The Current - How does involuntary treatment work in the U.S.?

Episode Date: November 28, 2024

Ricky Garcia struggled with addiction for years, and fought for laws that would allow people in crisis to be forced into involuntary treatment in his home state of Washington. As ideas around involuntary treatment gain traction in Canada, Julia Wong’s documentary Ricky’s Law explores how the approach is working south of the border.

In 2017, it felt like drugs were everywhere in the news, so I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. This is a CBC Podcast. Hello, I'm Matt Galloway and this is The Current Podcast. Conversations in Canada are intensifying over the idea of involuntary treatment for people with addictions. Alberta is expected to move forward with legislation in the spring. It was an election promise in British Columbia during that province's recent election, and it's being floated by mayors in Ontario as well. It is a different story, though, south of the border,

where laws already exist that can force people with addiction into treatment. The CBC's Julia Wong went to Washington state to find out how those laws are working there. Here's her documentary, Ricky's Law. Ricky would light up the room. He was extremely funny. He had a beautiful smile. He had one dimple, not two. A smile stretches across the face of Lauren Davis as she talks about her friend Ricky Garcia. Yeah, he just carried light with him wherever he was. He was extremely friendly, extremely disarming. The pair met in 2004 when they were both 18 and a bond quickly formed. Ricky had a big heart. He loved music, dance, and photography.

He was an enormous part of my world. But years later, Ricky started struggling, addicted to alcohol and opioids. Ricky's drug of choice was Yes Please. From 2010 to 2012, Ricky was in and out of emergency rooms more than 75 times. He went to ICU three times for suicide attempts and overdoses. Davis upended her life to be by his side.

And I would, you know, visit him at the hospital. And when visiting hours were over, I would leave and I would just cry the whole way home. I'd just break down. Over those two years, Davis felt helpless. At the time, the state didn't have an involuntary treatment law for people with addiction, but it did have one for mental health. Davis used that to get Ricky treatment. The only reason we were successful in that is because I learned to speak social work and I learned the correct buzzwords essentially to say to convince

individuals that he was suffering from an organic mental disorder and that his behavior was driven by a mental condition that was not substance use disorder, which was entirely inaccurate. Ricky was forced into psychiatric treatment six times. Then one day, he had a very blunt conversation with the doctor. He looked at Ricky and he said, you are going to die of this disease on the course that you're on. And if we were in another state and I could commit you involuntarily for addiction treatment, I would, but my hands

are tied in Washington. I just remember thinking, how can that be? Not long after, Ricky went into recovery. My name is Lauren Davis and I'm testifying on my own behalf today. And Davis found her new mission in life. When my best friend Ricky was suffering from alcohol and opiate addiction and unwilling to seek help, I had to convince the mental health professionals that his suicide attempts were related to his depression and anxiety, not his addiction. She shared Ricky's story at a meeting with politicians. Because he could not be committed involuntarily for chemical dependency treatment, he nearly died. It caught their attention and soon Davis was working with a state lawmaker to craft a bill. My name is Ricky It caught their attention, and soon Davis was working with a state lawmaker to craft a bill. My name is Ricky Garcia, and I'm two and a half years clean

and sober today. Ricky supported it and even testified at a Senate committee. Active addiction is a miserable existence. It didn't matter to me how much I was using or drinking because I didn't care anymore if I woke up or not. My organs slowly began to shut down. This is why involuntary treatment is necessary in certain cases. Sometimes you need someone to say no for you when you can't say no for yourself. In 2016, Rickey's law passed. It allows Washington state to force someone with addictions into treatment. It changed me profoundly. It shaped, it's the reason I'm sitting here talking to you right now. It's the reason I'm sitting here above the floor of the House of Representatives where I serve. So you were first elected in 2018.

Correct. And now this is where you work. This is where I work, yeah. My floor desk is just here. So normally this place is full of people, 98 humans making laws. Davis is a Democratic state representative. She's become a go-to authority on all things related to addictions. Why do you think involuntarily committing someone is the best avenue? I don't think involuntarily committing somebody is the best avenue. I think

involuntarily committing somebody is the worst avenue, but sometimes it's the only avenue. I am deeply supportive of harm reduction. I'm an enormous proponent of peer services and people with lived experience helping individuals who are currently in active addiction. And I am an enormous proponent of stopping preventable death. And so for some people, of stopping preventable death. And so for some people, really a small fraction of people with very severe substance use disorder, sometimes civil commitment is the only option other than death. Washington State has four involuntary treatment facilities for Rickey's Law.

We're just going to get organized in terms of our gear, and then we'll be heading over that way. Recovery Place Kent is one of them. It's a brown, one-story building off the side of the highway, about 30 kilometers south of Seattle. I think if you didn't know what you were looking at, you wouldn't know. This is a place where people get involuntary treatment. Hi, Julia. Hi.

So nice to meet you. Terry Hardy is the director. Wonderful. Hi, Julia. Hi. It's so nice to meet you. Terry Hardy is the director. Wonderful. Ready to show you around. Hardy takes us through the facility and down hallways painted beige. This is our intake room. And this is where our patients come to us for admit. They come from the ambulance bay outside.

In the room is a desk and a cart of medical supplies piled high with scrubs. It's what every patient wears. We get them the shower, we do screening questions and get them changed into scrubs. And on the wall, in a frame, a list of rights. It includes things like access to pen and paper, a phone and visitors. And generally speaking, I mean, what state are people in when they first arrive? You know, often they're confused. They may be medicated.

They may be tired. A lot of them are in withdrawal. So we're really looking at, you know, seeing what their withdrawal level is, you know, see what kind of medications that we need on board to give them comfort. From the intake room, patients are taken to their room. It's a bare-bones space with two single beds and side tables bolted to the floor. There are cubbies for some personal effects.

Patients can't bring much when they come here, just some books, magazines, and photos. Do you guys want to see the courtroom? Patients are initially held for 120 hours or five days. A court then decides if a patient is discharged or held for another 14 days. So patients can come in here, the judge, their attorneys on the screen. A subsequent hearing could see another 90 days added. Patients take part in sessions to discuss how to avoid temptations and stay sober.

There are gathering spaces for activities like bingo and karaoke. But to get around the building, you need a badge. Every door is locked. There are signs in red with white letters reading, please ensure door is closed and secured. Every entry point is locked. So it is a locked facility. We do have patients that aren't happy to be here of course and you know want to leave and refuse and we do have seclusion

and restraints and that's a last resort. We do everything else first and we only do that if they're a danger to themselves or others. Does it start to feel like a jail when you can only get in and out of a place with badges, when everything's locked, when you might have to restrain someone? I don't look at it like that because we look at it as treatment. I think the amazing approach that we have to patient care overshadows the stigma that we often deal with with involuntary commitment. This is not jail. We look at it as a treatment center. What do you have to say to critics who would argue, you know, we're in America,

and people have their personal rights and freedoms, and if someone doesn't want to be here, you shouldn't be allowed to force them to stay? You know, I really believe in the rights of people, of course, but I also believe in saving someone's life. Hi, my first name is K-R-I-S-T-O-V, and my last name is Burgos, B- name is K-R-I-S-T-O-V and my last name is Burgos, B-U-R-G-O-S. Someone like Christoph Burgos. Coming out here, I was able to release a lot of my frustration of being stuck here by running around this track in my bare feet. Burgos ran track when

he was younger and running around this small courtyard helped him come to terms with being involuntarily detained. It really centered me and made me happy. He's 29 and looks a little bit like a lumberjack, with his flannel shirt and thick beard. He was abusing drugs and alcohol and reached a crisis point in March when he blacked out. Like, I was practically dead when I went to the hospital and the doctors were like, dude, if you keep drinking, you're going to die. And your nostrils are inflamed from all the cocaine and your liver or your kidneys are failing

because of the pills. Which is how Burgos ended up at Recovery Place Kent. Do you remember what went through your head when you found out that you were involuntarily committed? I was very upset, very upset. After about the third, fourth day, I was kind of like, OK, so I can't leave. I tried calling family members to see if they could talk to the owners or whoever was in charge to possibly get me out sooner. Bergo says he mostly stayed in his room the first week.

The second week, he started participating in sessions. Then, as the weeks went on, a realization. Coming here and being able to actually stay away from alcohol, which was my main vice, it made me realize, dude, you don't need alcohol. He was discharged after 30 days and is now in recovery. Burgos is also in school to become a certified nursing assistant and hopes to come back to recovery place Kent to work. So you were involuntarily committed here. Do you think you would have got to a point where you decided you needed help? I was trying to kill myself. So I don't think I would have. So this saved your life? Yeah.

In 2017, it felt like drugs were everywhere in the news. So I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. The Tacoma Needle Exchange was the first legally sanctioned syringe exchange in the United States. They're cookers for heating up heroin. Here, storage rooms are crammed with boxes full of syringes, wound care and clean smoking supplies. We have sterifilts for filtering out crushed pills, different gauges of syringes. Paul Lekoski has been the director since 2017. In the years since Ricky's Law came into effect, do you feel like it's had an impact visibly on the streets just in general? No. Then do you think it's worth it to have a law like that?

Personally, no, I don't. I think that it makes people feel good. I think that it makes people feel good. And I do think that there are folks that, you know, that really would have liked that law to be around when their loved ones were struggling with substance use disorder. I don't think people should be snatched off the street and thrown into treatment.

Although I'm going to be completely honest, if I were the parent of a child who was in that situation, I would feel relieved if they were detained and involuntarily committed. At least I would know that they're safe from their own actions for now. You know, as we've been having this conversation, and I can see you kind of going between both sides of this, is it hard living in the gray instead of having this be a clear-cut black and white situation? So it would be so much easier if it were just Manichean, this is right and this is

wrong, but there's so much nuance because we're dealing with people. People are complicated. Life is messy. I just need to get an audio check from the two of you. Do you mind counting to ten for me, please? One, two, three. Life has been a bit complicated for Isaiah Fillmore. I was addicted to fentanyl, methamphetamine. Five years ago, the 23-year-old started doing drugs. Because I liked

it. I liked the feeling. And at a young age, it's really hard to kind of just quit something like that, especially when you surround yourself with other people who are using as well. So it became a daily activity. It became every single day going out my own way, doing everything I can to get what I wanted. Then in June, he overdosed in a parking lot. Like, my body was shutting down. I was stumbling. I couldn't, like, talk straight. Like, my vision was going blurry.

Feeling was being lost. Like, all senses of the body were just shutting down. Fillmore was rushed to hospital. It was there he decided to go into treatment voluntarily. I'm not getting any younger. How long am I going to keep going until I just lose all opportunity and chances to live a better life? It's just I can't, and I can't do that to my family. I wanted to break that cycle because can't do that to my family. You know what I mean?

I wanted to break that cycle because there is addiction history in my family, and I am that key person that went through it and survived. Now he's in recovery, looking for work, trying to go back to school. While he says involuntary treatment could work for some, he doesn't think it would work for everyone, including him. If you had been involuntarily detained at another point in your life, as you were dealing with addictions, how do you think that would have gone over with you? I think it wouldn't have gone so great. Fillmore says it was important for him to make that choice himself.

Like, oh, this person's trying to tell me what to do. I can't do what I want to do because I'm being told to do something different. That's what makes people rebel. Like, when you want something, no matter what the circumstances are, you will do anything to get what you want. Jonathan Buchholz agrees. So as an addiction psychiatrist, I'm trained in taking care of folks who are experiencing substance use disorders and mental health disorders. He says people with addictions need to want to change. When people are in a path toward recovery, these are lifelong diseases.

diseases. And so if someone is not interested in treatment, it is very difficult to sustain motivation in the hard work that's required. Buchholz says there's no one-size-fits-all when it comes to treating addictions. When folks are forced into treatment, there's actually inconsistent evidence that forced treatment has good long-term outcomes for people. And I think that there's a misconception that if we would just put them away for a while, that they would do better. And I just don't see that there's a ton of evidence that actually supports that. In the past eight years, two articles in major medical journals reviewed dozens of studies about involuntary treatment options, like drug court and prison-based treatments.

They found outcomes were mixed and further research is required. But Terry Hardy, the director of Recovery Place Kent, shrugs that off. And maybe the evidence doesn't show it, but I know that how many lives we have saved personally of the people that have been in here. We'll see, you know, the consensus will be that we've done some amazing work and lives were saved. She admits some people are sent back to the involuntary treatment center after being discharged. Do you have a general sense? Is it 10% might come back or is it like 80% might come back? Definitely not 80. I would say maybe 20 to 30% if that, but definitely not a high number. Back at the state capitol, Lauren Davis, who pushed for Rickey's law, admits there are problems with it. Do you feel like the average Washingtonian knows and understands Ricky's Law?

I would say no. Not all health care workers know about the law or how it works. It can be tricky getting patients to the facilities since they're spread out across the state. And the four facilities are often only half full. Why are these facilities not packed all the time? Great question. This is what keeps me up at night. So the process for civil commitment is very clunky. It involves, it's both a medical process, but it's also a legal process. So there's a huge amount of stakeholders that are involved. Even when I, the sort of author of Rickey's Law or proponent of Rickey's Law, was trying to use

Rickey's Law on Rickey, the subject of the bill. It took an act of God to get it to work right, to get all of the pieces to work right. So she's pushing for changes, like getting rid of restraints when patients are taken to facilities. She wants to make the process less frightening for people, something she saw firsthand in 2020 when Rickey reled. Ricky was detained under his own law four times, and it saved his life twice in 2020 and twice in 2023. In May 2023, Davis says Ricky was in the throes of addiction and traumatized from previous involuntary detainments.

So he fled to Oregon to escape his own law. I mean, Ricky himself advocated for Ricky's law. Ricky himself came to this Capitol campus and begged lawmakers to save lives like his. He believed in it. And when he was using, he was terrified of it. And I don't blame him. Ricky's mom and sisters eventually found him and he chose to come home. He entered treatment voluntarily. But 36 hours later, he was dead. His cause of death is under investigation. Do you think it says something, though, that Ricky, who you said was very smart,

who knew the law, understood how it worked that he himself after all of that did not want to be subject to it Ricky in recovery sober Ricky real Ricky believed in that law I mean he fought for that law with his own hands and his own heart a person in active addiction, you know, is not that person anymore. So Ricky in active addiction, I mean, was terrified. He was like, I don't wanna compare him to an animal in like a dehumanizing way,

but like he was like a scared animal that you're like chasing with a trap or something, right? It looks like a scary, frightening cage and the animal was skittish and running. It was traumatic for him. It was traumatic for all of us. And I think that is why he fled. It was a fear-based response.

Is the law effective if someone in active addictions, the very same people who you are trying to help have that ability to still flee and know that they can be out of arm's reach? I think Ricky's a very, very, very unique case. People in active addiction don't read state statutes. Most people in active addiction have never been detained for mental health or substance use disorder. They haven't had that experience and so they don't have that fear the way that Ricky did. Davis recognizes there are problems with the law,

and she knows the debate over involuntary treatment is far from settled. But it's something she believes in. And I will never minimize the trauma that Ricky did experience because of his civil commitments. I would do it again. I mean, I got 10 more years with him because of civil commitment, and I wouldn't trade that for anything. That documentary, Ricky's Law, was produced by Julia Wong,

Corey Seegers, and the CBC Audio Documentary Unit's Liz Hofe. For more CBC Podcasts, go to cbc.ca slash podcasts.