Participating in Criminalization: Healthcare workers have a choice
Art by Kate Colizza & Graphics by Corey Ranger
Alberta is embarking on a troubling new chapter in their response to unregulated drug poisonings, homelessness, and visible poverty. The proposed Compassionate Intervention Act allows a family member, doctor, or police officer to seek a treatment order which “would require that person to engage in treatment for their addiction and drug use to save their life and protect the safety of the community”. Calling it compassionate is an exercise in political framing, designed to rationalize coercion and forced treatment of people who use drugs. This is not a new, or innovative, idea. It’s actually just a recycling of tactics as old as the colonization and occupation of these lands. We do not have to replicate historical traumas generated through institutionalization and criminalized medicine. Healthcare workers have a choice under sec 2(a), freedom of conscience, of the Canadian Charter of Rights and Freedoms. People who use drugs, including people living with addiction, do not lose their human rights due to their drug use.
First, let’s talk about involuntary treatment, and all its inherent harms. The BC Centre for Disease Control published an evidence review on “Detention-Based Services for People who use Drugs” in 2021 and demonstrated that compulsory treatment services are not supported by the evidence. Instead, research demonstrates a clear pattern of harms, some of which can be deadly. Periods of forced abstinence can actually increase risk of death, due to the likelihood of relapse and the impact of a reduced tolerance. Detention-based services for people who use drugs have been shown to create or exacerbate mistrust between patients and providers, retraumatize people with prior negative healthcare encounters, and reduce the likelihood that people who use drugs will seek help in the future. Nurses who work in the mental health and substance use sector already know the system is stretched beyond capacity. Despite the need to regulate the private and public treatment sector, nurses still work tirelessly to facilitate referrals to treatment and recovery services whenever their patients are ready. To be clear, the people who are already trying to get into treatment are facing massive waitlists. This proposed piece of legislation will only increase the burden on an already overwhelmed system.
This isn’t about treatment or compassion. When Danielle Smith says “Albertans shouldn’t have to look over their shoulders in their own communities” she is signaling that the Compassionate Intervention Act will serve the purpose of criminalizing homelessness and visible poverty. This reaffirms the belief that the proposed legislation is nothing new or innovative. Instead, it represents renewed commitment to institutionalization and incarceration, a process that has contributed to the current unregulated drug poisoning, homelessness, and unmanaged mental health crises in this country. The new idea is actually the old idea that got us here in the first place.
Nurses have an ethical obligation to their patients that must supersede the political aspirations of any governing body. For that reason, nurses must know that they have the right to refuse to participate in the criminalization, coercion, and involuntary care of their patients. The Canadian Nurses Association (2017) code of ethics includes “Providing safe, compassionate, competent and ethical care”, “promoting and respecting informed decision-making” and “honoring dignity” among others. This must be a guiding light amidst the persecution of people who use drugs.
Social workers must resist engaging in colonial acts. Again, from the BCCDC, “Indigenous peoples are over-represented among PWUD [people who use drugs] and among those impacted by the overdose crisis. Compulsory treatment, and involuntary hospitalizations in particular, imposes health care practices that reinforce experiences of colonization among Indigenous peoples”. The Compassionate Intervention Act poses very real possibilities of creating new traumas and social workers know firsthand that they should not participate as agents of the state in the creation of those traumas.
All workers expected to participate in the Compassionate Intervention Act need to exercise solidarity and say no to involuntary care. On June 26th, 2023, 87 organizations called on the Federal Government to denounce calls for involuntary or coercive drug treatment and repeal punitive drug laws for the 2023 Global Day of Action, “Support. Don’t Punish”. Unions in Alberta are uniquely positioned to support workers in their refusal to engage in harmful and morally injurious activities. It is in the best interest of both the public, and the workers’ unions to collectively push back against punitive and coercive drug policy.
Implementation of the Compassionate Intervention Act is a potential catalyst for a more punitive, and more dangerous era of drug policy in Canada. The world’s eyes are on Alberta, for better or worse, and what transpires here will cast a ripple effect on the rest of this country and beyond. We can choose to replicate historical harms generated through colonization, racist drug laws, and medical paternalism. Or we can exercise our right to disrupt criminalization, and its many insidious forms.
Guest Contributors:
Cheryl Mack BSc Hons MD MA FRCPC
Kinnon Ross RN BScN BA
Kate Colizza MD FRCPC ISAM DRCPS