Chau Leena W, Erickson Margaret, Vigo Daniel, Lou Hayami, Pakhomova Tatiana, Winston Mark L, MacPherson Donald, Thomson Erica, Small Will
Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada.
Department of Psychiatry, Faculty of Medicine, University of British Columbia, David Strangway Building, 4th Floor 209, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
Int J Drug Policy. 2021 Nov;97:103208. doi: 10.1016/j.drugpo.2021.103208. Epub 2021 May 28.
In the Canadian Province of British Columbia (BC), the BC Mental Health Act permits involuntary care for treating mental disorders. However, the Act has also been applied to provide involuntary care to individuals with a primary substance use disorder, in the absence of specific guidelines and legislation, and with insufficient understanding of perspectives of people who use drugs (PWUD) regarding this approach.
As part of a larger mixed-methods research project providing an overview of involuntary care for severe substance use disorders in BC, three focus groups were convened with: PWUD, families and caregivers, and Indigenous community stakeholders. This analysis examines perspectives from the focus group of PWUD, consisting of nine participants from local and regional drug user and advocacy organizations regarding involuntary care. A qualitative descriptive approach and thematic analysis were conducted, using a coding framework developed deductively and inductively, and participant perspectives were interpreted drawing on problematization theory.
Participants did not endorse the use of involuntary care, instead emphasizing significant changes were needed to address shortcomings of the wider voluntary care system. When asked to conceptualize what an acceptable involuntary care scenario might look like (under hypothetical and ideal conditions), participants recommended it should include: individual control and autonomy, peer advocacy in decision-making, and elimination of police and criminal justice system involvement from treatment encounters. Participants saw involuntary care to be an inappropriate approach given the shortcomings of the current system, noting also problems inherent in its use to manage severe SUDs and imminent harm, and prioritized alternate approaches to offsetting risks.
Improving voluntary care for substance use, along with addressing the social determinants of health that put individuals at risk of problematic substance use and harm, were prioritized in participant perspectives. Participant comments regarding the use of involuntary care bring forward alternate solutions in the context of the opioid overdose crisis, and a reconceptualization of the 'problem' of managing severe substance use disorders.
在加拿大不列颠哥伦比亚省（BC省），《BC省精神健康法》允许对精神障碍患者进行非自愿治疗。然而，该法案也被用于为患有原发性物质使用障碍的个人提供非自愿治疗，且缺乏具体指导方针和立法，对吸毒者（PWUD）关于这种治疗方式的观点了解不足。
作为一项大型混合方法研究项目的一部分，该项目概述了BC省对严重物质使用障碍的非自愿治疗情况，召集了三个焦点小组，分别由吸毒者、家庭和照顾者以及原住民社区利益相关者组成。本分析考察了吸毒者焦点小组的观点，该小组由来自当地和地区吸毒者及倡导组织的九名参与者组成，讨论了非自愿治疗问题。采用定性描述方法和主题分析，使用演绎和归纳开发的编码框架，并运用问题化理论解释参与者的观点。
参与者不认可使用非自愿治疗，而是强调需要进行重大变革以解决更广泛的自愿治疗系统的缺陷。当被要求设想在假设和理想条件下可接受的非自愿治疗场景时，参与者建议应包括：个人控制和自主权、决策中的同伴倡导，以及在治疗过程中消除警察和刑事司法系统的介入。鉴于当前系统的缺陷，参与者认为非自愿治疗是一种不合适的方法，同时指出在用于管理严重物质使用障碍和迫在眉睫的伤害方面存在固有问题，并优先考虑其他降低风险的方法。
在参与者的观点中，优先考虑改善物质使用的自愿治疗，以及解决使个人面临物质使用问题和伤害风险的健康社会决定因素。参与者对非自愿治疗使用的评论在阿片类药物过量危机背景下提出了替代解决方案，并对管理严重物质使用障碍的“问题”进行了重新概念化。
