A prescription for liquor: Royal Alex program helping people with severe alcoholism

Patients can be prescribed up to six doses of vodka per day, taken every two to three hours.

Doctors are allowing severe alcoholics to drink under medical supervision

Alcohol doses are dispensed in 45 millilitre bottles, and are given to patients up to six times a day. (Supplied/Alberta Health Services)

People who struggle with severe alcoholism don't have to stop drinking entirely thanks to a new program at the Royal Alexandra Hospital, which allows doctors to prescribe alcohol to patients.

The program at the north Edmonton hospital's Addiction Recovery and Community Health Clinic is one of the first in-hospital managed alcohol programs (MAPs) in Canada.

The program launched in December 2016, and about 15 patients have participated so far, said Dr. Karine Meador, assistant director of the Inner City Health and Wellness program, which runs the MAP.

Hospital patients are typically prescribed up to six 45 millilitre (1.5 ounces) doses of vodka a day, which are consumed in two or three hour intervals.

Patients drink the alcohol instead of receiving it through an IV to allow for a sense of autonomy.

The program allows patients to drink prescribed alcohol, instead of receiving it through an IV. (CBC)

Participants were being treated in hospital for other ailments before entering the program.

The first person to take part in the initial pilot was homeless, and was being treated for alcoholism-related health problems.

"He was a patient that was never going to quit drinking and we knew that, so it allowed us to keep him happy and stable in hospital," said Monica Cookson, a registered nurse at the Royal Alexandra Hospital.

"I think he was just really appreciative. He got treated for his medical problems, but he also had his mental well-being looked after."

After the patient was discharged, he moved to an Edmonton housing organization that has a managed alcohol program. MAPs in Edmonton started in housing facilities before the program was established at the Royal Alex.

Redefining success

Having the program in-hospital helps keep patients around long enough to complete their treatment, as patients sometimes leave the hospital to get alcohol, Meador said.

She said physicians who specialize in the treatment of substance abuse have to shift their thinking in order to allow addicts to continue to use drugs or alcohol. 

Success doesn't necessarily have to mean that somebody quits alcohol or stops their drug use.- Dr. Karine Meador, Inner City Health and Wellness program

"It's about reframing what you see as success," Meador said. "So success doesn't necessarily have to mean that somebody quits alcohol or stops their drug use. Success can mean that they are simply more stable in their lives, or more stably housed."

Meador said the program has helped participants reduce their daily alcohol consumption. Some patients who previously drank a 26-ounce bottle of liquor each day cut back to five or six drinks a day.

The pilot project at the Royal Alexandra Hospital is one of the first in-hospital managed alcohol programs in Canada. (CBC)

Before introducing the treatment program, the Addiction Recovery and Community Health Clinic established a harm-reduction program for patients addicted to opioids.

"I'm not sure why this hasn't been done before," Meador said. "We kind of impose that artificial need for abstinence in hospital. But realistically we know that most people who struggle with a substance use disorder outside the hospital, they are going to continue to struggle with that substance use disorder in hospital.

"So it just makes sense to extend that harm-reduction thinking into an acute care setting."

Canadian substance-abuse researchers said while formal managed alcohol programs are new in Canada, doctors have prescribed alcohol to patients for years, on a case-by-case basis.

An alternative for treating withdrawal

Withdrawal can be fatal for people who are physically dependent on alcohol, Meador said. Withdrawal begins 12 to 24 hours after an alcoholic stops drinking,and begins with symptoms including tremors, anxiety and nausea. Left untreated, it can trigger more severe symptoms.

"That's where they get confused and delirious," Meador said. "[They] don't know where they are, don't know who they are — they're seeing things, they're hallucinating.

"If this is untreated, then there's a high risk of then having seizures and cardiac arrhythmia, which can lead to death."

In Canadian hospitals, the most common approach for treating alcohol withdrawal is to prescribe an anti-anxiety and muscle relaxant medication called benzodiazepine, though there isn't a standard hospital protocol for treating alcohol withdrawal syndrome.

A 2018 report published in the Drug and Alcohol Review journal found that 19 U.S. hospitals have researched the use of alcohol prescriptions. And while there isn't a standardized approach in those hospitals either, patients were typically given alcohol through an IV.

By administering controlled doses of alcohol to Royal Alex patients every few hours, withdrawal can be avoided.

Helping vulnerable people

A 2016 study from the Harm Reduction Journal on a MAP in a Thunder Bay housing facility quoted an unnamed participant, who said the program helped stabilize their drinking.

"I could still be drunk every day if I wanted to, with the people I was on the street with. Since coming here, I drink wine … I don't think about buying anything else, you know like the other garbage like antiseptic, hairspray, all the other stuff that you know that I used to consume when I was out there." 

Alcohol users ... they are not always a popular group and often they are at the bottom of the pecking order in terms of attention and care.- Tim Stockwell, researcher

A University of Victoria Canadian Managed Alcohol Program Study found that MAPs participants are less of a danger to themselves and others.

Tim Stockwell, one of the authors of the study, said programs like the one at the Royal Alex are rarely publicized for fear of losing funding, as stigma is a key barrier to gaining more support for alcohol management services.

"You talk to people on the streets and the most stigmatized are homeless people using alcohol," Stockwell said.

"There are so many services for people using injection drugs, but alcohol users ... they are not always a popular group and often they are at the bottom of the pecking order in terms of attention and care and service provision."