The mobile withdrawal management service (MWMS) was started by Klinic Community Health in Winnipeg in 2019. MWMS provides community-based mobile services to manage withdrawal from a variety of substances, including alcohol, stimulants and opioids. Clients can access withdrawal management services for up to 30 days. The program operates under the principle of meeting people where they are at, and goals are self-identified by each client. After approximately two years of program delivery, 343 people had been referred to MSMS, 225 people (65%) had completed the program (based on their self-identified goals when they started the program) and 92 people who completed the program had transitioned into treatment programs.1
Program description
The MWMS provided mobile detoxification services within community-based settings for up to 30 days. Clients chose where to access services within the community; they most often chose their own home. Short-term accommodations could be set up by the program if the person did not have stable housing. In cases where services were provided in short-term accommodations, clients were supported to find long-term housing if they were interested.
Individuals could be referred to the program in a variety of ways (e.g., self-referral, referral by other community-based organizations). Individuals could participate if they were medically and mentally stable (e.g., no active suicidality or psychosis) and had no history of complicated withdrawal (e.g., withdrawal seizures).
Program interventions were based on the individual needs and objectives of each client. Interventions ranged from short-term stabilization to longer term treatment. The program operated 365 days per year and its hours extended into the evening. Staffing for MWMS consisted of 60 nursing hours per week, 92 health and support worker hours per week, 64 peer support worker hours per week, four physician hours per week and eight program coordinator hours per week.
Interventions included pharmacological treatment (e.g., initiation of opioid agonist therapy) and psychosocial (e.g., mental health) supports. Harm reduction principles were included in all care plans, and access to harm reduction services (e.g., naloxone training, provision of clean drug use supplies and safer sex supplies) and other health services (e.g., sexually transmitted and blood-bone infection testing, pregnancy tests, COVID-19 vaccinations) was provided as needed.
Program staff made scheduled daily contact with individuals for the entire length of their enrolment in the program either in person or by text or phone call on the basis of the person’s preference. A 24-hour crisis line provided access to after-hours services if needed. Clients could also contact staff directly during working hours via phone or text to modify a care plan or request further support. Transportation was available to clients if they needed it.
MWMS helped clients get the services that they needed and wanted (e.g., Indigenous cultural support, trauma counselling, primary care), either through the MWMS program or through connections to other community-based organizations. A “warm hand-off” was used to connect clients to primary care; it included direct communication between MWMS program staff and partner organizations, with a client’s involvement. The program also provided more long-term (i.e., longer than 30 days) peer or counsellor support. To further meet the needs of clients and address barriers, virtual services were offered during the COVID-19 pandemic.
Results
Between August 26, 2019, and September 19, 2021, 343 people were referred to MWMS. Referrals came from community-based primary care practitioners (41%), specialized outpatient addiction clinics (38%), in-hospital transfers (14%), psychiatric services (5%) and other sources (2%).
Fifty-nine percent of participants self-identified as female (202) and 41% (141) as male. Most participants were between the ages of 25 and 44. Thirty-two people indicated that they were homeless or precariously housed and were offered short-term accommodations. These participants were linked to support workers for assistance with finding longer term housing if they were interested. The primary substance used by those participating in the program was alcohol, followed by methamphetamine and then opiates.
Two hundred and twenty-five individuals (65%) completed the program (on the basis of their self-identified goals when they started the program) and 92 people transitioned to treatment programs following the conclusion of the MWMS program. There were no overdoses, hospitalizations or deaths reported during the program.
What does this mean for service providers?
This program provides an example of a flexible approach to detox services that meets people where they are at. The flexibility of this approach became particularly important in the context of the COVID-19 pandemic, as substance use increased and services needed to be provided in virtual contexts. The program strived for an approach that linked clients to other community-based services as needed, so that detox services were not operating in isolation.
A major feature of this program was the ability to deliver detox services in a person’s home. This approach can provide greater privacy and flexibility for individuals. The majority of MWMS’ participants were female, a population that has been shown to access detox services less frequently than men in research studies.2 The availability of home-based services could have led to a greater number of females accessing the program because this approach addresses the potential discomfort that females experience when accessing facility-based co-ed services, for example. Individuals may prefer home-based services in general because they help to alleviate some of the barriers associated with withdrawal management services (e.g., caregiver responsibilities, stigma, the need for safety and comfort). To alleviate some of the barriers associated with providing detox services, it is important to consider offering more community-based options for service delivery, including bringing services to where people are.
Related resources
Reducing harms for people who use drugs: Emerging approaches and time-honoured programs
The drug toxicity and overdose crisis in Canada: a snapshot of what the current data tell us
References
- Lodge A, Partyka C, Surbey K. A novel home- and community-based mobile outreach detoxification service for individuals identifying problematic substance use: implementation and program evaluation. Canadian Journal of Public Health. 2022;113:562-68.
- Greenfield SF, Brooks AJ, Gordon SM et al. Substance abuse treatment entry, retention, and outcome in women: a review of the literature. Drug and Alcohol Dependence. 2007;86(1):1-21.