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Uzelman: Homelessness, addiction and death – The case for involuntary treatment

A column by Bruce Uzelman
Someone sleeping outside in Kelowna during Nov. 2022. (Contributed)

~Bruce Uzelman

Homelessness has tripled in Kelowna over the last year, says the City’s Bylaw Service. Kelowna’s Community Safety Director told CBC that Kelowna averaged 170 people who are “visibly unhoused” in October. Darren Caul continued, “I say visibly because this by no means reflects the true number of people who are in a precarious housing situation – and the numbers are staggering.”

Seven shelter operators in the Okanagan-Similkameen wrote an open letter on November 5. The shelter system, they reveal, offers insufficient services, and is under-resourced, short staffed and dangerous. As bad as the system is for users, the situation is much worse for those who do not access a shelter.

People are regularly turned away from full or understaffed facilities, and some homeless people, who are mentally ill or drug addicted, do not seek shelter or are incapable of getting themselves to a shelter. Some, literally, night after night, sleep in the snow or propped against a door. Very clearly, these people are at risk of hypothermia – particularly as temperatures fall well below zero – and of overdose.

David Eby, the new Premier of B.C., in the summer, spoke of the lack of necessary supports for people suffering from mental illness, following the decision to close the Riverview psychiatric hospital in the 1980’s and following more recent federal changes hindering the ability of courts to hold persons on bail. He said, “And that means [it is necessary for] things like involuntary mental health and addiction care for people to at least give them a chance to survive, but also to respond to the crisis they are obviously in.” A chorus of criticism met Eby from the BC Civil Liberties Association (BCCLA) and some doctors.

Meghan McDermott of the BCCLA falsely attacked Eby’s comments as, “misleading, immoral and reckless.” She warned involuntary care would violate Charter rights. It may, but Eby is a past executive director of BCCLA and a former attorney general of BC, who understands the implications of the policy and the need for caution in its application. McDermott also stridently advances the orthodox medical position on involuntary treatment, “All evidence is clear that involuntary drug treatment can cause great harm – even death – and does not save lives.” In fact, important evidence is contrary to this view.

Dr. Bruce Hobson, Dr. Jim Ketch, Dr. Robert Lehman, Dr. David Smith and Dr. Tom Warshawski, who all treat BC youth with substance-abuse disorders [SUD], in September, wrote, “we think that the evidence needs a fresh look.” In a balanced article, “Medical Evidence Supports Involuntary Treatment”, they assert, “While it is correct that enforced abstinence without the provision of opioid agonist therapy is dangerous, this approach is not being proposed. There is, however, relevant evidence to support time limited, involuntary treatment when it incorporates opioid agonist therapy and harm reduction.”

The doctors’ article quotes a Norwegian study, in which “the authors concluded that while ‘voluntary treatment for SUD generally yielded better outcomes, nevertheless, we also found improved outcomes for compulsory admission patients.’” The authors of the study add that it is important to recognize the alternative to compulsory treatment is no treatment.

The doctors’ article relays some sobering facts and statistics. BC declared a Public Health Emergency in 2016 after recording nearly 1000 drug overdose deaths in 2015. “The yearly death toll has continued to climb, with more than 1000 fatalities in the first six months of 2022. Overdose is now the leading cause of death for adolescents in BC. Current approaches are ineffective and our dogma must be questioned.”

The article continues, “When a youth suffers a life-threatening [illicit drug] overdose, it takes days for cognition to improve sufficiently for them to have the capacity to understand and appreciate, refuse and accept treatment. … Most have serious mental health issues, and many are suicidal….” Yet, it is current practice to release them just a few hours after overdose reversal, says the article. In contrast, youth with mental health disorders, who have “non-illicit” drug overdoses, receive a full psychiatric evaluation, and are not released until it is safe to be. They all deserve the same standards of care say the doctors.

Involuntary care for some individuals addicted to illicit drugs, whether housed or homeless, is critical. Unfortunately, those experiencing homelessness are particularly vulnerable. On October 12, the BC Coroners Service released a report which revealed that there were 247 deaths of homeless people (defined as sleeping outdoors or in a shelter) in 2021, an increase of 75% over the previous year. It also showed that almost four in five (79%) of these deaths were related to illicit drug toxicity. To abandon these people to potentially overdose or freeze to death alone in the night is callous and inexcusable.


Bruce W Uzelman

I grew up in Paradise Hill, a village in Northwestern Saskatchewan. I come from a large family. My parents instilled good values, but yet afforded us, my seven siblings and I, much freedom to do the things we wished to do. I spent my early years exploring the hills and forests and fields surrounding the village, a great way to come of age. My parents owned a successful general store. My siblings and I were required to help out in the business, no choices allowed there!

I attended the University of Saskatchewan in Saskatoon. I considered studying journalism at one point, but did not ultimately pursue that. However, I obtained a Bachelor of Arts, Advanced with majors in Economics and Political Science in 1982.

My career has consisted exclusively of small business, primarily restaurant and retail. I was originally based in Alberta, and then BC, first in Summerland, then Victoria and finally Kelowna (for over 20 years). I was married in Alberta, and we have two daughters, who have returned to Alberta as adults for career reasons, as did my now ex-wife. My daughters are successful, and now have families of their own.

I have maintained a healthy interest in politics throughout my adult years, and wish to put that and my research skills to work as a political columnist.


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