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

It's more difficult for Ontarians to buy alcohol right now as a standoff between the Ontario government and the union representing thousands of Liquor Control Board of Ontario (LCBO) employees moves into a second week, keeping hundreds of stores closed.

Roughly 9,000 members of the Ontario Public Service Employees Union (OPSEU) began a strike last Friday, leading to the closing 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 limiting access to the LCBO could harm people with alcohol use disorder or alcohol dependencies. 

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

Despite the strike, Ontarians can purchase alcohol from the LCBO online for home delivery. Ontario Premier Doug Ford has published an online interactive map of places to buy booze during the labour action.

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

Here's part of 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 that they are drinking daily, and they require that in order to avoid experiencing withdrawal. 

We know that people who are dependent on alcohol have the most significant risk factors around withdrawal, greater than any other substance addiction, followed closely behind opiates. It's the 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 LCBO was deemed an essential service, now these stores aren't open. There are other places that people can get alcohol, but is the LCBO essential to people?

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, maybe the LCBO is most convenient. Maybe it's close by or maybe 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 can assist in obtaining access. So it's not quite as bad as it was when there were no alternate avenues but 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 Hôtel-Dieu's health care and trying to bolster our withdrawal management program is we recognize that it's truly a medical type of issue when people come in with alcohol use disorder and they're seeking withdrawal, so much so that sometimes they even require inpatient hospital care.

I define it like this, for those who are significantly dependent on alcohol, meaning that they drink daily and a 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 are seizures that can result in death, related to alcohol withdrawal.

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

The second step is our bed-based withdrawal management program and we're bolstering that with medical support such as nurses and nurse practitioners in order to provide that withdrawal care, to avoid those complications for when people are seeking to withdraw. 

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