Protective care centres for meth intoxication

Bill 48 was passed on Nov. 5, extending the ability to hold individuals for 72 hours when their level of intoxication prevents them from safely caring for themselves. This change responds to the reality that methamphetamine intoxication, and the resulting psychosis or agitation, can last far longer than the 24-hour limit used for alcohol.

As leaders in the health system, we want to describe the clinical rationale behind this approach and emphasize the importance of evaluating its outcomes. Manitoba is facing a methamphetamine crisis that has changed how hospitals and emergency workers care for people in crisis. Unlike alcohol, meth intoxication lasts longer, is less predictable, and often leaves people unable to keep themselves safe. The new provincial sobering centre will include dedicated spaces for meth intoxication, as well as alcohol-related care, with additional capacity now being built to expand services.

When people are acutely intoxicated, at risk, and unable to make safe decisions, involuntary care is already part of standard medical practice. We do this every day for people experiencing delirium, brain injuries, acute psychosis, or overdose because our duty is to prevent harm. Whether that intervention occurs in hospital or in a sobering centre is based on the needs of the individual at the time.

Recognizing the meth crisis does not mean reducing people’s rights. It means admitting that our current system has gaps in caring for those who are temporarily incapacitated by severe stimulant intoxication.

Manitoba already has an effective system for alcohol intoxication. People who are too intoxicated to care for themselves are taken to a sobering facility where community paramedics assess them and supervise their recovery.

This usually takes only a few hours and rarely needs major medical intervention.

Methamphetamine does not fit into that system. People intoxicated by meth are often taken to emergency departments. But hospitals were never designed to safely contain someone for 24 to 72 hours while the effects of intoxication wear off. Bright lights, noise, and crowds can make agitation worse. Staff rely heavily on sedating medications, and sometimes restraints, not because it’s ideal, but to keep everyone safe.

Protective care centres are secure clinical spaces designed for short-term stabilization of individuals experiencing severe stimulant intoxication. Staffed by clinicians and paramedics, these centres provide continuous observation in quieter, controlled environments. Paramedics already have strong skills in monitoring complex patients. In calmer spaces, they can focus on vital signs and recovery instead of managing constant disruptions. Many patients would likely need less medication simply because the environment itself is less stressful.

Some ask why these patients aren’t simply admitted to mental health units. The answer is that most psychiatric wards are not designed to handle severe stimulant-related agitation. With most units having 20 beds and only one seclusion room, admitting a highly agitated patient can disrupt care for everyone. As a result, people remain in the emergency department — too unwell to leave, but with nowhere else to go.

Others worry about people with opioid dependence being held for several days. Protective care centres are not meant for opioid withdrawal or detox. If opioids are involved, patients will still receive medical assessment and addiction specialist input to start appropriate care.

As Manitoba becomes the first jurisdiction in Canada to allow a longer period of stabilization, evaluation will be crucial.

We must track both the benefits and risks. Benefits may include fewer sedating medications, reduced emergency department crowding, better staff safety, and faster stabilization. Potential harms include additional trauma from involuntary care, avoidance of future care, and missed medical problems.

With the extension of Bill 48, we can mitigate these harms with on-site availability of addiction physicians and psychiatrists to ensure expert clinical oversight. We have developed clear protocols to identify any medical complications that arise and, when necessary, transfer patients to emergency departments for further assessment.

If done right, protective care centres can free up emergency rooms, improve safety, and provide care that truly fits the physiology and needs of stimulant intoxication.

Finally, the above changes will be one piece of a multi-faceted strategy to address substance use crisis, including expansion of affordable housing, addressing infrastructure and capacity issues in health system.

Jitender Sareen and Rob Grierson are medical doctors, and Ogo Chukwujama is a doctor specializing in psychiatry. James Bolton MD, Geoffrey Konrad MD, Shauna Sawich MD, Erin Weldon MD (emergency response services), Paul Ratana MD, Travis Minish MD, Chau Pham MD (emergency medicine), and Ben Fry, chief operating officer, mental health and addictions, Shared Health, contributed to this piece.