Opioid addiction: a symptom of trauma

Nurse Practitioner Mae Katt.

Suboxone program helping First Nations overcome addiction

“The drug just took over.”

That simple statement from Mae Katt, a nurse practitioner helping to break the cycle of addictions within several First Nations, sums up the result of opioid use – predominantly OxyContin – in many communities. But the socio-economic, cultural and historic causes of widespread addictions in First Nations across Northern Ontario cannot be summed up so concisely.

These challenges were brought to the forefront during a screening of a documentary by Candida Paltiel called “In This Heaven” (originally broadcast in July as “Rings of Fire”) and subsequent panel discussion by health care experts, industry, and community leaders. The event took place on October 8 at Lakehead University, coincidentally during the inquest into the deaths of seven First Nation teens in Thunder Bay over 10 years – another facet of the challenges facing First Nations.

Up to 80 per cent of the people living in some communities are addicted to opioids. But it is perhaps a symptom of wider, systemic problems. Poverty, unemployment and mental health issues including depression and the ongoing suicide crisis are all factors. At its root is historic trauma.

“People think that people just like to do drugs and drink, and that is so wrong,” said Dr. Cynthia Wesley-Esquimaux, vice-provost of Aboriginal Initiatives at Lakehead and the evening’s panel moderator. “There is this historic trauma question. There are things that have been happening over the course of time that have put people into these positions where they want to shut it all down.”

Lost culture

Historic trauma includes the residential school system and other effects of colonialism. Children torn away from their families lost their culture, language, community and family interactions.

“One of the things about intergenerational trauma is that it can be profoundly disrupting,” said Dr. Christopher Mushquash, Canada Research Chair in Indigenous Mental Health and Addiction at Lakehead. “When we start talking about trauma across generations, we’re only now becoming in the research community aware of how profound these changes can be.”

Problems with addiction can be a result. “In This Heaven” follows Mae Katt while she sees community members from Marten Falls and Neskantaga at various stages of their addiction recovery, thanks to a newly available medication Suboxone.

Methadone is a frontline medication used to help people addicted to opioids get off the drug. However, due to regulations controlling its use, methadone clinics in smaller communities such as First Nations are not a practical option. Suboxone (a brand name of buprenorphine), on the other hand, can be administered by a nurse practitioner. Like methadone, Suboxone is an opioid replacement therapy that may achieve similar success rates with a lower risk of overdose. The biggest advantage is that those struggling with opioid addiction can get treatment (the drug plus counselling and support) right in their home community.

“They don’t have to leave and come to Thunder Bay,” Katt said. “Now that we have a new medication in Canada (Suboxone), we can actually offer treatment in a doctor’s office or a community.”

However, the program is expensive. “The costs are well beyond the means of the communities who most need it,” said Paltiel in the documentary. The Ring of Fire development could hold the answer, though some First Nations see it as a double-edged sword. “Mining threatens the land, but it might also be an opportunity to lift the area out of endemic poverty and isolation.”

Resource companies have already started to help with Noront Resources providing funds for the initial mobile Suboxone program.

“Mining is a piece of the puzzle. Resource development is a piece of the puzzle,” said Glenn Nolan, vice-president of Aboriginal affairs for Noront and past chief of Missanabie Cree First Nation, during the panel discussion. “It’s about what is right… The Ring of Fire is a multi-generational opportunity to change the status of their communities today so that in the future, they’re going to be in control of these companies that will be working up there.”

1,500 treated

Katt herself regularly sees about 200 clients at any one time in five First Nations. The model of care was developed with the help of the Centre for Addiction and Mental Health (CAMH), adapted to communities’ needs. It’s proven successful – Katt said the program has treated 1,500 people so far. But, with an estimated 9,000 people in First Nations struggling with addictions when the program began in 2011, there is still a way to go and funding is always an issue. New problems are arising within the communities.

“Drug dealers are very smart. Once we start treating opiates, they start bringing in other drugs. We’re starting to see things like crack cocaine,” Katt said. “We’re trying to help clients be a little more selective about what they’re doing with their own lives. They are making choices. They are saying no to drugs.”

WATCH: https://www.youtube.com/watch?v=lgFJm45ZVJQ