The Addiction Services programs include an 11-bed medical withdrawal management unit, a hospital-based addiction consult service, a Rapid Access to Addiction Medicine (RAAM) clinic, and several outpatient clinics designed to support the above services.
The Addictions Unit is an 11-bed hospital 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. Patients are most often 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 comorbid physical and psychiatric illnesses, and pregnant women. Admissions can also be arranged by contacting the nurse clinician responsible for triaging or the doctor on call for the unit.
The Addictions 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 support patients in early recovery from 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 comorbid 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 Addictions Unit generally offers a short stay (between 5-10 days) until the patient is medically and psychologically stable. During this time, referrals are often made to community addiction treatment agencies (e.g. The Addictions Foundation of Manitoba) or self-help groups (e.g. Alcoholics Anonymous, SMART Recovery, SOS), since withdrawal management alone is usually not sufficient for sustained recovery from drug or alcohol use. If indicated, medications to assist with long-term recovery are initiated. The patient's family doctor also receives copies of discharge summaries from the unit with recommendations for ongoing treatment.
The Addiction Consult Service runs Monday-Friday 9am-5pm at Health Sciences Centre and Women’s Hospital. Through this service, people who are admitted to medical, surgical, or obstetrical wards and who have substance-related concerns can be seen by an Addiction Physician and/or nurse. Inpatient referrals can be faxed to 204-787-3996 and are generally seen within 24 hours. This service can also provide telephone support to clinicians practicing in other hospitals across the province who have addiction medicine questions.
The outpatient components of Addiction Services are:
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 are 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 triage nurse clinician or the on-call doctor for the Addictions Unit.
2) The Complex Addiction & Recovery Medical Assessment (CARMA) Clinic, previously known as the Opioid Assessment Clinic, is a non-urgent consultation service for outpatients with problematic substance use who are interested in addiction medicine assessment and recommendations. This may include patients struggling with prescription medications, illicit substances, and/or alcohol, where medical review is warranted. Referrals are accepted from the patient’s primary physician/prescriber for consultation and collaboration. The CARMA Clinic may make recommendations about prescribing and polypharmacy, but does not take over prescribing of medications. Referrals can be faxed to the attention of Talia Carter, CARMA Clinic Liaison, at 204-787-3996.
3) The Bridging Opioid Agonist Therapy (BOAT) Clinic was developed to provide short-term follow-up for patients initiated on opioid agonist therapy with buprenorphine/naloxone or methadone, by the Addictions Unit or the Addiction Consult Service while in hospital, thus facilitating discharge. Once stable, patients are connected with long-term care in the community.
4) The Rapid Access to Addiction Medicine (RAAM) Clinic is located at the Crisis Response Centre at 817 Bannatyne Avenue. This clinic provides walk-in access to an addiction physician or physician assistant and counselor, and can provide assistance with withdrawal management, medication-assisted treatment, and referral to addiction treatment programs. No booked appointments and no referrals are needed. Current information and hours of operation can be found at http://mbaddictionhelp.ca/services/rapid-access-to-addictions-medicine-raam/.
Addiction Services at Health Sciences Centre also plays an active role in teaching/medical education in Manitoba. Various trainees spend time with the Addictions Unit, with the Addiction Consult Service, and the RAAM clinic, to further their knowledge about addiction and relevant treatment resources. This includes medical students, psychiatry and family medicine residents, nursing students, and physicians and nurse practitioners from the community who wish to further their addiction knowledge or obtain prescribing privileges for methadone and/or buprenorphine/naloxone.
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.
CLINICAL PROGRAM MEDICAL STAFF
Erin Knight MD, CCFP, ISAM
Medical Director, Addictions Unit
Health Sciences Centre