional CDT. If the CDT determined that the case was criminal (e.g., they deemed the person was engaged in trafficking), they would refer them to a criminal court.[v]
This model is generally viewed as having been very successful. For example, drug related deaths dropped significantly between 2000 and 2005, the number of prisoners sentenced for drug offences dropped significantly, and HIV diagnoses attributed to injecting drugs have all but disappeared.[vi]
Questions regarding Alberta’s proposed model
The UCP has not yet put forward a formal proposal for the Compassionate Intervention Act. However, based on the information currently available, I have a number of questions:
1. How will the Compassionate Intervention Act mesh with the criminal justice system?
By decriminalizing drug possession and drug use, the Portugal Model clearly distinguished the lines of authority between CDTs and the justice system. If Alberta does not decriminalize drugs, it is unclear how the administrative panel will fit in with the rest of the justice process. If officers are encouraged to refer users to administrative panels in place of criminal charges, then Alberta is effectively decriminalizing drugs. If criminal proceedings occur concurrently, the administrative panel will have significantly less autonomy.
2. Should family members and legal guardians be permitted to refer users under the act, and can people be referred for non-illicit substance addiction?
Allowing referrals from family members and legal guardians may put significant additional responsibility on administrative panels to investigate whether referred individuals are using drugs. In the Portuguese model, CDTs were not responsible for confirming whether an individual was using or had been in possession of illicit drugs because referrals were made only under these conditions. It also raises the question of whether referrals could be made for non-illicit substances. If so, the Compassionate Intervention Act would represent a notable expansion of state authority into the lives of Albertans.
3. What powers will the administrative panel have?
The largest point of uncertainty regarding the potential Alberta model is the powers of the administrative panel. A feature of Portugal’s CDTs was their wide-ranging autonomy to impose sanctions but minimal ability to enforce treatment. It is currently unclear whether Alberta’s administrative panels would function in the same way. Danielle Smith’s chief of staff Marshall Smith has stated that the panel’s primary function is to discuss an individual’s needs and connect them with services[vii], but that cases could be referred to a judge with the power to mandate treatment. Based on this description the administrative panels may lack the autonomy of the Portuguese panels, with their only source of leverage being the threat of referring the case to a judge.
4. How paternalistic is the UCP prepared to be on addiction?
Taking away citizens’ rights to self-determination should only be done in the most extreme cases. Some users represent a risk to those around them; in such cases involuntary treatment is often justified. However, if this is not demonstrably the case, justifying involuntary treatment becomes much more difficult. Canada is a liberal democracy, and as Canadians we generally value the right to live as we see fit as long as we are not causing harm to others.
Involuntary treatment also has a long history of abuse, from asylums to residential schools. Though addiction may make the lives of many users unpleasant, a poorly implemented involuntary state program can damage the fundamentally important trust government should seek to inspire in its citizens.
Finally, it is important to consider that the voluntary nature of treatment in the Portugal model may be an important aspect to its success. Even though CDTs could pressure users to enter treatment, it was still ultimately the user’s choice. There is research to suggest that involuntary treatment is less effective, and the UCP should take this fact under careful consideration.
Conclusion
The Compassionate Intervention Act may represent a major shift in addiction policy in Alberta, but much depends on the specific powers of the administrative panels and their relationship with the justice system. If panels have wide-ranging autonomy to leverage sanctions to encourage users to voluntarily accept treatment, then I am cautiously optimistic. However, if the primary tool panels have is the threat of involuntary treatment, then I am concerned that the Act may unnecessarily deprive users of their autonomy and reduce the effectiveness of treatment.
[i]Opioid- and stimulant-related harms in Canada. (2022). Government of Canada. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/
[ii]Blair Gibbs, Ryan Workman, Jake Kiefer, & Chosen Canlas. (2023). Canada’s Health Crisis: Profiling Opioid Addiction in Alberta and British Columbia. https://addictionpolicy.stanford.edu/sites/g/files/sbiybj25011/files/media/file/canadas-health-crisis-opioid-addiction-in-alberta-and-british-columbia-web-version-1.pdf
[iii]Alanna Smith. (2023, April 18). Alberta eyes legislation on involuntary treatment for some drug users. The Globe and Mail. https://www.theglobeandmail.com/canada/alberta/article-albertas-ucp-exploring-sweeping-legislation-on-involuntary-treatment/
[iv]Alanna Smith. (2023, April 24). Alberta Premier says involuntary care ‘last resort’ for people with severe drug addictions. The Globe and Mail. https://www.theglobeandmail.com/canada/alberta/article-alberta-premier-says-involuntary-care-last-resort-for-people-with/
[v]Woods, J. B. (2011). A Decade After Drug Decriminalization: What Can The United States Learn From The Portuguese Model? University of the the District of Columbia Law Review, 15(1). https://deliverypdf.ssrn.com/delivery.php?ID=264110083004126101002110124016107126046015033002001029031097075103031019090094006091027055001103025062017092104017097072117109044000006035020011117015022007022110024021016009071085117086023096081004116010031102025083086067088098123122123089107072073&EXT=pdf&INDEX=TRUE
[vi]Drug decriminalisation in Portugal: Setting the record straight. (2021). Transform Drug Policy Foundation. https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight
[vii]Saif Kaisar. (2023, April 21). Alberta government clarifies Compassionate Intervention Act after criticism. Global News. https://globalnews.ca/news/9643493/alberta-government-compassionate-intervention-act-explanation/
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