Give More Chronic Drinkers Safe Doses of Alcohol, Say Researchers

Safe supply programs are just as valuable for people living with severe alcohol dependencies as they are for illicit drug users, say two B.C. researchers calling on the province to expand managed alcohol programs.

Managed alcohol programs provide free prescribed doses of alcohol to people who drink chronically and are experiencing homelessness.

Alcohol is stored securely and then dispensed or delivered to clients in prescribed doses between one to 15 times per day. Clients may be asked to cover part of the cost of the service, which is $213 to $639 per client per month, depending on the dose.

The goal is to prevent people from drinking non-beverage alcohol, like mouthwash or hand sanitizer, which can lead to injury or hospitalization.

But the harm reduction programs, which range from live-in centres to mobile outreach teams, also connect people with services and resources for housing, employment and health care.

B.C. currently has five of Canada’s more than 22 MAPs, including three in Vancouver, one in Port Hardy on Vancouver Island and one in Kelowna.

Bernie Pauly, head of the nine-year-old Canadian Managed Alcohol Program Study, says the need for the programs has increased during the COVID-19 pandemic.

“People’s sources of income were really limited because bottle depots were closed, so people couldn't recycle, and obviously, panhandling was impacted, and liquor stores were not taking cash,” said Pauly, a scientist at the Canadian Institute for Substance Use Research and professor at the University of Victoria. “So they are at more risk for withdrawal, but also heightening their harm for overdose, because sometimes people would substitute illicit drugs for alcohol.”

A 2013 report on MAPs in Vancouver showed that participants all were able to maintain housing, reported their mental and social well-being had improved, were less likely to suffer withdrawal seizures and drank less non-beverage alcohol.

“Managed alcohol programs take the search for alcohol off the table as the main focus of the person each day,” said Meaghan Brown, a PhD candidate at the UVic school of nursing and collaborator on the study. “A lot of people have told us that when they don't have to worry about their alcohol supply, and they feel confident and secure, they can focus on other things in their life and their quality of life in general.”

Health authorities in B.C. and elsewhere in Canada took fast action to begin short-term MAPs to support people’s isolation after exposure to COVID-19 or while awaiting test results. The programs were mainly delivered by outreach teams deployed to social and supportive housing.

But Brown and Pauly say these programs need to continue on a permanent basis even after the risks of COVID-19 transmission subside.

“Yes, it’s important to have MAPs for people to isolate,” said Pauly. “But that's a pretty limited version of a MAP, and doesn't really capitalize on the full benefits.”

As the province prepares an expansion of safe supply programs providing alternatives to illicit drugs, Pauly says the value of MAPs needs to be recognized. That value goes beyond the pandemic, she adds.

“A liquor store is safer supply for everybody,” she said, “except these people can’t afford it or can’t access it and they’re left to manage their own consumption.”

Brown and Pauly are now focusing on the challenges and benefits of outreach models of MAPs. These could be provided by teams of health-care workers and peers who do mobile delivery or be added to existing services used by people who could benefit from a MAP.

While live-in MAPs are effective, outreach teams cost less and can be set up more quickly, making them the most responsive solution for the urgent pandemic situation.

The two researchers are also partnering with a number of Indigenous organizations to understand how these supports can be culturally safe and rooted in Indigenous knowledge and tradition. 

In Vancouver’s two programs that report the race of their clients, 57 and 80 per cent of people who accessed MAPs were Indigenous.

“There are Indigenous participants in MAPs who would benefit from receiving alcohol harm reduction support that is more in line with approaches to healing and safety within an Indigenous framework,” said Brown, whose dissertation focuses on Indigenous-led alcohol harm reduction.

While the pandemic created urgency, Brown and Pauly said the harms and risks that already existed need to remain the focus of future solutions.

“Unfortunately, I think what can maybe happen as a consequence of COVID-19 is that we can become very focused on certain outcomes, such as successful isolation, COVID-19 prevention and withdrawal management,” said Brown.

“Whereas if we shift our understanding of what alcohol harm reduction means, and what the benefits of harm reduction are, and what the potential impacts of these programs can be, then we'll hopefully be able to advocate for more longer term and accessible programs.”