A novel home- and community-based mobile outreach detoxification service for individuals identifying problematic substance use: implementation and program evaluation

SETTING: Substance use remains a pervasive public health issue throughout Canada, exerting substantial economic, social, and political pressure on health care systems, while impacting lives of affected individuals. The advent of COVID-19 has been doubly perilous; it restricts existing programming, while exacting a worsening toll on mental health and substance use fronts across the demographic landscape. INTERVENTION: In response to the crisis, the Mobile Withdrawal Management Service (MWMS) was established in 2019 through a Winnipeg-based community health centre. MWMS is a community-based outreach withdrawal service that supports individuals for up to 30 days. Clients may choose where services are accessed in the community, including their own home. For those without safe housing, short-term accommodation is offered. Additionally, Indigenous cultural support, peer support, trauma counselling, and linkage to primary care are available. OUTCOMES: The MWMS approach is resolutely patient-centred. The program meets people where they are at, both figuratively and literally. Agility and adaptability—particularly in the context of substance use treatment—is uniquely advantageous in maintaining service delivery to the broad demographic cross-section revealed in the data. Moreover, relative to inpatient detoxification services, MWMS holds significant potential for system-wide cost savings. IMPLICATIONS: The presented approach addresses a significant gap in addiction services. There is substantial capacity for both increased access and system savings with implementation of this approach. Furthermore, the principles behind the program are readily transferable to different contexts and easily modifiable to local conditions. There is particular potential for servicing hard-to-reach populations, with respect to both physical and social geography.