Doctor: Keeping the liquor stores open is the right thing to do

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A Nova Scotia family doctor is applauding the province’s decision to keep Nova Scotia Liquor Corporation (NSLC) stores open as the COVID-19 pandemic continues to change the way we navigate our daily lives.

“I am so pleased that the premier and our provincial leadership has advocated to keep the NSLC open because I think that’s crucial,” Dr. Leah Genge said in an interview Monday.

The novel coronavirus has shuttered many businesses and prompted a provincial state of emergency. This has resulted in some people taking to social media to demand why NSLC stores remain open.

The reasons are health-related, explained Genge, a family physician with expertise in addiction who works at Mobile Outreach Street Health (MOSH), Direction 180, and Spryfield Medical Centre.

“We have many people who live with alcohol use disorder in the HRM and across the province. Alcohol use disorder can affect anybody, and it is particularly prevalent here in Nova Scotia,” she said.

“The risk of just removing all access to those safe substances can have very severe consequences.”

The risk of alcohol withdrawal can be potentially fatal for some people due to withdrawal seizures and other complications of severe withdrawal.

“That not only has immediate health risks to the patient, but it also puts undue strain on our health care system which is already coping with COVID right now,” Genge said.

“We also do not have enough detox beds to even support our detox needs without this crisis, so if we were to add that on top of this, we just don’t have the resources for that.”

In addition, some patients experiencing severe alcohol withdrawal may require very high doses of benzodiazepines. Genge said while this is best managed in a hospital setting, “we just don’t have access to that.”

While the acute risk of withdrawal is one concern, so is the consumption of non-beverage alcohol. When they don’t have money or easy access, patients with severe alcohol use disorder consume things like mouthwash, rubbing alcohol, and hand sanitizer.

“We saw this in the SARS epidemic when liquor stores were closed in Ontario. As I’m watching hand sanitizer fly off the shelves, I’m concerned for public health from COVID but I’m also concerned about all my patients who consume that on a regular basis,” she said.

“What happens then, and what we saw in SARS, is that people turn to even more dangerous things such as antifreeze just to cope with their withdrawal and with their alcohol use disorder.”

That, she explained, puts people at risk for more severe toxicity and other health-related harms that can occur from consuming high risk, non-beverage alcohol.

“The risks are there and they are very serious and potentially fatal on either side of that,” Genge said.

It’s also important to remember that alcohol use disorder affects people from every walk of life. Genge described the disorder as “just as common as depression,” adding that if you’re reading this and aren’t personally affected by it, you’ll certainly know someone who is.

“There are lots of people in this province who would probably meet the criteria for an alcohol use disorder but it’s socially very acceptable here. We all kind of need to look within our own social circles and look at how people cope in adversity and how they cope when they don’t have access to alcohol and things like that,” she said.

“There are some people who are drinking hand sanitizer and who have chronic homelessness. There are also people who drink a bottle of wine every night after work and that’s how they’re coping and getting through it. If they weren’t to have that, how might that trickle down to their families?”

The issue of family violence or substance-related violence is also a factor when considering the NSLC an essential service. As with all things COVID-19, Genge said you can’t look at any of the pieces in isolation.

“Going through something like alcohol withdrawal or any withdrawal for that matter is a terribly anxiety provoking experience, and from that can come all kinds of behaviours that may be out of keeping for people,” she explained.

“When it comes to the issue of domestic violence or family violence, when we talk about that in the context of alcohol it is a double-edged sword. Sometimes that’s worse when people are intoxicated, and a lot of times it’s worse when people are withdrawing.”

Cindy MacIsaac, executive director of Direction 180, also applauded the province’s decision and in particular praised Nova Scotia’s chief medical officer Dr. Robert Strang for being mindful of this issue. She said substance use remains one of the most stigmatized health issues in our society, and she urged people to show compassion during these uncertain times.

“Socially it’s okay to have a drink and socially it’s okay to smoke marijuana or whatever you choose. For some folk, trauma and pain and life on life’s terms puts them in a position where they become dependent upon that,” MacIsaac said.

“Nobody sets out to end up sleeping on a bench or losing touch with their loved ones, and so we have to have compassion for people and put measures in place where we’re still connecting with them so we can help reduce those risks for them. During this coronavirus pandemic those folk are even more marginalized.”

Genge agrees.

“We are a community and we must take care of each other, and that means thinking outside of people who are immediately around you and just treating everybody with the empathy and respect that we all want to be treated with,” she said.

“I think if we do that, then we can have openness for conversations around simple things like the NSLC being open and supporting those who need the most support and we’ll all get through this.”

If you require help with a substance addiction, you should talk to your primary care provider if you have one, or access Mental Health and Addictions services via the NSHA. Homeless or vulnerably housed people can turn to MOSH.  

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