A call for upstream solutions to the unregulated drug crisis in British Columbia, Canada: Locked up or locked out.

The unregulated drug crisis has raised growing concerns about the care and treatment of people experiencing complex mental health and substance use issues in British Columbia (BC). The BC government's recent plans for expansion of involuntary treatment across the province demonstrate a misguided understanding of mental health and substance use disorders. Relying on involuntary treatment as a primary response to this public health issue raises several ethical and clinical concerns. With the majority of evidence on involuntary treatment demonstrating limited effectiveness, and potential for increased harms, alternative evidence-based approaches are urgently needed. Addressing this public health challenge requires a shift away from involuntary treatment to person-centered, voluntary, integrated, and community-based solutions that address the social determinants of health. This commentary will review the limitations, clinical challenges, and policy alternatives to involuntary treatment of adults with substance use disorders.