Dialogue Volume 15, Issue 3 2019 - Page 21

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 21