Alcohol must keep flowing during pandemic to prevent serious withdrawal: addiction experts

Making sure alcohol is available may not seem like a necessity during a public health emergency, but it can be a matter of life or death for those with severe addiction. 

So far, Manitoba liquor stores remain open during the COVID-19 pandemic. On Monday, Ontario liquor stores were deemed to be an essential service under a broad public health order that forced every non-essential workplace to shut down. 

"If we were to cut off that alcohol, we know that [people with alcohol addiction] may get into withdrawal symptoms," said CBC's medical columnist, Dr. Peter Lin.

"You can have terrible seizures," he said. "People can collapse. They could go into all sorts of hallucinations."

Mild withdrawal symptoms include feeling jittery, insomnia and slight nausea, but severe symptoms can result in hospitalization or death. 

"I have not advised the closure of [liquor] outlets," said Manitoba's chief provincial public health officer, Dr. Brent Roussin. "According to my orders, they will remain open, but we are reviewing those types of things constantly, and all of the unintended consequences of any choice we make."

Roussin said he's heard reports of people with opioid use disorder buying illicit drugs from unknown suppliers, which increases the chance of overdose. These reports prompted the province to make sure there is an adequate supply of naloxone — a drug used to reverse opioid overdose.

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Rick Lees runs the Main Street Project, which operates a 60-bed detox unit. Patients are given a variety of prescription drugs to treat withdrawal symptoms during their stay, which can range from 10 to 21 days. 

Lees says stopping alcohol without medical help can be dangerous for people with addictions.

"You could have a real crisis because people would get sick really fast, and with the potential of death, obviously, if they were not given access to some safe supply."

Lees has been in talks with Manitoba Liquor & Lotteries to figure out the best way to ensure there is a safe supply of alcohol during the pandemic. 

"If [liquor stores] were forced to shut down by order of government, we would create perhaps a safe delivery supply and set up a safe distribution site within our programs, so that we could continue to have a baseline of alcohol available to clients who would absolutely have to have access."

Safe supply can take different forms in the event of store closures. Some of the possibilities include turning closed liquor stores into distribution sites, staffed by both Main Street Project and Manitoba Liquor & Lotteries workers, where people could buy alcohol without going into in-person treatment. 

A managed alcohol program is also being considered for in-person treatment and for those who must self-isolate during the pandemic.

A managed alcohol program is a harm-reduction approach that gives measured doses of alcohol to people with severe alcohol dependency.

Winnipeg does not currently have any managed alcohol programs.

"In good times, managed alcohol has actually been challenged as an appropriate response. And now in a pandemic, it's something that's squarely on the table," said Lees. 

"One of the reasons I think [liquor stores] are seen as being somewhat essential is because of the unintended consequence — a new kind of crisis you could create by suddenly withdrawing a substance."

The press secretary for Minister of Crown Services Jeff Wharton says the provincial government is following Dr. Roussin's advice closely, and at this time liquor stores remain open. 

 "Manitoba Liquor & Lotteries are taking a number of actions in Liquor Marts to help reduce the risk of spreading COVID-19," the spokesperson said.