Harm Reduction Nurses Association & Doctors for Safer Drug Policy encourage colleagues to stand down from implementing BC NDP Mental Health Act changes
Proposals to expand so-called “involuntary treatment” for substance use disorders is not a health intervention, it is a political response to fear, misinformation, and moral panic.
Joint statement from Harm Reduction Nurses Association and Doctors for Safer Drug Policy
British Columbia stands at a pivotal moment. The government’s proposals to expand the use of so-called “involuntary treatment”[1] for substance use disorders is not a health intervention, it is a political response to fear, misinformation, and moral panic. As nurses, physicians, and allied health providers, we state clearly and unequivocally: we do not support this legislation, and we will not participate in involuntary treatment for substance use disorders.
This proposal contradicts our professional ethical obligations, undermines human rights, and will increase, not reduce, harm. We call on the Premier to withdraw this bill immediately and allow the current Charter challenge of BC’s Mental Health Act[2] to proceed without political interference.
A Health and Human Rights Crisis Demands Evidence, Not Coercion
Since 2016, more than 17,000 people in BC have died from the toxic unregulated drug supply[3]. Many more have faced the irreparable harms of hypoxic brain injury and long-term disability[4]. Despite this scale of loss, the response to date has failed to reflect the urgency we apply to any other mass-fatality public health emergency.
Further, BC already overutilizes its Mental Health Act relative to other provinces. As noted by the Canadian Mental Health Association, “every year in BC, the Mental Health Act is used around 30,000 times to involuntarily detain individuals experiencing mental health and/or substance use challenges – the highest rate of any province in Canada.”[5] This is not an activity that we need to further facilitate, to the detriment of our patients.
The BC Human Rights Commissioner, in her November 2025 statement, was unequivocal: the toxic drug crisis is a human rights violation driven by toxic supply, structural inequities, and systemic discrimination, not by voluntary use of substances[6]. She warns that involuntary treatment:
Violates autonomy and self-determination;
Disproportionately harms Indigenous, Black, disabled, gender-diverse, and low-income people;
Lacks evidentiary support; and
Cannot be justified when BC’s voluntary, community-based system is profoundly under-resourced.
The Commissioner states plainly that the government must first build a functional voluntary system before even contemplating expanded involuntary measures. Instead, the government has chosen to defy this guidance and move in the opposite direction.
Compulsory Substance Use Treatment is Ineffective and Dangerous
The evidence is clear and consistent:
Compulsory treatment has no demonstrated long-term benefit.[7]
Relapse rates are extraordinarily high: one study reported 96.4% relapse within two months after mandated treatment.[8]
The risks of overdose[9] and death are significantly elevated immediately after discharge from compulsory treatment.[10]
Involuntary settings sever trust, increase trauma, and escalate risk.[11]
Leading human rights scholars have concluded that mass detention for “treatment” constitutes a grave violation of human rights and cannot be justified by claims of substance use disorder alone. As research and our own clinical experience demonstrate, people are most vulnerable to overdose after periods of forced abstinence. Coercion increases risk, it does not reduce it.
Ethical Obligations: We Cannot Provide Care Without Consent
The Canadian Nurses Association Code of Ethics[12] requires nurses to:
“respect the inherent dignity and autonomy of all people”;
Provide care only with voluntary informed consent;
Support capable people’s right to refuse treatment; and
Uphold human rights as protected by the Canadian Charter.
The Canadian Medical Association Code of Ethics[13] similarly requires physicians to respect autonomy, avoid harm, and maintain integrity even in the face of political pressure.
Forced treatment is incompatible with these standards. To participate in involuntary treatment for substance use disorders is to violate the core values of our professions, including non-maleficence (“do no harm”), respect for persons, and justice. No government can legislate away these obligations.
Moral Distress: Forcing Clinicians to Harm Patients Harms Us Too
Nurses and physicians across BC already experience extreme moral distress due to the ongoing crisis, chronic system failure, and the daily preventable deaths they witness. Involuntary treatment would force us to act against our ethical commitments, inflicting profound moral injury and exposing us to liability even with legislative shielding.
We cannot say we are on the right side of medical ethics when the government needs to amend a law just to shield us from lawsuits for our activities. Coercion of practitioners mirrors the coercion proposed for patients. Both are unacceptable.
Rooted in Moral Panic, Not Science
This legislation emerges from election-season moral panic rather than public health evidence. Research on moral panics shows predictable features: concern, hostility, consensus, disproportionality, and volatility.[14] The current framing of people who use drugs as “unable to make decisions” is not evidence-based - it is stigma that fuels criminalization and further harms.
Mis- and disinformation about safer supply, decriminalization, and voluntary treatment have circulated widely. But policy must be driven by evidence, not by fear, political pressure, or manufactured outrage.
A Better Path Forward Exists
BC once led the world in harm reduction. We can do so again by:
Investing in voluntary, evidence-based treatment;
Expanding regulated alternatives (safer supply);
Scaling housing-first and trauma-informed supports;
Improving crisis care, primary care, and community outreach;
Conducting a comprehensive review of the Mental Health Act, using a human rights lens
Working alongside people who use drugs and their families to design care that meets their needs.
These are the solutions that save lives. Coercion does not.
Our Commitment and Our Call-to-Action
We refuse to participate in involuntary treatment for substance use disorders.
This is consistent with our ethical codes, human rights obligations, and the best available evidence.
We call on the Premier to withdraw the proposed amendments to the Mental Health Act.
The current Charter challenge must proceed without political interference.
We invite physicians, nurses, social workers, and allied care providers to sign on to this statement.
We urge public health institutions, civil society groups, and municipal leaders to join us.
Silence from power holders, including the BCCDC, BCCSU, and Health Authority leadership, is no longer acceptable.
We commit to advocating for solutions that uphold dignity, autonomy, and life.
People who use drugs deserve evidence-based care, not coercion. Health care providers deserve ethical working conditions, not moral injury. The public deserves policies rooted in human rights, not fear. Considerations of safety and security of the person should be weighted equally for both patients and healthcare workers in policy reforms.
This Moment Demands Courage
As health professionals, we choose the path of evidence, ethics, and humanity. We call on the government to do the same.
Sincerely,
The Harm Reduction Nurses Association
Doctors for Safer Drug Policy
[1] BC Government. (2025). Province taking action to strengthen involuntary care, better support for patients. https://news.gov.bc.ca/releases/2025HLTH0055-001158
[2] Canadian Mental Health Association – BC Division. (2025). Critically important charter challenge on BC’s Mental Health Act underway today. https://bc.cmha.ca/news/charter-challenge-on-bcs-mental-health-act/
[3] BC Coroners Service. (2025). Statistical reports on deaths in British Columbia. https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports
[4] BC Centre for Disease Control. (2025). Knowledge update: Brain injury following toxic drug events in British Columbia. https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports
[5]Canadian Mental Health Association – BC Division. (2025). Critically important charter challenge on BC’s Mental Health Act underway today. https://bc.cmha.ca/news/charter-challenge-on-bcs-mental-health-act/
[6] British Columbia’s Office of the Human Rights Commissioner. (2025). A human rights-based approach to the toxic drug crisis. https://bchumanrights.ca/resources/publications/publication/toxic-drug-crisis/
[7] Werb et al., (2015). The effectiveness of compulsory drug treatment: A systematic review. International Journal of Drug Policy, 28, 1-9. https://doi.org/10.1016/j.drugpo.2015.12.005; Canadian Mental Health Association – BC Division. Involuntary care already exists in BC, but is it working? https://bc.cmha.ca/news/involuntary-care-in-bc/; Pilarinos et al., (2018). Secure care: more harm than good. Canadian Medical Association Journal, 15, E1219-20. https://www.cmaj.ca/content/190/41/E1219
[8] Nakhaee et al., (2024). The effectiveness of court-mandated compulsory treatment in promoting abstinence among people with substance use disorders in Iran. International Journal of Drug Policy, 124, 1-4. https://doi.org/10.1016/j.drugpo.2024.104325
[9] Rafful et al., (2018). Increased non-fatal overdose risk associated with involuntary drug treatment in a longitudinal study with people who inject drugs. Addiction, 113(6), 1056-1063. https://pmc.ncbi.nlm.nih.gov/articles/PMC5938130/pdf/nihms934849.pdf
[10] Ledberg, A., & Reitan, T. (2022). Increased risk of death immediately after discharge from compulsory care for substance abuse. Drug and Alcohol Dependence, 236, 1-7. https://doi.org/10.1016/j.drugalcdep.2022.109492; Borschmann et al., (2024). Rates and causes of death after release from incarceration among 1471526 people in eight high-income and middle-income countries: an individual participant data meta-analysis. The Lancet, 403(10438), 1779-1788. https://doi.org/10.1016/S0140-6736(24)00344-1
[11] Cha et al., (2021). The perspectives of people who use drugs regarding short term involuntary substance use care for severe substance use disorders. International Journal of Drug Policy, 97, 1-11. https://doi.org/10.1016/j.drugpo.2021.103208; O’Brien, D., & Hudson-Breen, R. (2023). “Grasping at straws”, experiences of Canadian parents using involuntary stabilization for a youth’s substance use. International Journal of Drug Policy, 117, 1-9. https://doi.org/10.1016/j.drugpo.2023.104055; Health Justice. (2024). Regarding recent announcements on involuntary treatment in BC. https://www.healthjustice.ca/blog/involuntary-treatment-announcement; Health Justice. (2024). Fast facts on Mental Health Act and involuntary treatment. https://www.healthjustice.ca/fast-facts-mha#Involuntary-Treatment-Facts-2024
[12] Canadian Nurses Association. (2025). Code of Ethics for Nurses. https://www.cna-aiic.ca/en/nursing/regulated-nursing-in-canada/nursing-ethics/2025-coe
[13] Canadian Medical Association. (2018). CMA Code of Ethics and Professionalism. https://www.cma.ca/cma-code-ethics-and-professionalism
[14] Garland, D. (2008). On the concept of moral panic. Crime, Media, Culture, 4(1), 9-30. https://journals.sagepub.com/doi/epdf/10.1177/1741659007087270
