Substance use treatment
Care for the stimulants, alcohol and other substances that sit alongside opioid use.
Who it is for
Anyone whose use goes beyond opioids. Stimulants, alcohol and benzodiazepines are common alongside opioid use, and treating one while ignoring the rest rarely holds.
What we can treat
Medication for alcohol use disorder, structured support for stimulant use, and concurrent mental health assessment and prescribing.
What we refer for
Counselling, housing and income support, and hepatitis C or HIV care. We refer, then follow up on whether the referral actually went anywhere.
Nothing on this page is a substitute for an assessment by a clinician who knows your history.
Stimulant use
Methamphetamine and cocaine use alongside opioid treatment is extremely common in British Columbia. There is currently no medication for stimulant use disorder with anything like the evidence base that methadone and Suboxone have for opioids, and it would be dishonest to suggest otherwise.
What does help is structure. Contingency management, which links concrete rewards to verified periods of non use, has the strongest evidence of any approach to stimulant use. Regular contact, sleep repair and treating underlying mental health conditions all move the needle.
Some medications show promise for specific patterns of use, and we will discuss the evidence honestly with you rather than promising more than it supports. What matters most is that stimulant use is not a reason to be turned away from opioid treatment. Being on OAT while still using stimulants is far safer than being on neither.
Alcohol use
Alcohol is the substance most often left out of the conversation, and it is the one that most reliably makes opioid treatment dangerous. Alcohol and methadone both suppress breathing, and together they account for a large share of overdose deaths among people who are otherwise stable in treatment.
There are effective medications for alcohol use disorder, and they are consistently underused. Naltrexone reduces the reward from drinking, though it cannot be combined with opioid agonist treatment. Acamprosate helps maintain abstinence and is compatible with OAT. Both are available in British Columbia.
One warning matters more than the rest. Alcohol withdrawal, unlike opioid withdrawal, can be fatal. If you drink heavily every day, do not stop abruptly on your own. Tell us, and we will arrange a safe withdrawal plan.
Alcohol withdrawal, unlike opioid withdrawal, can be fatal. If you drink heavily every day, do not stop abruptly on your own.
Mental health alongside substance use
Depression, anxiety, post traumatic stress and ADHD appear far more often in people with substance use disorders than in the general population. The old argument about which came first has largely been abandoned, because in practice treating them separately works badly and treating them together works.
We assess mental health as part of your care rather than treating it as someone else problem, and we prescribe for common conditions where that is appropriate. Where you need more than we can provide, we refer, and we follow up on whether the referral actually went anywhere.
Support beyond the prescription
A prescription does not fix housing, income, a criminal matter or the loss of a relationship, and pretending otherwise wastes everyone time. What we can do is connect you to the services that handle those things and stay involved.
- Referral to counselling and structured treatment programmes
- Connection to housing and income assistance workers
- Testing and treatment referral for hepatitis C and HIV
- Take home naloxone and overdose prevention information
- Documentation for court, employers or income assistance where you ask for it
You are not obliged to take any of it. Some people want only the medication, and that is a legitimate way to use this clinic.
What this treatment does well, and what to weigh up
Every option has trade offs. Here are both sides.
What this covers
- Assessment of all substance use, not opioids in isolation
- Medication for alcohol use disorder where appropriate
- Structured support and close follow up for stimulant use
- Concurrent mental health assessment and prescribing
- Referral to counselling, housing and community services
Being straight with you
- No medication yet matches OAT for stimulant use disorder
- Counselling is by referral, since we do not provide therapy in house
- Heavy daily drinking needs a planned withdrawal, never an abrupt stop
- We do not provide inpatient detox or residential treatment directly
- Progress here is usually gradual rather than dramatic
Substance use treatment: your questions answered
These are the questions our physicians are asked most often about this treatment. If yours is not here, call us and ask.
Will I be refused opioid treatment if I am still using other drugs?
No. This is the single most common fear people bring to a first appointment, and it keeps people away for years.
Continued substance use is information about how well your treatment plan is working, not grounds for discharge. It may change practical details, such as how quickly take home doses are offered, because those decisions are about safety. It does not change whether you are welcome here.
Is it safe to drink alcohol while on methadone or Suboxone?
Alcohol with methadone is genuinely dangerous. Both suppress breathing, and the combination is a leading cause of overdose in people who are otherwise doing well in treatment. The risk with Suboxone is lower because of its ceiling effect, but it is not absent.
If you drink, tell us how much, honestly. We would far rather adjust your care around real drinking than plan around a number you thought we wanted to hear.
Can you help me stop drinking?
Yes. Medication for alcohol use disorder is effective and underused. Acamprosate can be combined with opioid agonist treatment. Naltrexone works well for alcohol but cannot be used alongside methadone or Suboxone, so it is an option only in specific circumstances.
If you drink heavily every day, the first step is a safe withdrawal plan rather than medication. Alcohol withdrawal can cause seizures and can be fatal, which is not true of opioid withdrawal. Do not stop suddenly on your own.
Is there a medication for methamphetamine or cocaine use?
Not one with the evidence behind it that methadone and Suboxone have for opioids. Some medications show modest benefit for particular patterns of use, and we will go through what the research actually shows if you want that conversation.
The strongest evidence for stimulant use is behavioural. Contingency management, which provides tangible incentives for verified periods of non use, outperforms everything else currently available. Regular contact, sleep and treating underlying mental health conditions all help meaningfully.
Do you provide counselling at the clinic?
Not in house. We are a medical clinic, and our physicians provide assessment, prescribing and follow up rather than therapy.
What we do is refer, and then check that the referral led somewhere. Many patients combine our medical care with counselling elsewhere, and the two work considerably better together than either does alone.
What if my main problem is benzodiazepines rather than opioids?
Then start with our benzodiazepine support page. Benzodiazepine dependence needs a different approach from opioid dependence, and stopping abruptly is genuinely dangerous.
Many patients need both, since benzodiazepines are increasingly present in the unregulated drug supply. We treat them together rather than asking you to solve one before we address the other.
Will what I tell you be shared with police, my employer or child services?
Your medical record is confidential and protected under British Columbia health privacy law. We do not report drug use to police or to employers.
There are narrow legal exceptions that apply to all health professionals in the province, principally an immediate risk to your life or someone else, or a duty to report a child at risk of harm. These are legal obligations rather than clinic policy, and we will tell you plainly if one applies.
If this is an emergency, call 911. Overdose symptoms, trouble breathing, chest pain, seizures or an immediate mental health crisis need emergency care, not a callback form. In British Columbia you can also reach the Suicide Crisis Helpline at 988 or call 811 for HealthLink BC nurse advice.
Ready to talk about substance use treatment?
No referral needed. Assessment and, where appropriate, treatment the same day.