The major component of the Addictions Program is an 11-bed unit located at the Health Sciences Centre. The Addictions Unit admits patients with active addiction who require inpatient treatment for complications of drug and alcohol use and withdrawal. The unit also provides treatment for co-occurring medical and psychiatric conditions. Admissions are generally arranged by contacting the nurse clinician responsible for triaging or the doctor on call for the Unit. Patients may also be admitted through the Health Sciences Centre Emergency Department at the discretion of the doctor on call for the Unit. Priority is given to patients at risk for life-threatening complications due to withdrawal (e.g. delirium tremens for alcohol withdrawal), serious co-morbid physical and psychiatric illnesses, and pregnant women. The unit is voluntary (patients must agree to admission), and actively suicidal or behaviorally disruptive patients are generally excluded from admission.All patients receive a full medical examination and relevant investigations on admission. Patients are closely monitored for symptoms of withdrawal and treated as required. Individual supportive psychotherapy and educational groups are offered to assist patients in coming to terms with their addiction. Referrals are made as needed to other medical specialists and allied health professionals such as Social Work, Occupational Therapy, Physiotherapy, and Spiritual Care.
Patients are assessed on the unit for the presence of co-morbid psychiatric disorder and psychiatry can be formally consulted to assist with diagnosis and initial treatment recommendations. As the clinical picture can be somewhat obscure during initial withdrawal stages, formal consultation often occurs after a few days of treatment.
The unit generally offers a short stay (between 7-10 days) until the patient is medically and psychologically stable. During this time, referrals can be made to community addiction treatment agencies (e.g. The Addictions Foundation of Manitoba) or self-help groups (e.g. Alcoholics Anonymous) for longer-term treatment. If indicated, referrals are made to specialized psychiatric outpatient department clinics. The patient's family doctor also receives copies of discharge summaries from the unit with recommendations for ongoing treatment.
Physicians are required by law to report certain medical conditions to the motor vehicle branch. These medical conditions may make it unsafe to drive. This includes several substance use disorders. More information on this topic can be found at: https://www.mpi.mb.ca/en/PDFs/MedicalConditionsDriving.pdf.
Members of the inpatient team also provide addiction consultation to patients admitted to the other Health Science Centre units. Inpatient referrals can be faxed to 204-787-3996. This is a non-urgent service, available Monday to Friday (days).
The outpatient component of the Addictions Program consists of the 1) Alcohol Recovery Clinic (ARC) and the 2) Opioid Assessment Clinic (OAC).
1) The Alcohol Recovery Clinic (ARC) is an urgent outpatient service that provides medical assessment for patients with active alcohol use disorder who are in mild to moderate alcohol withdrawal. Referrals are typically accepted from the Health Sciences Centre Emergency Department and patients seen within 24 hours. This type of urgent assessment may result in admission to the Addictions Unit or referral to other community-based treatment resources. Since space is limited, physicians outside of the Health Sciences Centre who wish to refer patients to the Addictions Unit, need to arrange this by phone with the nurse clinician responsible for triage or the doctor on call for the Unit.
2) The Opioid Assessment Clinic is a non-urgent consultation services for outpatients and Health Sciences Centre inpatients who are misusing, abusing, or dependent on opioids, and interested in addictions assessment and treatment recommendations. This may include patients misusing prescribed and/or illicit opioids. Referrals are accepted from physicians only. Referrals can be faxed to the attention of Talia Weisz, Opioid Clinic Liaison, at 204-787-3996. This is a non-urgent service, available Monday - Friday (days). The service is not available after hours or weekends; please do not contact the Addictions Unit doctor on call with referrals or follow-up concerns regarding opioid patients.
The Addictions Program at Health Sciences Centre also plays an active role in teaching/medical education in Manitoba. Various trainees spend time on the Addictions Unit to further their knowledge about addiction and relevant treatment resources. This includes medical students, psychiatry and family medicine residents, nursing students and physicians from the community who wish to further their addiction knowledge or obtain a methadone and Suboxone exemption.
CLINICAL PROGRAM MEDICAL STAFF
Marina Reinecke MBChB, CCFP
Medical Director, Addictions Unit
Health Sciences Centre