Prescribed beer to save lives

The pandemic has shed light on the plight of dozens of indigenous homeless people who have settled in downtown Montreal. However, shelters generally refuse to accommodate those who are under the influence of alcohol, even if a few hours of withdrawal can be life threatening. Against the grain, in a small specialized center in the Center-Sud, alcohol is… prescribed. An example to follow ? Visit.

“It’s the first time that my mind comes back to me”

It’s 10 a.m. In an apartment in the Center-Sud district of Montreal, discussions are punctuated by pschitt characteristic of cans that are uncapped. The beer sparkles in the glasses and the fridge is overflowing with Labatt and Pabst. Nothing suggests that we are in a center specializing in drug addiction and homelessness. Alcohol is not only permitted here, it is prescribed. The goal: to save lives.

Withdrawing from alcohol is one of the most dangerous around. Sweating, tremors, palpitations, anxiety, diarrhea, vomiting, convulsions. In extreme cases, a delirium tremens – where the person loses touch with reality – can lead to death.

For the first time in Quebec, a roaming resource has chosen to offer alcohol to its users to avoid withdrawal. For a year now, the Quebec Native Projects (PAQ) organization has been distributing a precise dose of alcohol every hour to the participants of its new residential program, according to a structured medical plan.

In partnership with the drug addiction medicine clinic of the Center hospitalier de l’Université de Montréal (CHUM), the project was launched in the midst of a pandemic. He offers his services to itinerant Aboriginal men in Montreal with a significant alcohol dependence. Press went there to discover the underside of this little-known approach in Quebec, but very present everywhere in Canada.

End the quest for alcohol

The eight-bedroom apartment that hosts the project is located in the heart of Montreal. From the outside, the building looks like a duplex like any other. The tenants share a kitchen, a living room, bathrooms, a small courtyard and a billiard room. Every day, at regular intervals, they receive a glass of beer. Caregivers supervise and document their consumption, while supporting them on a daily basis.

Note that residents pay for their alcohol themselves by adding an amount to their rent. And they have a home, the right to do whatever they want, when they want – as long as they respect other roomers. A luxury they hadn’t tasted for a long time.

“This is the first time that my mind comes back to me,” enthuses Delmar Garry Whattam, comfortably seated in an armchair, a beer in his hand. With his short beard, hood and contagious smile, the man from the Nisga’a nation, near Prince Rupert in northern British Columbia (and the killer whale tribe, he says. ), is surprised. ” It’s really unbelievable ! ”

A hole in the service offer

The majority of homeless shelters and services in Montreal close the doors to people under the influence of alcohol. They also do not allow the consumption of alcohol on the spot. During the eight to ten hours of accommodation, alcoholics will start to withdraw and will be sick, explains D^D Annie Talbot, medical co-director at the CHUM, in addition to being a researcher and family doctor in the drug addiction medicine service. “It was a hole in the service offers for homeless people, to force them to stop consuming in order to access accommodation,” she says.

Each future participant in the Quebec Native Projects program is evaluated according to their goals and consumption habits. “For a long time, in the field of [lutte contre les] addictions, we advocated abstinence, exposes the D^D Stéphanie Marsan, researcher responsible for the project at the CHUM. But there is an idealism there, she continues. There are many people for whom it is not possible to access abstinence. ”

Up to seven out of ten people experiencing homelessness are severely addicted to alcohol. Some are even considered to have a serious addiction, that is, they ingest more than 20 drinks per day.

For these people, quitting drinking is not always an option. Even less a priority.

At Quebec Native Projects, it was the death of Dinah Matte, an Inuit woman hit by a car on Sainte-Catherine Street while she was drunk in 2020, which launched the reflection on the project. “There are those who say: ‘It’s cold outside, I don’t want to die in a construction site, in the middle of the night” “, sums up the D^D Talbot.

Diagnose alcoholism

Alcoholism is considered a mental health problem, just like depression. the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) details a list of criteria for making a diagnosis of this substance use disorder. For example, “desire, strong desire or need to consume alcohol” or “recurrent use of alcohol in situations where it is physically dangerous”.

These are the criteria that the CHUM team uses to develop the alcohol consumption protocol for residents of the PAQ program.

The regular presence of doctors and nurses on site also allows residents to be medically taken care of. Delmar Garry Whattam is now being treated for his hepatitis C. “Before, I couldn’t even go to a doctor! », He denounces.

However, all is not perfect in the project. In the past year, residents have had to be fired because of behavioral problems or non-payment of rent. The men are also bereaved by the death of two tenants, who succumbed to chronic illnesses.

If beer is everywhere in the house, it is absent from conversations. Maybe even thoughts. In this accommodation, which has become a home, participants can finally focus on something other than finding their next neighbor. drink. When visiting Press, they encourage and bicker, like a real family. “Qanik! “, Exclaims Mark Alsop, program coordinator, suddenly, pointing to the window. Snowflakes, the first of the season, swirl around. ” It’s snowing ! », In Inuktitut.

Simeonie Tuckatuck, a 66-year-old man from Kuujjuarapik, Nunavik, watches the snow fall for a few seconds. “It’s going to be a cold winter,” he said at last. We have a bed, and a roof. His gaze returns to the living room. A warm and welcoming room. “We can live with that. “

The blind spot of roaming services

Alcohol consumption is the blind spot of roaming resources, which often require sobriety to benefit from their services. While the pandemic has increased the needs of homeless people in Montreal tenfold, a program like that of Quebec Native Projects offers an option for those left behind on the streets.

Alcoholism costs Canadians dearly in health care and legal issues. In 2017, according to a study by the Canadian Center on Substance Use and Addiction, financial losses were estimated at $ 16 billion, more than Quebec’s total budget deficit.

Alcohol consumption management programs (managed alcohol programs), like that of Quebec Native Projects (PAQ), allow a significant reduction in hospitalizations, altercations with the police, emergency room visits, assaults and dangerous consumption (consumption of rubbing alcohol and gel for children). hands, for example) in people who benefit from it, according to several studies conducted in Canada.

The first program of its kind saw the light of day in Ontario at the end of the 1990s. Today, more than twenty projects exist in the country, but PAQ’s is the first in Quebec. “In general, we are fairly conservative in Quebec in our approaches to roaming,” notes the D^D Annie Talbot, medical co-director at the CHUM.

Priority issue

It is estimated that 3,100 people are homeless in Montreal. The problem is such that it became one of the priorities of the last election campaign. Mayor Valérie Plante has also promised to double investments in roaming, increasing them from $ 3 to $ 6 million per year.

This year, two homeless Indigenous people lost their lives on the streets of Montreal. Raphaël André, last January, was found in a mobile toilet a few steps from a closed refuge. Then, in November, the remains of Elisapie Pootoogook were found at a construction site in the west end of downtown.

These deaths and several others, in addition to the pandemic, accelerated the establishment of the PAQ specialized residence. Montreal shelters have also broadened their admission criteria and now accept people who have consumed alcohol. This is particularly the case of the center for controlled alcohol consumption (wet shelter) of PAQ.

At Square Chabot, in the west of downtown Montreal, a heated tent has been erected in honor of Raphaël André. Since last winter, it has been welcoming aboriginal people. The funds have also been renewed so that this tent remains accessible until next spring, according to a newspaper article. Metro.

Nearby, in the Milton-Parc district, cohabitation between the homeless and residents is often difficult. Residents also demonstrated in early October to demand a revitalization of their neighborhood and more services for the homeless.

The Quebec Native Projects initiative could help in the fight against homelessness in the province. Other organizations recently visited the site to learn more about the project, told Press Christie Chapman, PAQ worker. In the spring, the program will move and will be able to accommodate more than twenty residents. PAQ hopes in particular to expand its service to Aboriginal women.