OPIOIDS
Dr. Sharon Cirone
for places like North
Caribou Lake to own
the solutions. “There’s
a sense of community
and belonging,” she
says.
The Toronto-based
family physician special-
izes in mental health and
addiction medicine. At
least one week each month, Dr.
Cirone works in northwestern On-
tario First Nation fly-in communities. There,
she provides opioid substitution therapy and
concurrent disorders treatment.
“Keeping people with opioid use disorder
alive is the easy part. The tough part is having
the appropriate supports and community en-
vironment to address the underlying issues,”
says Dr. Cirone.
Intergenerational trauma
Dr. Cirone says one can’t separate substance
use disorder from some of the legacies in these
communities – the individual, family and
community harm that has occurred as a result
of colonization.
“Many people have psychological wounds
and scars, and have been affected by intergen-
erational trauma,” she says. “We know that
early life trauma and adverse events contrib-
ute to substance dependence.”
Consider the impacts over time of loss of
language and culture, assimilation policies
(like residential schools), weakened connec-
tions to the land, high school dropout rates,
lack of employment, inadequate housing,
food insecurity, and reduced access to health-
care services. The effect on identity and health
– physical, emotional, mental and spiritual –
can be enormous. Everything is related.
“For many Canadians, ‘intergeneration
trauma’ and ‘truth and reconciliation’ are just
22
DIALOGUE ISSUE 3, 2019
phrases. For me, I see faces,” says Dr. Clau-
dette Chase.
She helped pioneer a community-based ad-
diction treatment program in a First Nation
community in northwestern Ontario. Out of
a population of 1,400 people, 200 are in the
program. Dr. Chase doesn’t like to name the
community out of concern for labelling it.
Institutional and nationwide racism still
loom large, she says. The effects linger. She
mentions residential schools, where children
were separated from their families and taken
somewhere with no affection. When they re-
turned home, they often developed a detach-
ment disorder. Survivors who were abused
sometimes became abusers. Trauma has a long
tail.
“People told me that when they tried Oxy
it was the first time in their lives they felt
relaxed. It was very seductive,” says Dr. Chase,
who serves on the board of the Canadian
Society of Addiction Medicine.
The best model of health
It’s vital to understand those stories. Dr.
Cirone advocates a trauma-informed ap-
proach when dealing with substance abuse
disorder. The addiction is a symptom of a
larger problem. Until you address the under-
lying causes, no solution can be fully effective.
Dr. Robinson adds that some results are
promising. She sees a higher retention rate to
treatment than in typical urban-based pro-
grams. But consider the environment. “The
challenge is the relapse, which is true regard-
less,” she says, “but especially when there’s this
common experience, with so many people
having these struggles.”
In July 2019, the Public Health Agency of
Canada funded the Thunderbird Partnership
Foundation to conduct separate adult and
youth surveys. They’ll look at opioid use and
its impacts on First Nations communities.