B.C.’s brain-injured, mentally-ill drug users: Forced treatment on the table for ‘clinical triad’

When B.C.’s premier announced a new scientific advisor to address some of the province’s most difficult patients to treat, he raised an issue that’s often overlooked: drug overdose survivors.

“Some of those people are badly injured by those overdoses and survive with life-altering brain injuries that affect their ability to function in society,” David Eby told reporters, emphasizing some people are functionally unable to care for themselves.

He’s created a new position for Dr. Daniel Vigo to address a very specific subset of drug users who have brain injuries, mental illness and repeated exposure to toxic drugs – a group Eby said is growing, and one that “addictions doctors are struggling to support.”

Vigo, an associate professor at UBC who’s advised the World Health Organization and lectured at Harvard Medical School, is now tasked with identifying which people meet that “clinical triad” definition and make recommendations on how to address complex needs that often see them struggle with family relationships and housing, while going in and out of hospital or jail.

When CTV News asked what his first recommendation would be, Vigo replied that it was his first day on the job and he had a lot or research and analysis to do first, but when another reporter asked whether he’d expand forced treatment, he didn’t deny it’s on the table.

“The important things is that the interventions are effective, whether they are voluntary or involuntary and that is what our work will be focussed on,” he said, noting the Mental Health Act already has such provisions for clinicians.

British Columbia continues to detain thousands of patients per year under the Mental Health Act at more than 70 institutions and hospitals across the province, with advocates warning that while some people are grateful the decision was taken away from them, and value the psychiatric or substance use treatment they received, others are deeply traumatized by the experience. 

The premier has expressed support for involuntary treatment in the past and when asked about it in the wake of Vigo’s appointment said he would consider whatever his advisor suggested.

“We’ve said to Dr. Vigo, ‘Bring forward your best advice about what we need to do support this population,’” Eby said, while also committing to consulting with stakeholders before making any new policy decisions.