OPIOIDS
"Data will enable First Nations in telling a story of the
inequities that must also be addressed for First Nations
communities to survive the opioid crisis."
The goal is to inform the development and
evaluation of local interventions.
At the time of the funding announcement,
Carol Hopkins, Thunderbird’s Executive
Director, said that “Data will enable First
Nations in telling a story of the inequities
that must also be addressed for First Nations
communities to survive the opioid crisis.”
There’s no shortage of ideas around preven-
tion, prescribing practices, outreach, educa-
tion, coordination, crisis response, treatment
and wraparound care. That’s on top of efforts
to deal with the diversion from legitimate
prescriptions, and thwart the illicit flow of
substances into the community.
Beyond the specific solutions, focus is on
the model of health. Hopkins has talked
about how action to address the crisis must
be measured. You can track things like access
to therapies, overdoses and child welfare cases
due to addictions. That all matters.
But success rests too on the extent to which
actions create mental wellness among First Na-
tions. That means Indigenous-based outcomes
like hope, belonging, meaning and purpose.
A strength-based approach also respects
the core belief that everyone has inherent
strengths, and that the community is re-
sourceful and capable of solving its problems.
A 2018 session at TOPHC (the Ontario
public health convention) dealt with the First
Nations opioids epidemic in northwestern
Ontario. Francine Pellerin, Health Director
for Matawa First Nations in Thunder Bay,
mentioned the chi kee way meno biimadeseyung
strategy. In Oji-Cree, that’s a back-to-our-roots
idea of walking in a good, healthy life.
Practice patient-centred medicine
While many solutions are unique to First Na-
tions, Dr. Robinson says that in a few respects
opioid addiction there should be viewed as it
would anywhere.
First, see it for what it is. Dr. Robinson says
that society, and the medical community too,
has been slow to recognize that addiction isn’t
a moral problem. It’s a chronic illness. She
hopes family doctors will view this as a disease
they can treat, like diabetes.
“Helping people overcome addictions is the
most rewarding work I’ve ever done. If you
just leave it to the specialists to manage this,
there will be an awful lot of people who can’t
access care.”
Second, hold off on assumptions and be
curious. That’s true for all patient-centred
medicine.
“Consider all of the contextual factors for
your patient,” says Dr. Robinson. “If you work
with one particular culture, learn as much
as you can to be informed about where the
patient is situated. Ultimately, you’re engaging
with the patient as an individual. But you want
the background to have a broader view.”
The kind of mindset that works for opioid
response in First Nations can have broad ap-
plications, suggests Dr. Chase.
“We learned something that would work
all across the province: approach the commu-
nity,” she says. “Decolonize your thinking, to
feel you always know best. Ask how you can
help. Is advocacy needed? The doctor can be
a voice. Start listening, and say to Indigenous
people, ‘How might I support you?’ That’s the
kind of transformation we need.”
MD
ISSUE 3, 2019 DIALOGUE
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