Innovative medication-assisted service is helping patients engage in recovery

Substance withdrawal can be difficult, both emotionally and physically. Sometimes people need professional care and support to make the withdrawal process safer.

CAMH has been providing medication-assisted withdrawal services long before the onset of COVID-19. But as overdose deaths hit new highs throughout most of Canada, fueled by an increasingly toxic illegal drug supply and the social isolation and stress sparked by the pandemic, the need for this kind of service has never been greater.

Despite the logistical challenges posed by COVID-19, the Medical Withdrawal Service (MWS) partnered with the newly-created Intensive Recovery Discharge Team (IRDT) to work collaboratively to provide care in the midst of service disruptions at a time where patients need increased support. The IRDT provides two weeks of intensive remote support to patients who have recently been discharged from the MWS and other acute care units at CAMH. This team offers continued support with relapse prevention, strategies to help patients meet the challenges that lie ahead, and overall mental health support.

“This is a new and innovative model of care that the team developed in response to the challenges that COVID-19 has presented. The IRDT meets with patients before they are discharged from the hospital to act as a bridge for them as they transition back into the community.  Patients have told us how much they value receiving continued support from care providers that they are familiar with during the two weeks following their inpatient stay in the MWS,” said Holly Ito, a Social Worker in the MWS and IRDT. 

The MWS consists of a team of nurses, pharmacists and doctors; along with a social worker, occupational therapist, dietician and recreation therapist who work with patients to develop a comprehensive care plan based on their unique needs. 

Patients admitted to the MWS have varying needs and requirements for specialized support, depending on the substance use disorder for which they are seeking treatment—this may be from alcohol, opioids or other substances. Patient safety and comfort throughout this process is critical. That is why CAMH adopted cutting-edge practices, for example, through the introduction of intravenous (IV) administration of thiamine in coordination with the Mobile Medical Team and Nurse Educators, for some patients with severe alcohol use disorder (AUD).

Thiamine supplementation is critical in reversing and preventing cognitive impairment that can occur with severe AUD and is a best practice in the treatment of this condition for some patients. It can greatly enhance their ability to engage in further treatment and enable an upward trajectory toward wellness.

“Before we were able to do IV administration of thiamine, patients would have to receive intramuscular injections three times a day over a period of three days. This process was difficult and very painful for patients, particularly for those who had a fear of needles. Through the IV administration of thiamine, patients not only respond much quicker to the treatment, but their treatment is significantly more manageable and comfortable—requiring only one IV start instead of nine injections,” said Mary Cruise, a Registered Nurse in the MWS. 

The MWS and IRDT also support patients who are seeking treatment for opioid use disorder. On the unit, clients are rotated to other medications, which is a far safer option than simply providing withdrawal management for opioids, and can prevent overdoses and support patient engagement in other treatments. 

While these care providers partner with patients in their recovery, the reality is that the process isn’t always smooth or linear. If a patient needs readmission to MWS, they return to a judgement-free and supportive space as they continue to progress on their unique recovery journey.