The RAAM clinic provided services for people with opioid use disorder (OUD, “opioid addiction”) or an alcohol use disorder (AUD, alcoholism). This is a private clinic funded by OHIP. We regularly get referrals from the emergency department, residential withdrawal management (detox), family doctors and addiction counselors but a referral is not necessary – we are here if you think you have a problem, when you think you need help. You can call and make an appointment or just walk-in. We started in January 2016 as part of the META:PHI project.
Offering Rapid Assessment:
Patients are usually seen and have their intake completed the same day they ask for help or the next day we are open. The front desk staff will have you complete some paperwork, then you see a case- manager who takes a history, next you see an addiction physician who reviews the history, provides information and answers questions about the medication assisted therapies (MAT) we offer and then you see our nurse for some tests and the doctor completes a brief physical exam.
Medication Assisted Treatment:
We offer evidence-based MAT for both AUD and OUD. In both cases the medications decrease withdrawal and craving and therefore increase your chance of staying substance free or at least decreasing your substance misuse.
The case-managers will also help patients navigate and connect with other services available in the community that they might benefit from. We also have a psychotherapist who provides counselling and other psychotherapies to our patients.
Alcohol Use Disorder:
There are several evidence-based medication assisted treatment options. Our first goal is to control or prevent significant alcohol withdrawal in those people that have recently quit drinking or are planning to abstain. For most people home based “detox” has been found to be safe and is preferred by many. Medication has also been found to reduce craving after withdrawal resolves by improving sleep and decreasing daytime anxiety – two common symptoms that persist in people that have quit drinking. Correcting these two problems increase the chance of not using or decreasing the amount of alcohol used.
An additional protocol offered is the Sinclair Method (TSM). This process uses medication on an as needed basis to disrupt the association your brain has made between euphoria and alcohol use. Those people whose brains do respond to TSM do see a significant decrease in their drinking and many completely quit.
TSM is very popular in Europe. See the links on the other side of this brochure to go to a popular TSM website for more info and an youtube address to watch a TED talk on one woman’s experience with TSM.
The Sinclair Method
The Sinclair Method (TSM) is a treatment for alcohol addiction that uses a technique called pharmacological extinction—the use of an opiate blocker to turn habit-forming behaviors into habit-erasing behaviors. The effect returns a person’s craving for alcohol to its pre-addiction state.
TSM consists of taking Naltrexone at least one hour before your first drink of the day for the rest of your life as long as you continue to drink. Naltrexone is an oral opioid blocker. One of the effects of alcohol is to cause the release of endorphins (our bodies own opioids). This causes a mild euphoria (pleasant feeling). Sinclair believed this euphoria is what drives people to drink and that by blocking it the brain would extinguish the association between alcohol and the euphoria. People on this treatment are also counseled to moderate their drinking – something that does not work without naltrexone. For those people that this treatment works for notice a marked decrease in their alcohol intake.
Sinclair’s original human study found about 75% of people in the group counselled to moderate their consumption of alcohol and taking naltrexone before drinking were able to consume alcohol at safe dinking levels (for men no more than 15 standard drinks per week, no more than 3 at a sitting) or be abstinent. The study was repeated by another researcher a few years later and found 45% of the people in the “Sinclair” group hit the combined endpoint of abstinence or safe drinking levels. Given that attempts of abstinence may only be successful 15% of the time many people are willing to try TSM.
Extinction usually occurs within 3-4 months and may happen quite rapidly.
About one quarter of those on TSM become 100% abstinent. Those who continue to drink will have to take their medication prior to drinking for as long as they continue to drink.
People that are using or prescribed opioids can not start TSM
Information including his original study can be found on the website below.
This above information was replicated from the C Three Foundation website: https://cthreefoundation.org/
Below is an informative link to a Ted Talk video that describes the Sinclair Method and use of Naltrexone in more detail.
Opioid Use Disorder:
Opioid replacement therapy (ORT) is the standard of care for OUD. This means that there is so much quality evidence supporting its use that to suggest another approach to a person with OUD would be substandard treatment – malpractice.
The Canadian Research Initiative in Substance Misuse (CRISM) is a guideline for the treatment of OUD that was published in March 2018. The four main points in the guideline are:
- ORT is the standard of care for the treatment of OUD;
- Use buprenorphine (Suboxone) first as it is safer and has fewer side effects;
- Switch to methadone if buprenorphine is not tolerated or effective;
- Avoid sending people with OUD to abstinence-based treatments as they are ineffective and increase mortality.
Bluewater RAAM Clinic is staffed with physicians who are very familiar with ORT. We can answer any concerns you have during the intake process.