OPIOIDS
KI has a population of about 1,700 (960
on-reserve), and Cutfeet says its suboxone
program now has about 135 patients. Given
his own recovery, “I try to remain hopeful,”
he says. But he knows that in battling opi-
oid misuse and addiction, communities like
KI face challenges. How can doctors rise to
them?
As the use of opioids has increased in On-
tario, the province’s 133 First Nations com-
munities have been disproportionally affected.
A report for the Chiefs of Ontario (by the
Institute of Clinical Evaluative Sciences)
found that rates of prescribing opioids, doses
dispensed and opioid-related hospitaliza-
tions are all higher in First Nations people
compared to the general population. The rate
of opioid-related deaths is also significantly
higher, nearly four times as much. The report
called this a public health crisis for First Na-
tions communities.
In responding to this crisis, First Nations
communities are dealing with a host of com-
plex issues: funding, remote location, coordi-
nation of care, training, treatment program
design, prescribing practices and, not least,
root causes.
Dr. Anne Robinson, a family physician with
added competency in addictions, has worked
in the Sioux Lookout Regional Physicians
Services for almost her entire career.
She says that, despite the prevalence of
opioid addiction, First Nations communities
have real capacity to overcome the obstacles.
And some circumstances that might appear to
be negative can, in fact, have positive conse-
quences.
For instance, in a tiny and tight-knit com-
munity it’s harder to have anonymity. “That
would be intolerable in a larger centre,” she
says. “Everyone knows who’s on addiction
treatment. For an outsider, that seems like
a major disadvantage. But there’s also some
strength to the community aspect,” she said.
“The community doesn’t see this as an
individual problem but as a community prob-
lem,” Dr. Robinson continues. “They come
together as a community to figure out what to
do. Because they know these people beyond
their addiction. They don’t just see them as
junkies. They see that by supporting them
and their treatment, that’s beneficial to the
community too. The community is invested
in this. With the right resources, they can
come up with wonderful community-based
approaches.”
Culturally-appropriate treatment
Thunderbird Partnership Foundation, the
national voice advocating for First Nations
culturally-based addictions services, points
to a success at the North Caribou Lake First
Nation. They developed a treatment program
that combined buprenorphine substitution
therapy with intensive and culturally-appro-
priate counseling.
Patients got treatment in their home com-
munity, without having to travel to an outside
clinic. Along with the positive interventions
for the patients, the community as a whole
benefited. The community clinic became
more of a primary care centre, less of a
trauma centre. Attendance at community
events and sales at the general store were up.
Meanwhile, drug-related violence fell. One
year later, criminal charges were down 61%,
child protection cases had dropped 58%, and
school attendance was up 33%.
As the Thunderbird Partnership Founda-
tion stated, the whole community participates
in and backs the program, which is deeply
focused on helping patients return to their
community activities and responsibilities.
The treatment program was highlighted
in Canadian Family Physician. One of the
authors, Dr. Sharon Cirone, says it’s vital
ISSUE 3, 2019 DIALOGUE
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