Saskatchewan medical groups point to fundamental flaws in forced drug treatment legislation

The Saskatchewan Medical Association warns involuntary treatment poses risks, as the province defends its plan. Donovan Maess reports.

Two key organizations representing Saskatchewan’s medical doctors are flagging “significant concerns” with the government’s involuntary addiction treatment legislation.

The Compassionate Intervention Act was tabled in the legislature Wednesday, and both the Saskatchewan Medical Association (SMA) and the College of Physicians and Surgeons of Saskatchewan (CPSS) say the law risks putting even more strain on overloaded emergency rooms and could cause a spike in overdoses when patients forced into treatment are eventually released.

Both organizations are concerned that emergency rooms, already overburdened, will become the de facto intake point for these involuntary patients. That would mean doctors have less time for those who want and need urgent lifesaving care.

Dr. Pamela Arnold, president of the SMA, told CTV News that physicians support the government’s goal of saving lives, but there just isn’t evidence to support involuntary treatment, and patients need to participate in their care for it to be successful.

“We know that people need to buy into these decisions. These are life-changing decisions that people are making.”

Speaking for the CPSS, which regulates the professional practice of medicine in Saskatchewan, Registrar Bryan Salte told CTV News there aren’t enough facilities to treat the people voluntarily seeking help — and that’s where the province should be focusing its resources.

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“With the lack of evidence supporting the effectiveness of compelled treatment for addiction, the cost of developing secure facilities to provide compelled treatment and the shortage of trained health professionals to deal with addiction treatment, the committee did not support compelled treatment at the present time,” he said.

The college’s own code of ethics is clear on the issue of patient choice.

“Always treat the patient with dignity and respect the equal and intrinsic worth of all persons. Always respect the autonomy of the patient,” it said.

“Respect the decisions of the competent patient to accept or reject any recommended assessment, treatment, or plan of care.”

They say the law lacks any clinical criteria to guide the decision — a major gap.

Speaking to reporters in the legislature Wednesday, Mental Health and Addictions Minister Lori Carr did not seem fazed by the potential pitfalls outlined by the medical experts.

“We don’t agree on everything, but what we do agree [on] is we need to get individuals help with getting into recovery,” said Carr.

“And yeah, we do need to be careful about how it’s framed and the process that it takes, and we will take what they’ve said and take that under advisement as we develop.”

Carr says the legislation isn’t intended to replace existing treatment options, including the Rapid Access to Addiction Medicine program — also provided virtually in some communities — and opioid agonist therapy, which gives patients a medication that serves as a safer substitute for dangerous street opiates like fentanyl to help them stop using the drug without suffering the full physical effects of withdrawal.

“We think that this is just one more tool in that toolbox, truly for those individuals that don’t have the capacity to actually make that decision to get into any of those options,” she said.

While Carr acknowledges the concerns of Saskatchewan doctors, she says the government has no intention of pausing the legislation to incorporate their advice.

“First we will pass the legislation,” she said.

The details will come later, through a set of regulations, she says.

Carr also maintains that decisions about whether a patient deserves the right to refuse treatment and potential institutionalization will be made by a panel of industry professionals.

Patients who have been deemed incompetent will also have the right to appeal to the courts to overturn the panel’s decision.

Still, Arnold is concerned about what will happen to patients after they’re released.

Involuntary addiction treatment has been shown to increase the risk of overdose if there’s no “continuity of care” when people get out of treatment, says Carr.

“Patients will have had a sudden decrease in their tolerance, and if they haven’t had the supports that they need in place to maintain their sobriety when they leave, if they go out and use the same substances that they used before they’re at an increased risk of overdose,” she said.

That “continuity of care” — the support for the difficult task of carrying on with life, sober, after you’ve been deemed incompetent and institutionalized, does not appear to be considered in the legislation, as it’s written.