The authors respond to comments on the use of secure care in youth

Secure care: a question of capacity, autonomy and the best interests of the child

“…2 Further, the references used in the authors' response to comments, if anything, support the opposite conclusions to those reached in the response, which states, "Coercive interventions to treat addiction have been found to be inadequate in reducing negative substance use outcomes while increasing mental duress and risk of overdose." 3 Contrast that with what the references cited in that sentence said. From Pasareanu and colleagues: "Voluntary treatment for SUD [substance use disorder] generally yielded better outcomes; nevertheless, we also found improved outcomes for CA [compulsorily admitted] patients.…”

“There's No Supports for People in Addiction, But There's No Supports for Everyone Else Around Them as Well”: A Qualitative Study With Parents and Other Family Members Supporting Youth and Young Adults

“…For example, advising loved ones to withdraw support (eg, “stop enabling”) or to shut a young person out (eg, “practice tough love”) may have the opposite of their intended effects in terms of diminishing trust and secure attachment between the young person and their family. This tension is evident in current discussions in Canada about the effectiveness and ethical implications of involuntary treatment or “secure care” for treating youth substance use 39–41 . Although endorsed by some parent advocates and clinicians, critics argue coercive treatment for addiction can be associated with harms—in terms of increased overdose risk at discharge, irreparable harm to the youth–parent relationship (ie, mistrust, loss of autonomy) and destabilization that can lead to increased use and risk 39 …”

“…This tension is evident in current discussions in Canada about the effectiveness and ethical implications of involuntary treatment or "secure care" for treating youth substance use. [39][40][41] Although endorsed by some parent advocates and clinicians, critics argue coercive treatment for addiction can be associated with harms-in terms of increased overdose risk at discharge, irreparable harm to the youth-parent relationship (ie, mistrust, loss of autonomy) and destabilization that can lead to increased use and risk. 39 It is also important to note that this paper largely addresses the needs of women family members, particularly mothers.…”

Involuntary stabilization care of youth who overdose: a call for evidence- and ethics-informed substance use policy

“…Yet, there is limited to no empirical evidence to support the effectiveness of this intervention spectrum when used without full, informed consent. Indeed, as argued in detail by our colleagues (DeBeck et al 2019 ; Pilarinos et al 2018 ), while the “burden of proof” should rest on establishing that secure and/or stabilization care is safe and effective, scientifically credible data of this nature are not currently available.…”