Lack of universal oral thiamine coverage a missed opportunity for alcohol harm reduction in BC

Thiamine supplementation is a recommended best practice in alcohol withdrawal management, outpatient care, and harm reduction for people who are diagnosed with severe alcohol use disorder, a population that includes many managed alcohol program (MAP) service users.[1] In spite of thiamine’s efficacy as treatment prophylaxis for many acute and chronic alcohol-related harms, including malnourishment, alcohol-related liver disease, Wernicke encephalopathy, and Korsakoff syndrome, gaps in access to affordable vitamin B1 are stark for structurally marginalized illicit drinkers.[2-4] The Eastside Illicit Drinkers Group for Education, a collective of current MAP clients, former illicit drinkers, and allied community organizers working to reduce alcohol-related harm in Vancouver’s Downtown Eastside, urges policy change to improve access to oral thiamine throughout BC. The inclusion of oral thiamine on the BC PharmaCare Plan C formulary is a logical and attainable first step toward this goal.

In BC, intramuscular thiamine HCl injections (DIN 02193221) have been covered by numerous PharmaCare plans since February 2018. In contrast, prophylactic oral thiamine HCl 100 mg (DIN 00816078), which is anecdotally preferred by MAP service users in Vancouver and recommended by the BC Centre on Substance Use 2023 Canadian clinical guideline for high-risk drinking and alcohol use disorder, is exclusively covered by PharmaCare Plan W.[1,5] Without broader coverage for over-the-counter thiamine supplements, a significant segment of the high-risk drinking population is unable to regularly access oral thiamine from health care providers or MAP services, choosing instead to pay out of pocket on low incomes.

While holistic Plan W coverage will always remain a crucial part of care for eligible MAP clients who are Indigenous, the potential for oral thiamine to reduce health harms and associated costs for drinkers not presently covered by First Nations Health Benefits will remain unrealized in the absence of universal coverage under BC PharmaCare.

The Eastside Illicit Drinkers Group for Education routinely advocates for the benefits of thiamine supplementation to our membership. Steering committee members regularly review the scholarly literature on vitamin B1 supplementation for alcohol use disorder clients, create resources to support our drinkers,[6] lead educational meetings with peers, and share our own experiences of benefiting from thiamine supplementation. Our sweatshirt sleeves proudly read “Take your thiamine.” While we will continue to advocate for (and, in many cases, provide) oral thiamine to our MAP and non-MAP client membership as needed and at their discretion, we feel that the broader inclusion of oral thiamine on BC’s provincial formulary is necessary to realize the clinical benefits of this work at a larger scale.
—Eastside Illicit Drinkers Group for Education
—Aaron Bailey, MSc
Program Coordinator, Vancouver Area Network of Drug Users
—George Sedore
Steering Committee Member and Community Organizer, Eastside Illicit Drinkers Group for Education

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References

1.    BC Centre on Substance Use. Canadian clinical guideline: High-risk drinking and alcohol use disorder. Accessed 24 May 2024. www.bccsu.ca/alcohol-use-disorder/canadian.

2.    Pruckner N, Baumgartner J, Hinterbuchinger B, et al. Thiamine substitution in alcohol use disorder: A narrative review of medical guidelines. Eur Addict Res 2019;25:103-110.

3.    Martin PR, Singleton CK, Hiller-Sturmhöfel S. The role of thiamine deficiency in alcoholic brain disease. Alcohol Res Health 2003;27:134-142.

4.    Chou W-P, Chang Y-H, Lin H-C, et al. Thiamine for preventing dementia development among patients with alcohol use disorder: A nationwide population-based cohort study. Clin Nutr 2019;38:1269-1273.

5.    Government of BC. BC PharmaCare formulary search. Accessed 24 May 2024. https://pharmacareformularysearch.gov.bc.ca/Search.xhtml.

6.    Eastside Illicit Drinkers Group for Education, Vancouver Area Network of Drug Users. Nutrition and alcohol harm reduction. Accessed 24 May 2024. https://vandu.org/wp-content/uploads/2024/05/Nutrition-5.pdf.