Yes. The problem with forced treatment.... First of all, we don't do it for diabetes, hypertension, rheumatoid arthritis or pneumonia. That's because we want to preserve your autonomy over health care. The underlying hypothesis of forced treatment is that it's one and done. I treat you, you're better and you go home. That's not the case.
When you're working on the sharp end of the stick like I am, you recognize that addiction or substance use disorders are a complex and wicked problem that involve not only health care but the social determinants of health. A simple, single approach for all patients is never going to work. It's a chronic disorder; it's not an acute disorder.
It's no different from managing diabetes. We know what the problem in diabetes is, for example, which is insulin. We still can't cure diabetes, and we've known about insulin since 1922. If we can't cure diabetes, how can we hope that a single addiction treatment is going to solve a complex and wicked problem like addiction?
You have to start somewhere. As an ICU doctor, my fundamental job is to keep you alive. It's to buy you time and, in the meantime, figure out what is actually going on and come up with a comprehensive plan to look after you. It's no different on Murray Street and King Edward Avenue. When somebody is addicted, my job is to keep them alive using a harm reduction approach.
We use harm reduction in all aspects of our life. This committee just used a harm reduction approach when it made me go through security. You don't know who I am. You might be afraid that I might hurt you, so you have a harm reduction process that prevents me from doing that. Most of you probably drove here today, or you had somebody drive you. Your car has harm reductions: seat belts, anti-lock brakes and airbags. You put your seat belt on. Why did you do that? There are traffic signs and traffic laws we all have to follow, yet people still die from traffic accidents. I know this because I look after them in the ICU, but we don't ban driving.