Against her will

Warning: This story references sensitive subject matter that may be upsetting to some readers.

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Every five weeks Kirsten Anvik takes two buses to a strip mall pharmacy in Esquimalt, B.C., to pick up 300 milligrams of an antipsychotic medication. Then, with a vial of the drug in hand, she pushes through an interior door that connects the pharmacy to a medical office and sits in the waiting area, dreading the injection to come.

A 54-year-old single mother, Kirsten — who goes by Kir — once aspired to teach yoga. But that dream vanished soon after she was prescribed Abilify Maintena. “My balance started going off,” she says, “and I was getting nerve muscle spasms in my limbs.” She also began to notice debilitating nerve pain, swelling throughout her body, and problems with her hips. “Little by little, my body started to stiffen up.”

She says that the drug has taken a toll on her mind as well, that it dulls her emotions and causes brain fog. She takes four other medications—lisdexamfetamine, pregabalin, clonazepam, and zopiclone—to minimize its effects.

Abilify Maintena is the injectable form of Abilify. Both are widely prescribed to treat schizophrenia and bipolar disorder. Their active ingredient, aripiprazole, activates dopamine receptors in the brain. Aside from its possible physical side effects — which include loss of balance, muscle pain and stiffness, inner restlessness, weight gain, seizures, and involuntary muscle contractions — aripiprazole has been linked to compulsive behaviours, such as pathological gambling, binge eating and hypersexual activity.

Despite the harm the drug can cause, and the harm Kir says she’s experiencing, the B.C. government is forcing her to take it. She isn’t allowed to stop — or to swap it out for a substitute she might better tolerate.

In 2016, she lost the right to meaningfully weigh in on her own psychiatric treatment.

One day in February of that year, she was overwhelmed by the demands of single parenting and the specific behavioural issues of her five-year-old child. A call to the province’s Ministry of Children and Family Development (MCFD) changed the course of her life.

She says she was looking for help —  “I thought it was a support line” — and in no way wanted to relinquish her parental rights or duties. But after making the call, she was admitted involuntarily to Royal Jubilee Hospital., where she’d spent two weeks under psychiatric observation in the fall of 2014. During that previous admission, also involuntary, she’d been diagnosed with and treated for bipolar disorder.

In the intervening year and a half, she’d taken Abilify in pill form. She says she had no further interventions. But after calling MCFD, she was “deemed to be mentally ill,” according to her medical records, and her daughter was sent to live temporarily with relatives.

The psychiatrist who admitted Kir to the hospital noted that she was “presently manic” and had “delusions of being targeted by MCFD after apprehension of her child.” Kir spent ten days in psychiatric intensive care and four months in a mental-health unit.

She was able to regain custody of her daughter after ten months. But eight years later, her own status hasn’t changed: she remains involuntarily detained under B.C.’s Mental Health Act.

Every six months since her 2016 hospital admission, Kir has been reassessed by a psychiatrist as required by law, recertified under the Mental Health Act, and then placed on what’s known as “extended leave.”

Extended leave is like parole. Patients are released to the community with conditions. Complying with the treatment plan is one of them. In Kir’s case, that means being injected with Abilify Maintena. As a result, she says, “I live in agony.”

Health Canada approved Abilify Maintena for schizophrenia in 2014. In 2017, it approved the drug for a type of bipolar disorder after finding the incidence of most adverse events was “low and fairly comparable” to other products. The exception was akathisia — an inner restlessness, often occurring in the lower extremities — which it said was “higher with Abilify.” Since 2014, at least 1,684 suspected serious adverse reactions to Abilify and Abilify Maintena have been reported to Health Canada, according to its adverse reaction database.

Under B.C.’s Mental Health Act, involuntarily detained patients like Kir are not only stripped of their right to refuse treatment, they are unable to appoint a trusted friend or family member to act as a substitute decision maker.

If Kir doesn’t show up for monthly injections, she’ll set off what she calls a traumatic chain of events: her family doctor will alert her case manager, who will alert her psychiatrist, who will sign a medical warrant authorizing police to bring her to the hospital so she can be forcibly injected.

She knows well the feel of handcuffs, the startling burst of activity when the police appear. One time they came for her when she was sick, sitting in a robe on her couch, eating ice cream. She says their insistent knocking — which she describes as “sharp and ominous” — made her feel instantly ill. Upon opening the door, she told a police officer she had to use the bathroom. The next thing she knew, her ice cream was in the sink and she was in handcuffs.

For a long time, Kir lived with anxiety about her provincially mandated appointments. Had she lost track of time? Had a month already passed? She’d shudder at the sight of the police. Once, when a friend spotted her in a Walmart aisle and called out her name, she froze in fear. Out of context, her friend’s voice was unrecognizable; Kir thought the police were about to swarm her.

For eight years, she has wanted nothing more than to feel well physically and to have control over all aspects of her life. “I’ve got these invisible shackles on me,” she says.

An artist, Kir has painted murals on commission and designed table keepsakes for weddings. She has also earned money by cleaning hotel rooms and working as a nanny. But she says the side effects of Abilify Maintena now make it impossible for her to meet the demands of a job. She spends her good hours on her own art, creating a collection of fairy dress sculptures from natural materials, such as twigs and bamboo leaves.

She receives disability assistance and lives in a subsidized two-bedroom townhouse in Victoria with her now 13-year-old daughter, who keeps a neighbour’s number in her phone in case the police show up again and take away her mother.

Kir repeatedly has asked her psychiatrist to take her off Abilify Maintena.

“You have a voice,” he reminded her recently. “But unfortunately you don’t have a choice.”

Kir creates dress sculptures in her home studio. Photo: Tori Marlan

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Depriving people of their freedom and bodily autonomy is an extraordinary state power — one the provincial government deems necessary at times to protect health and save lives.

“Government understands the gravity of these situations and takes seriously the need to balance the rights of the individual with our obligation to help and protect people living with mental illness,” a B.C. Ministry of Mental Health and Addictions spokesperson said via email.

Under B.C.’s Mental Health Act, people can be involuntarily detained and medicated only under certain conditions. A doctor or nurse must first determine that they have a mental disorder that “seriously impairs” their “ability to react appropriately” to their environment or to associate with others; that the disorder requires treatment; that voluntarily treatment is not an option; and that supervision is necessary to protect them or others or to prevent their “substantial physical or mental deterioration.”

Each year, more than 19,000 people in the province meet those criteria and are involuntarily admitted to a mental health facility, according to ministry data. In fiscal year 2022-23, 3,662 people certified under the act were placed on extended leave.

Involuntary patients have no way to challenge specific decisions about their psychiatric treatment. The most they can do to advocate for themselves is to challenge their detention by requesting a Mental Health Review Board hearing, for which they’re entitled to free legal assistance.

At the hearings, a three-person panel that includes a physician, a member of the legal profession, and a community member considers only one issue: whether the patient meets the criteria for certification under the Mental Health Act. The panel cannot overturn a diagnosis or alter a treatment plan.

Understanding that the surest way to stop the Abilify injections would be to extract herself from the system, Kir has appeared twice in front of the board claiming she no longer met the criteria for detention.

At her last hearing, on Feb. 18, 2022, Kir did what she could to portray herself in a light more favourable than what could be found in her medical records. She provided written testimonials from family and friends and submitted a 14-page document she titled “case notes” as an answer to the doctor’s submission.

She told the panel that her upbringing was “a war zone,” and that her father was a violent alcoholic. Traumatized by the dynamics in her home, she sought psychiatric treatment in her late teens. She said she was prescribed antidepressants but was told “there was nothing wrong with me except my thoughts about myself.”

Consumed by negative emotions in her twenties, she twice intentionally overdosed on the antidepressants, though she considers only one of those times as a true attempt at suicide.

At 36, she began a spiritual journey that, over the years, included alternative health measures, such as craniosacral massage, “energy healings,” and yoga therapy. She became a mother at age 40 and developed an empathic view of her father and his own struggles. “I learned deep-hearted forgiveness,” she told the board, adding, “I’ve worked hard to heal.”

From her mid-20s to her early 40s, Kir was stable. She told the board what she’d long been telling her doctors: that she does not believe she has bipolar disorder and that aspects of her spiritual journey have been misinterpreted as signs of mental illness.

Friends and family also testified on her behalf. One friend, a pain and trauma therapist, called her an “excellent mom, caring and wise” and told the board that Kir had been traumatized by her experience in the mental health system.

Kir’s mother submitted a letter describing her as a “gentle soul and passionate artist.” She also tried to correct the record regarding the 2014 incident that led to Kir’s bipolar diagnosis. At the time, Kirsten’s life had been recently upended. She’d split up with her daughter’s father and gone through a period without stable housing. She was also grieving the death of her own father and worried about her mother, who’d had a heart attack the previous year. “While visiting me she admitted how terrified she felt that I would have another heart attack,” her mother wrote. According to records from Vancouver Island’s health authority, police had found Kir, who “claimed to be a ‘healer,’” on top of her mother, restraining her. Kir maintains that she had reason to be worried about her mother’s stress level that day and was trying to help her relax by offering her a reiki massage.

“Kirsten would never harm me or anyone,” her mother wrote. “My words were misinterpreted by the police.” She told the board, “I would like to see Kirsten take stewardship over her life again.”

The hospital psychiatrist who’d been recertifying Kir since December 2020 made it clear he thought that would be a terrible idea. He advocated for her continued detention, basing his opinion “on my interactions with Kirsten” and “the documents in the health record,” though he told the board he’d met Kir only once in person. “I have not gotten to know her,” he said, adding that meaningful conversations with her weren’t possible because her strenuous objections to her diagnosis and treatment turned “every single conversation” into a debate.

The doctor expressed concern that if Kir were released, she would stop taking her medication. She’d been prescribed oral Abilify before, and either didn’t take it or didn’t take it correctly, he said: “The underlying issue is that she rejects the diagnosis, and thus rejects the suggested treatments for it.”

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Critics of B.C.’s mental health system say better safeguards need to be in place to protect involuntarily detained patients’ rights and to ensure that their liberty isn’t unduly restricted.

Jonathan Blair, a Vancouver-based lawyer for the Community Legal Assistance Society, specializes in bringing tribunal decisions to the B.C. Supreme Court for judicial review. His work involves both systemic litigation and individual representation. When he takes on clients who are sectioned under the Mental Health Act, it’s not to dispute their psychiatric diagnoses, it’s because their cases raise human rights issues.

In 2022, Blair argued in A.T. v. British Columbia that the Mental Health Act is meant to provide temporary protection only for people who are in acute distress, or those who have active symptoms of a mental disorder. “What we essentially say is that if the person is no longer impaired when you're reviewing their case, then they shouldn't be detained anymore,” Blair says — but what’s happening is that “people who have no symptoms are continuing to be detained for years.”

The case made its way to the B.C. Court of Appeal, which, in siding with the government, looked to the legislative debates of the ’90s that led to the Mental Health Act being amended to prevent the “revolving door of release, distress, and recertification.”

Today, as a result of that concern, when patients argue for release, the Mental Health Review Board considers whether there’s a significant risk that they would stop following their treatment plans. If so, the board asks: would they be likely to deteriorate, become seriously impaired, or need to be readmitted to the hospital?

If the board believes the answer to those questions is yes, it won’t release a patient from involuntary status. The patient doesn’t have to be considered a danger to themselves or others. The board’s fear of revolving-door care is enough to justify keeping patients like Kir detained when they aren’t impaired at their hearings.

“It’s sort of a catch-22,” says Blair. If patients disagree with their doctors, they’re found to have a lack of insight into their own illness and are therefore considered at risk of relapsing. But if they agree with their diagnosis and treatment plan, they could be treated voluntarily and wouldn’t need to be detained.

Kir’s psychiatrist acknowledged at her hearing that she wasn’t impaired. But he said the monthly injections of Abilify Maintena were what enabled her to function well in the community. Without them, he said, she ran a “very high risk of relapse.”

Kir offered evidence she believed spoke to the contrary. She’d had a six-month lapse in her injection schedule in 2021 — from July, when she requested the review panel hearing, to December, when police handcuffed her in her home and brought her to the hospital.

Her case manager had told her she could postpone the next injection until the Mental Health Review Board determined her status. But after Kir cancelled and rescheduled her board hearing five months in a row — once because she caught COVID and was hospitalized — her case manager realized she’d made a mistake. She texted Kir, “I am wrong. You must stay on your injection until you win your review panel.” She urged Kir to go for the shot “ASAP or you will be recalled and picked up by the police and brought to emergency for your injection.”

When Kir cancelled her review panel hearing for a sixth time, in January 2022, her psychiatrist noted in her file, “Her pattern appears to be reporting physical symptoms that purportedly prevent her from attending appointments, getting an injection, or having a review panel hearing. Today she reports that she has ‘strep throat.’”

When Kir’s review panel was finally held, she pointed out that she’d had no adverse effects from stopping the medication. She hadn’t wound up back in the hospital or found herself in the midst of a mental-health crisis. She’d simply gone about her life, only happier and feeling better physically, making her art and taking care of her daughter.

Kir’s psychiatrist read nothing into those uneventful months. Abilify Maintena is a long-acting injectable. He told the board that it “stays in your system quite a long time, and it leaves your system very slowly when you’ve been getting these injections for a long time. It takes months to get rid of it.” For Kir, he continued, a relapse was only a matter of time. Allowing her to continue marching toward that inevitability would be unethical and expose her to “unacceptable risk.”

The board ruled to keep Kir detained. The lawyer who represented her flagged the decision for the Community Legal Assistance Society. Blair took on the case, requesting and winning a judicial review of the decision. The B.C. Supreme Court nullified it, saying it lacked a “careful weighing of evidence,” and sent Kir’s case back for reconsideration.

Her victory was short-lived. After reconsidering, the board came to the same conclusion it had before.

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Abilify is a widely prescribed medication for a type of bipolar disorder. Photo: Tori Marlan

The provisions of the Mental Health Act that allow involuntary patients like Kir to be injected with a drug against their will are unique in Canada and are facing a Canadian Charter of Rights and Freedoms challenge in the B.C. Supreme Court.

Under the Mental Health Act, a patient’s decision-making capabilities are irrelevant. Doctors don’t have to get a patient’s consent for treatment — or the consent of a substitute decision maker. They have what’s known as the patient’s “deemed consent” to administer any treatment that’s been approved by the director of the mental health facility.

“Deeming is a really specific and interesting choice that we made here in B.C.,” says Laura Johnston, legal director for Health Justice, a non-profit organization that’s working to reform the province’s laws and policies pertaining to coercive health care. “Deeming provisions, usually you find them in relation to things like serving documents—like if you send something by registered mail, you're deemed to have received it five days later, even though obviously we all know maybe it got lost in the mail or maybe there was a Canada Post strike and it was delayed. A deeming provision is sort of like a broad statement, where the law is asserting something to be true legally, even if it's not true factually. And B.C.'s the only deemed consent to psychiatric treatment model in Canada.”

The province fought to have the constitutional challenge to its Mental Health Act thrown out after two individual plaintiffs dropped out of the case in 2017. But in 2022, the Supreme Court of Canada gave the Council of Canadians with Disabilities (CCD) public interest standing to continue it, noting that doing so would “promote access to justice for a disadvantaged group who has historically faced serious barriers to litigating before the courts.” More than 20 groups from across the country representing a range of interests, including the British Columbia Civil Liberties Association and Ecojustice Canada, joined the CCD’s fight for public interest standing. The case is expected to be heard in B.C.’s Supreme Court in the spring of 2025.

Ministry of Mental Health and Addictions spokesperson Preet Grewal declined to comment on the Charter challenge but said in an email that it is “always necessary to ensure that legislation is meeting the needs of people in B.C.” and that B.C. “operates under a ‘deemed consent’ model of care. . .  when it is necessary and appropriate to do so to ensure the safety of a patient or others.”

Kyle Fawkes, co-host of the Reimagine Mental Health podcast, considers B.C.’s deemed consent model problematic in part because it gives medical professionals the sole responsibility for an individual’s treatment. “In practice, they're supposed to consult with the families but that's not a legal obligation in any sense,” he says. And in his family’s experience, it didn’t happen.

Fawkes’s father, Glen, killed himself in 2020 shortly after being discharged from Royal Jubilee’s psychiatric emergency services, where he was admitted involuntarily after exhibiting signs of psychosis. Fawkes and his family tried to participate in Glen’s care.

“We were barred entry to facilities and provided little opportunity to speak with his health-care practitioners,” Fawkes wrote in a Tyee article calling for Mental Health Act reform. “We were forced to watch from afar as physicians dictated his path — based solely on their ‘opinions’ of short assessments conducted in isolation.”

Even when involuntary patients are capable of making decisions for themselves, B.C. doctors aren’t required to consult with them or consider their wishes. That means patients could be forced to undergo electroconvulsive therapy, for example, even if they understand the risks and benefits of the procedure and don’t want it.

In other provinces and territories, involuntary patients undergo capacity assessments to determine whether they’re capable of giving informed consent.

“The Supreme Court of Canada has said quite clearly that forced treatment is an infringement of your Charter right to security of the person,” says Blair. “And so the question becomes, is it justified to do? And most acts say no, it's not justified if the person has the capacity to refuse.”

In some places, a finding of incapacity is a condition of being involuntarily detained. In other places, it’s a condition of receiving coercive treatment.

In Starson v. Swayze in 2003, the Supreme Court of Canada drew a distinction between people who have the capacity to give consent but choose not to and those who lack the capacity. “A patient who is capable has the right to refuse treatment, even if that treatment is, from a medical perspective, in his or her best interest,” according to the court’s decision.

In other words, people have the right to make bad decisions — or decisions that seem likely to lead to bad outcomes.

The ruling, though, pertained to a case in Ontario and hasn’t been applied to involuntarily detained patients in B.C. But it could be seen as an indication that B.C.’s deemed consent model won’t be able to withstand legal scrutiny.

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In December 2021, not long after Kir was given the injection that ended her six-month reprieve from Abilify Maintena, she lay on a couch, opened her computer and began a shopping spree that would last more than half a year. She says during that time she maxed out three credit cards and incurred $10,000 of debt — redecorating her daughter’s room three times, repeatedly filling her closet with “new looks” and buying presents for “everyone I knew.”

Aripiprazole’s link to impulse control behaviours has been known since at least 2012, when the European Medicines Agency required label revisions on Abilify and Abilify Maintena to warn users of the risk. Such label warnings didn’t appear in Canada until 2015, after a Health Canada safety review found an increased risk of pathological gambling and hypersexuality associated with the drug. The U.S. Food and Drug Administration required a warning about “impulsive or compulsive behaviors” to be added to Abilify’s label the following year.

Aripiprazole was discovered by the Japanese company Otsuka Pharmaceutical in 1995, and then developed and marketed under its brand name in partnership with Bristol Myers Squibb. Otsuka later co-developed Abilify Maintena with Lundbeck for intramuscular use as a long-acting injectable.

By 2014, Abilify had become the U.S.’s top-selling drug, bringing in $7.5 billion USD in annual sales. In 2020, there were 7.7 million prescriptions for Abilify in Canada and 80,000 for Abilify Maintena.

Abilify Maintena’s product monograph states that aripiprazole may lead to an increase in impulsive and compulsive urges such as binge eating, hypersexual behaviour, and spending, but maintains that such issues have been reported “very rarely.”

Still, the pharmaceutical companies that have developed, manufactured and marketed the drug have faced thousands of lawsuits from users claiming to have suffered from such side effects.

In the U.S., more than 2,000 claims by people who’d developed compulsive behaviours were consolidated, resulting in a confidential settlement in 2019 between the pharmaceutical companies and the plaintiffs. In other settlements, Bristol Myers Squibb agreed to pay  $515 million USD to resolve claims over illegal marketing and pricing practices, and Otsuka agreed to pay $4 million USD to make allegations of off-label marketing go away — among them, that the company had promoted Abilify for use in children.

Lawsuits have also been filed in Canada. One concerned Sameh Magid, a Vancouver investor and entrepreneur who took Abilify for eight years. In that time, he gambled away about $9 million USD in Las Vegas. After his death in 2018, his brother sued Bristol Myers Squibb and Otsuka, and their Canadian operations, in B.C. The case was thrown out for jurisdictional reasons, in part because Magid had been living in the U.S. when he died.

A national class action suit against Otsuka, Bristol Myers Squibb and Lundbeck that was certified in Ontario in 2020 accuses the pharmaceutical companies of the “negligent development, research, design, manufacturing, testing, marketing, promotion, distribution and sale of aripiprazole under the brand names Abilify and Abilify Maintena in Canada.”

Calling the drug “defective and inherently dangerous,” the claim alleges that the companies not only failed to warn users of the potential compulsive-behaviour risks, they conspired to conceal the drug’s link to such behaviours.

A similar class action against Otsuka Canada Pharmaceutical and Bristol Myers Squibb Canada is in process in Quebec on behalf of people who took Abilify and developed impulse control behaviours.

Otsuka, Lundbeck and Bristol Myers Squibb did not respond to inquiries about the lawsuits or the side effects of Abilify and Abilify Maintena. A spokesperson for Bristol Myers Squibb Canada did, however, say in an email that the medicine is neither “owned nor marketed by Bristol Myers Squibb (BMS) Canada.”

In a ruling related to the national class action suit, a superior court judge in Ontario noted that the pharmaceutical companies claimed there was “no evidence of any harms suffered in common by the class members.” The companies contested much of the evidence put forth by the plaintiffs’ expert witnesses and argued “that scientists do not agree on how, exactly, aripiprazole works at the cellular level to impact on the brain’s dopamine receptors.” The judge acknowledged the complexity of the science, that it was “somewhat up for debate among the experts,” and that Bristol Myers’s counsel “says that all of this amounts to ‘lots of theory, not really any evidence,’” before certifying the class action.

In 2021, Kir posted about the ravages of the drug on a Facebook group whose members had bad experiences with Royal Jubilee’s psychiatric emergency services. “I recently developed ‘piriformis syndrome’, a condition that affects the muscles and nerves in my thigh, hip and back,” she wrote. “Too many years of injections has crippled my body.”

The response she got was overwhelming. “I was like, ‘Oh, wow, I’m not alone?’” she says.

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An excerpt from Kir's testimony before the Mental Health Review Board in 2022.

One of the people who reached out to Kir was Anna Sylwestrowicz, a former Island Health anesthesiologist who resigned from the health authority in 2020 and who now operates a medical aesthetics clinic in Victoria.

Sylwestrowicz became an outspoken critic of Royal Jubilee’s psychiatric services and Big Pharma, and an advocate for reforming the Mental Health Act, after a close family member was involuntarily detained and prescribed Abilify Maintena.

“His behaviour on the drug was very unusual,” Sylwestrowicz says. “He was very excited, disinhibited.” He began exercising compulsively and exhibiting hypersexual behaviour. She tried to get involved in his treatment but says she was met with resistance by his psychiatric team. Disturbed by the decisions they were making, Sylwestrowicz did everything she could to get him out of the system, including hiring private lawyers to represent him at his review board hearing and feeding them questions from the sidelines. Her efforts were successful — but expensive. “I spent $20,000 on this,” she says. Her family member was among the minority of patients (16 per cent) in fiscal year 2022-23 to be decertified by the Mental Health Review Board.

After helping him, Sylwestrowicz turned her attention to others who were being forcibly injected with Abilify Maintena, connecting with them or their loved ones through Facebook.

Armed with what she learned, she began a full-throttle campaign against the drug, writing to government officials with criticisms of the Mental Health Act, encouraging patients on Abilify Maintena to report adverse side effects to Health Canada and Otsuka, and railing against the pharmaceutical industry and Royal Jubilee’s mental health services on social media. After she called out Royal Jubilee psychiatrists by name, the College of Physicians and Surgeons of B.C. investigated her for unprofessional conduct.

She says the B.C. Psychiatric Association accused her of practicing outside her scope of expertise and using her position as a physician to slander psychiatry in general and psychiatrists at the Royal Jubilee Hospital specifically.

Her advocacy was seen as dangerous, as it had the potential to turn people away from seeking help or continuing with a prescribed treatment. “They tried to take my licence away,” Sylwestrowicz says, adding that she was summoned to a Zoom meeting with representatives of the college but was able to fend off dire consequences from the investigation by agreeing not to disparage her colleagues.

She says she’s now in touch with about 20 people who have horror stories about forced injections. Four, like Kir, are single mothers on extended leave. The rest have grown children who are involuntarily detained. All are concerned about the drug’s side effects.

Christine, a single mother of three, began to struggle after having her second and third child in close succession. “I was having some challenges postpartum,” she says. She took Abilify Maintena — “kind of a crazy medication” — for about a year. “I was never a smoker before,” she says, “and then I just started smoking on Abilify.”

A woman named Joan in Port Moody says that her 30-year-old daughter deteriorated on Abilify Maintena. She gained about 50 pounds, Joan says, and started having a faraway look in her eyes and stiffness and pain in her body —  “like having shredded glass going through you.” To counteract the pain, Joan’s daughter self-medicated with cannabis.

“She went from a functioning young woman who was holding down a full-time job and was making sales of a quarter million dollars to where most days she can’t function,” Joan says. “She doesn't sleep. She has this ravenous appetite. This drug causes you to lose bowel control and urinary control. My daughter has been out in public and peed herself and, actually, I'm going to be quite blunt, lost all functions of her bowels.”

She says in December, after two years on the drug, her daughter tried to kill herself — and that it was only after her daughter spent a week on life support that doctors stopped prescribing it: “I made such a stink at the hospital, they agreed it wasn’t working for her.”

Sylwestrowicz encouraged the mother, as she has others, to report adverse reactions to Otsuka and Health Canada, even tweeting out Otsuka Canada’s phone number.

Kir has taken her advice and reported adverse effects to Health Canada and Otsuka. She has also contacted the B.C. Ombudsperson and Island Health with complaints and requested a hearing before the Human Rights Commission.

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At Kir’s last review panel, a member of the Mental Health Review Board told her that the “best remedy” for a different outcome would be to present a different medical opinion at her next hearing. Involuntarily detained patients, or anyone acting on their behalf, can apply for a second opinion regarding their psychiatric care once per certification period.

Usually the psychiatrists offering the second opinions work at the same hospital in which the patient is being treated, according to Blair, and usually they affirm their colleagues’ assessments and treatments. In the rare case that a second opinion differs, Blair adds, “the hospital doesn't even need to follow it.”

Kir met with Island Health’s medical director of psychiatry on Dec. 6, 2022, for a second opinion. A few months earlier, she’d sought help at the Helmcken Pain Clinic in Victoria. A doctor there determined that Kir met the American College of Rheumatology’s guidelines for fibromyalgia and told her family doctor that Abilify could lead to symptoms that mimic the chronic disorder.  Kir says she talked with the medical director of psychiatry about her problems with Abilify, and that she left the meeting with some hope, as the director brought up various options for treating bipolar disorder. He ended up prescribing the status quo.

In the wake of that disappointment, Kir briefly swore off review panels. But eventually, she came around to the idea of trying again — if she could get a favourable second opinion.

At an appointment for her monthly injection, she implored her family doctor to provide it. But the doctor didn’t believe Kir would thrive as a voluntary patient. “If I look at everything I know about you, including all your records—” the doctor told her.

“But I am not my history,” Kir interrupted.

It had been nearly a decade since she was first prescribed Abilify, and nearly eight years since she’d begun the injections.

“What about people healing?” Kir said. “What about people getting better? What about people moving forward? What about people, you know, getting away from that grief and pain?”

“Well, I would recommend somebody else do the second opinion,” her doctor said. “Not me.”

The doctor then turned the conversation to the reason Kir was there. “You brought your medication?” she asked.

Kir protested, futilely: “I feel better and I'm happier off it.”

The previous month, when Kir had gone to the pharmacy to pick up her vial of the drug, she was happy to learn it wasn’t in stock. Days passed without a call, and she started feeling long-lost emotions return. She’d been particularly struck by the joy she felt while parenting. But it was accompanied by sadness for all she’d been missing out on with her daughter.

Now, in her family doctor’s office, she remembered a text message she’d received from her case manager: “When [your daughter] moves out at age 20, then you have a better chance at being off meds.”

The thought of seven more years on the drug was unbearable.

She pleaded with her family doctor not to give her the shot. The doctor had heard it all before. “You either get it done here or they’re going to pick you up and take you to the hospital,” she warned. If that were to happen, the doctor continued, “They might just admit you at this point.”

Kir couldn’t bear the thought of going back into the hospital. She had no choice but to submit. Defeated, she rolled up her sleeve.

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‍ This story was co-published with the Investigative Journalism Foundation .