The Closure of the MUHC Addiction Psychiatry Program:

The statement issued by the MUHC does not accurately portray the current services offered by
the Addiction Psychiatry Program. More importantly, it does not reflect the impact of the
program’s closure on patients, nor does it address the underlying discrimination against
individuals who suffer from substance use disorders.

Substance use disorders remain among the worst treated chronic illnesses in our society. It still
shocks most people to learn that there is greater heritability for cocaine addiction than for
other illnesses with genetic risk factors, such as hypertension or type 2 diabetes. While there
are lifestyle contributions to these latter illnesses, there is hardly the same stigma or blame
levied against patients as in addictions. Let’s face it, it’s easy to cut services and funding for
substance use disorder patients. These individuals are less likely to vote anyway – right?

But the reality is, you would be hard pressed to find a family that hasn’t been touched by
addictions. Emergency rooms are full of patients who are seeking help for the acute or chronic
complications of substance use. Withdrawing services from substance use disorders will make
this situation worse, not better.

The addiction psychiatry program already provides priority services to ALL patients referred
from the MUHC “mental health mission and… medical and surgical missions”. NO services will
be gained; however, services will be lost, as patients from other hospitals (or patients who
failed treatment at the Centres de réadaptation en dépendances (CRDs)) will no longer be able
to access treatment.

Currently, the program receives referrals from hospitals and CRDs across the province,
including the CHUM, as the services offered are complimentary and do not duplicate those at
the CHUM. In particular, the MUHC has an intensive outpatient program that allows patients
with severe addictions to participate in treatment 5 days per week. This is not available at the
CHUM. A day hospital is part of the continuum of care for individuals recovering from substance
use disorders – more intensive than regular outpatient services, less time-consuming and less
expensive to the health care system than inpatient care. Moreover, it allows individuals to
continue to care for children or elderly relatives while receiving addiction treatment (vs
residential programs).

It is far from clear that the CHUM is prepared to absorb the volume of patients treated at the
MUHC. In fact, several patients who called the CHUM in a panic after learning that the MUHC
addiction psychiatry program is closing were not offered services.

Furthermore, the statement regarding the lack of modernization of the addiction psychiatry
program is unfounded. The program has gone through multiple updates over the years; both
psychopharmacological and psychotherapeutic interventions have evolved over time and are
evidenced-base (e.g., buprenorphine for opioid use disorders, and integrated psychotherapy for
women with concurrent addictions and PTSD). The program’s “limits”, outlined in the MUHC
statement, are a direct consequence of underfunding and stigmatizing addiction, not of
outdated clinical initiatives on the part of the dedicated team.

The response from the MUHC is disingenuous. Internally, they have announced that they are
closing the program. There is no restructuring and no clear offer of services beyond December.
If the goal had been to improve treatment, then consultation and planning would have
occurred prior to the dismantling of the team. Ultimately, it is the patient population that will
suffer, but they lack a voice, and are easy to ignore.

Addiction often occurs at multiple, co-existing axes of discrimination – this closure, along with
its reductive justification – only serves to further marginalize those who have already been
abandoned by the healthcare system.

Sincerely,
The MUHC Addiction Psychiatry Program Team