Withdrawal from alcohol can be deadly, expert says as LCBO stores remain closed

It'smore difficult for Ontarians to buy alcohol right nowas a standoffbetween the Ontario governmentand the union representing thousands ofLiquor Control Board of Ontario (LCBO) employees moves into a second week,keepinghundreds of stores closed.

Roughly 9,000 members of the Ontario Public Service Employees Union (OPSEU)began a strike last Friday, leading to theclosing of all 680 LCBO's retail outlets.

Ford's plan could add up to 8,500 locations where alcoholic beverages can be bought. The OPSEU says the plan would hurt the LCBO's bottom line and result in thousands of job losses in a few years.

Some health care workers and mental health advocates have raised concerns that limitingaccess to the LCBOcould harm people with alcohol use disorder or alcohol dependencies.

Patrick Kolowicz is the director of Htel-Dieu Grace Healthcare's mental health and addictions department. He says losing access to alcohol for those with severeaddictions can be "problematic."

Despite the strike, Ontarians canpurchase alcoholfrom the LCBO online for home delivery. Ontario Premier Doug Ford has published an online interactive map of places to buy boozeduring the labour action.

Kolowiczsays these additional ways for people to access alcohol are crucial for those with addictions to prevent them from experiencing withdrawal.

Here'spartof his conversation with the CBC's Jacob Barker. This interview has been edited and condensed.

So tell me about this strike.... is it disruptive in somebody's care?

We experienced this during [the COVID-19 pandemic]. The conversation is specific for those who are dependent on alcohol, but for those who do have a dependency on alcohol.I would refer to that as is thatthey are drinking daily, and they require that in order to avoid experiencing withdrawal.

We know that people who are dependent onalcohol have the most significant risk factors around withdrawal, greater than any othersubstance addiction, followedclosely behindopiates. It'sthe highest risk in terms of health complications secondary to withdrawal, so that's why whenever there's an issue around their ability to access it, it could become problematic.

During the pandemic the LCBOwas deemed an essential service, now these stores aren't open.There are other placesthat people can get alcohol, but isthe LCBOessential topeople?

I think you hit on it in your second point,there are alternate avenues that people can utilize now to gain access to alcohol. I would imagine that for some people, maybethe LCBO is most convenient. Maybe it's close by ormaybe they have mobility issues and they're able to access [the store] but there are alternate ways.

There's [ordering]online but not everybody knows how to do that, so it can be deemed essential from some perspectives. Maybe loved ones canassist inobtaining access. So it's not quite as bad as it was when there were noalternate avenuesbut given that there are now, it's not quite so problematic.

But definitely still a concern, especially for circumstances where the LCBO was that person's primary location to obtain alcohol they are in fact dependent on.

If you can speak generally, what have you experienced with your clients, how has the LCBO strike affected their treatment?

For people accessing our bed-based withdrawal management service, alcohol use disorder is the number one presenting concern or reason why they seek service.

So, that hasn't changed and continues to grow as a problem within society. We can correlate based on the evidence that as we improve or create more access to alcohol, subsequent to that, we will see more addiction or disease and so that notion hasn't changed.

What we've done as part of Htel-Dieu'shealth care and trying to bolster our withdrawal management programis we recognize that it's truly a medical type of issue when people come in with alcohol use disorder and they're seekingwithdrawal, so much so that sometimes they even require inpatient hospital care.

Idefine it like this, for those who are significantly dependent on alcohol, meaning that they drink daily anda large amount or if they have other risk factors, for some of those individuals it's actually most appropriate that they withdraw in a hospital setting.

We give them a medication routinely to avoid things like what we call DTs or delirium tremens, which areseizures that can result in death, related toalcohol withdrawal.

Those who are most dependent orhave the highest risk factors they actually may require an inpatient environment.

The secondstep is our bed-based withdrawal management programand we'rebolstering that with medical support such as nursesand nurse practitioners in order to provide that withdrawal care, to avoid those complications for when people are seeking to withdraw.

Then, theleast intense service is that you can withdraw in the community and a lot of times that's that's perfectly fine. We haveoutreach workers that would help liaise that person withmaybe their family physician or primary care practitioner or an addiction specialist in what we call a RAMclinic or an outpatient addiction medicine clinic to prescribe some of that medication.