Substance use-related health issues remain a public health and health service crisis in Canada, particularly in Alberta. For the first time in four decades, Canada’s life expectancy has stopped increasing. Turning the tide on this issue requires the concerted, evidence-based and compassionate efforts of all healthcare providers.

When a person with a substance use disorder presents to hospital, it represents a critical opportunity. The symptoms of a substance use disorder do not resolve upon admission to hospital, and substance use will often continue during admission. This use can pose challenges for patients, hospital clinical teams and employees. While patients admitted to acute care may use a variety of legal and illegal substances, this Guidance Document focuses specifically on approaches and interventions for alcohol, stimulants and opioids—commonly used substances that are challenging for patients and staff.

The Guidance Document on the Management of Substance Use in Acute Care was jointly drafted by 28 authors and an Advisory Committee comprised of 26 expert stakeholders with the mandate to create an Alberta-based resource to support effective acute care for hospital inpatients who use alcohol, opioids and methamphetamines. The Advisory Committee included people with lived/living experience (PWLLE), front-line care providers, addiction specialists, a public health specialist, a medical ethicist, health administrators and medical, nursing and pharmacy regulatory colleges. The work of the committee was jointly funded by the College of Physicians and Surgeons of Alberta and Population, Public, and Indigenous Health, Alberta Health Services. The Guidance Document development process included an environmental scan and literature review with support from the Canadian Agency for Drugs and Technology in Health (CADTH). The initial draft of the document was circulated to 36 individual and organizational stakeholders across Canada for feedback.

To the best of our knowledge, this is the first document of its kind in Canada. We hope it is useful to you in the care you provide for your patients.

Debra Allen: MN RN; Chief Professional Practice Officer, College and Association of Registered Nurses of Alberta (CARNA)

Jennifer Brouwer: RN, MN; Program Manager, Inner City Health and Wellness Program, and Professional Practice Office, Royal Alexandra Hospital

Kathryn Dong: MD, MSc, FRCP, DABAM; Director, Inner City Health and Wellness Program & ARCH Team, Royal Alexandra Hospital; Associate Clinical Professor, Department of Emergency Medicine, University of Alberta

Dianne Dyer: BN, MN; Provincial Initiatives Consultant, Provincial Addiction and Mental Health, Alberta Health Services

Nicholas Etches: MD, FRCPC; Lead Medical Officer of Health for Provincial Harm Reduction, Alberta Health Services; Clinical Assistant Professor, Community Health Sciences, University of Calgary

Laura Evans: MD, CCFP, D.ABAM, C.ISAM, C.CSAM; Medical Lead, Addiction Inpatient Consultation Service—Foothills Hospital; Co-Medical Lead, Renfrew Recovery and Detox; Opioid Dependency Program, Calgary; ARCH-PLC Staff Physician; CUPS Medical Centre; Clinical Assistant Professor, Department of Family Medicine, University of Calgary

Helgi Eyford: Clinical Ethicist, Calgary Zone, Alberta Health Services

Fizza Gilani: RPh, BSc(Pharm); Program Manager Prescribing & Analytics, College of Physicians and Surgeons of Alberta

Harbir Singh Gill: MD CCFP C.ISAM C.CSAM; Physician and Medical Director, Northeast Addiction and Mental Health (NAM) Centre for Holistic Recovery; Addiction Consultant, Addiction Recovery and Community Health (ARCH) Team, Peter Lougheed Centre, Alberta Health Services

Sara Gill: Educator, Harm Reduction Services Team, Alberta Health Services

Robert Gurney: Peer Support Worker, Inner City Health and Wellness Program & ARCH Team, Royal Alexandra Hospital

Lovneet Hayer: MD, FRCPC, BSc.; Psychiatrist, Addiction Services Edmonton; Staff Physician, Addiction Recovery and Community Health (ARCH), Royal Alexandra Hospital; Staff Physician, Opioid Dependency Program and Edmonton iOAT Program; Clinical Lecturer, Department of Psychiatry, University of Alberta

Rita Henderson: Assistant Professor and Models of Care Scientist, Department of Family Medicine and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary

Elaine Hyshka: Assistant Professor, School of Public Health, University of Alberta; Scientific Director, Inner City Health and Wellness Program, Royal Alexandra Hospital

Michael Lee: Registered Nurse, Nurse Practitioner, Inner City Health and Wellness – ARCH, Royal Alexandra Hospital

Esther Leung: Social Worker, Inner City Health and Wellness and ARCH, Royal Alexandra Hospital

Tammy McCorkell: Executive Director, Alberta Addicts Who Educate and Advocate Responsibly (AAWEAR)

Karine Meador: MD, CCFP(AM), DABAM; Assistant Director, Inner City Health and Wellness Program & Addiction Recovery and Community Health (ARCH) Team, Royal Alexandra Hospital

Heather Morris: RN; Research Trainee, Inner City Health and Wellness Program, Royal Alexandra Hospital and School of Public Health, University of Alberta

Daniel O’Brien: Research Trainee, Inner City Health and Wellness Program, Royal Alexandra Hospital and School of Public Health, University of Alberta

Marni Panas: BHAdmn, CCIP; Program Manager, Diversity and Inclusion, Alberta Health Services

Janice Pyne: MN; Nurse Practitioner, Inner City Health and Wellness Program & ARCH Team, Royal Alexandra Hospital

Jean Repchuk: Nurse Practitioner, YESS Armoury Youth Medical Clinic, Edmonton Southside Primary Care Network; Nurse Practitioner, ARCH, Royal Alexandra Hospital

Ginetta Salvalaggio: Associate Professor, Department of Family Medicine, University of Alberta; Associate Scientific Director, Inner City Health and Wellness Program, Royal Alexandra Hospital

Corinne Sawarin: Addictions Counsellor, Inner City Health and Wellness and ARCH, Royal Alexandra Hospital

Elizabeth Taylor: Director of Regulatory Services, College of Registered Psychiatric Nurses of Alberta

Tammy Troute-Wood: RN, MN; Sexual and Reproductive Health Specialist, Alberta Health Services, Calgary Zone

Jeanne Weis: Executive Officer, Professional Practice, Professional Development, Policy and Research, College of Licensed Practical Nurses of Alberta (CLPNA)

Debra Allen: MN RN; Chief Professional Practice Officer, College and Association of Registered Nurses of Alberta (CARNA)

Angela Baird: RN, BN, MBA

Don Baker: Alberta Addicts Who Educate and Advocate Responsibly (AAWEAR)

Kathryn Dong: MD, MSc, FRCP, DABAM; Director, Inner City Health and Wellness Program & ARCH Team, Royal Alexandra Hospital; Associate Clinical Professor, Department of Emergency Medicine, University of Alberta

Dianne Dyer: BN, MN; Provincial Initiatives Consultant, Provincial Addiction and Mental Health, Alberta Health Services

Nicholas Etches, Committee Co-Chair: MD, FRCPC; Lead Medical Officer of Health for Provincial Harm Reduction, Alberta Health Services; Clinical Assistant Professor, Community Health Sciences, University of Calgary

Laura Evans: MD, CCFP, D.ABAM, C.ISAM, C.CSAM; Medical Lead, Addiction Inpatient Consultation Service—Foothills Hospital; Co-Medical Lead, Renfrew Recovery and Detox; Opioid Dependency Program, Calgary; ARCH-PLC Staff Physician; CUPS Medical Centre; Clinical Assistant Professor, Department of Family Medicine, University of Calgary

Helgi Eyford: Clinical Ethicist, Calgary Zone, Alberta Health Services

Gabriel Fabreau: MD, MPH, FRCPC; Assistant Professor, General Internal Medicine, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary

Jennifer Fisk: Advisory Committee Coordinator

Fizza Gilani: RPh, BSc(Pharm); Program Manager Prescribing & Analytics, College of Physicians and Surgeons of Alberta

Harbir Singh Gill: MD CCFP C.ISAM C.CSAM; Physician and Medical Director, Northeast Addiction and Mental Health (NAM) Centre for Holistic Recovery; Addiction Consultant, Addiction Recovery and Community Health (ARCH) Team, Peter Lougheed Centre, Alberta Health Services

Owen Heisler: MD, MBA, FRCS(C); Chief Medical Officer, Covenant Health

Rita Henderson: Assistant Professor and Models of Care Scientist, Department of Family Medicine and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary

Elaine Hyshka: Assistant Professor, School of Public Health, University of Alberta; Scientific Director, Inner City Health and Wellness Program, Royal Alexandra Hospital

Karen Mazurek, Committee Co-Chair: MD, CCFP; Deputy Registrar, College of Physicians and Surgeons of Alberta

Tammy McCorkell: BCC, CPHR, CVA; Executive Director, Alberta Addicts Who Educate and Advocate Responsibly (AAWEAR)

Karine Meador: MD, CCFP(AM), DABAM; Assistant Director, Inner City Health and Wellness Program & Addiction Recovery and Community Health (ARCH) Team, Royal Alexandra Hospital

Rita Notarandrea: CEO, Canadian Centre on Substance Use and Addiction

Monty Stanowich: BSc Pharm; Compliance Officer, Alberta College of Pharmacy

Elizabeth Taylor: Director of Regulatory Services, College of Registered Psychiatric Nurses of Alberta

Michael Trew: MD, FRCPC; Medical Lead, Addiction & Mental Health Special Projects, Knowledge Lead – Addiction & Mental Health, CKCM, Alberta Health Services

Sarah Weeks: MD, FRCPC; Director of Specialist & Inter Professional Education, CME, Associate Clinical Professor, Cumming School of Medicine, University of Calgary

Jeanne Weis: Executive Officer, Professional Practice, Professional Development, Policy and Research, College of Licensed Practical Nurses of Alberta (CLPNA)

Monica Wickland-Weller: MD, Senior Medical Advisor, College of Physicians and Surgeons of Alberta

Amy Woroniuk: RN, BN, MN; Director, Harm Reduction, Communicable Disease Control, Population, Public & Indigenous Health, Alberta Health Services