Remote reserves say Ottawa’s response to OxyContin crisis inadequate

While the world was distracted by Attawapiskat, another desperate cry for help was getting little notice in remote northern Ontario, where addiction to the prescription drug OxyContin is devastating reserves.

Although the federal government is well aware of the spiralling drug crisis in the North — it provides health care on reserves — First Nations officials from northwestern Ontario say they can’t understand why, at a time when the government is being accused of ignoring the plight of people on reserves like Attawapiskat, it is not only providing inadequate resources to cope with the drug problem, but is throwing roadblocks in the way of treatment that could be a low-cost, effective solution.

Tiny, fly-in reserves in northwestern Ontario have become Ground Zero for addiction to the synthetic opioid OxyContin. The drug is a growing public health problem across Canada, but the scale of abuse and addiction on northern Ontario reserves is like nowhere else, according to a growing body of health research. These communities do not have the extreme housing situation of Attawapiskat, but by southern Canadian standards, their housing is substandard, in some cases much worse, and they face numerous other challenges. The drug crisis is a tipping point in many communities.

“In northern Ontario, narcotic abuse (in particular oxycodone in long-acting OxyContin or short-acting Percocet) has become an increasing problem” says a study recently published in the journal Canadian Family Physician. “Remote First Nations communities with high rates of unemployment, poverty and overcrowding bear the additional social and economic burden of narcotic abuse and addiction, with profound narcotic abuse in some of these communities.”

The pills arrive sewn into baby blankets, hidden behind false bottoms of pop cans and mixed in with meat, say First Nation health officials. In the summer, when the only way in is by plane, prices go up. But once winter roads are built, the market is wide open, despite treacherous 12-hour-plus drives through northern wilderness to deliver the drugs. The addictions have created an economy that leaders say is killing the communities.

In places like Eabametoong First Nation, sometimes known as Fort Hope, 350 kilometres north of Thunder Bay, as many as 75 per cent of adults in the community of 1,200 are addicted to the prescription painkillers, including pregnant women and, more worrisome, their newborn babies. It is a similar story at many of the small reserve communities throughout northern Ontario.

If Attawapiskat is Haiti at 40 below zero, as it has been called, Fort Hope is closer to the Afghanistan of the frozen North — with drug addiction hollowing out an already struggling community.

The drugs sell for as much as $600 for an 80-mg pill, which some addicts swallow and others inject. The signs of mass addiction are visible everywhere, from increased crime (which has nearly doubled in the region since 2005) and suicides, to brimming shelves at grocery stores — because money is being used instead to buy drugs — to eerily empty streets as growing numbers of residents spend their days in a cycle of drug addiction, sleep and withdrawal. Grandparents have taken over child-rearing duties from addicted children.

And when addicts like Doris Slipperjack — who told her story in the moving documentary The Life You Want: A Young Woman’s Struggle Through Addictions — want to quit, things get really difficult. Slipperjack, a young mother of three from Fort Hope, waited months to get drug treatment, finally leaving her young children behind to move to Kenora, Ont., where there was a methadone clinic.

She was so desperate for the treatment she was prepared to put her children in foster care. She has become an outspoken advocate for the need for better treatment and support.

“It’s mind-boggling,” said Mike Metatawabin, Deputy Grand Chief of Nishnawbe Aski Nation, the political organization that represents 49 First Nations communities in northwestern Ontario. “They thought alcohol was bad, but OxyContin is the worst thing that has hit these communities.”

Three years ago, the situation led the Nishnawbe Aski Nation, known as NAN, to declare a state of emergency.

Last year, the community of Fort Hope also declared a state of emergency after a series of assaults, arsons and three murders. Sharon Johnston, the wife of Gov.-Gen. David Johnston and Ruth Ann Onley, wife of Ontario’s Lt-Gov. David Onley were reduced to tears when they visited Fort Hope in an attempt to draw attention to the situation last year.

The visit briefly shone a light on the community, but First Nations leaders say they aren’t getting enough government support to cope with the public health crisis.

Recently, leaders in the area said they will launch a human rights complaint against both the federal and provincial governments for inadequate responses to the situation which, they say, demands more nurses, physicians, mental health and addictions workers and community-based training for treatment, security and counselling. They also plan to take their case for more help to the United Nations.

“No is not on when it comes to treatment,” says nurse-practitioner Mae Kitts, who oversees drug treatment programs for NAN in some of the communities. “You wouldn’t withhold treatment for cancer. That’s ridiculous.”

Health Canada cites security, safety and the need for “sustainable, comprehensive community plans that address adequate capacity and training of staff before these community-driven programs are implemented.” It also says its Non-Insured Health Benefits Program has introduced limits on daily doses of OxyContin for chronic pain and limits on the number of tablets that can be dispensed at one time.

Kitts and others say the need is desperate. The Nishnawbe Aski First Nation and chiefs from the communities in the region have waged a battle with both the federal and provincial governments to get help dealing with the crisis, engaging academics and addictions experts to help find solutions. A timeline put together by NAN tells a tale of delayed response from both the federal and provincial governments, requests for meetings to discuss solutions to the crisis and, notably, a series of cancelled visits to northern reserves by federal Health Minister Leona Aglukkaq.

Aglukkaq, says Kitts, needs to come and see the situation for herself. “It’s her responsibility and duty.”

While Metatawabin said there recently has been some headway with the federal health department and the promise of co-operation in the future, lack of support from officials is a significant barrier. The First Nations have set up their own community treatment programs, despite what they say is resistance from the federal government.

“No one has ever come and said, ‘We can help you with this program,’” said Kitts. “There is real resistance within the government.”

Health Canada, in email responses to written questions from the Ottawa Citizen, said it is working with the leadership in Nishnawbe Aski Nation to develop a long-term comprehensive strategy to tackle prescription drug abuse. “Health Canada shares the concern that opioid reduction strategies are a priority for many communities, but continues to stress the need to have in place sustainable, comprehensive community plans that address adequate capacity and training of staff before these community-driven programs are implemented.”

Health Canada also said it is committed to providing funding where additional nurses are needed in the Sioux Lookout region.

Getting people off OxyContin has become a major focus of the Nishnawbe Aski First Nation. It has taken the lead on creating pilot programs that are helping people get off the drugs in their own communities using the drug Suboxone, which is distributed in pill form and used as an alternative to methadone. The NAN-run programs have pioneered the use of Suboxone detox treatment in communities. Using Suboxone, they say, is both cheaper and more successful than the alternative — flying residents, and their families, in some cases, out to communities such as Thunder Bay or Sioux Lookout where there are methadone programs. Not only is the wait long — months in most cases — for methadone treatment, but the cost to treat everyone from remote communities would be “outrageous,” according to Kitts.

Methadone, which is a restricted drug, can only be dispensed at special clinics. Suboxone doesn’t have the same restrictions, which means it can be distributed in remote communities.

NAN has set up drug detox research projects in five communities, paid for with money from band council funds and, in one case, from a nearby mining company. But the federal government has told its nurses not to participate in the program. Just last month, Health Canada issued a directive to its nurses in the Sioux Lookout Zone, which includes Fort Hope and other mostly fly-in reserves in northwestern Ontario, that they can no longer take part in detox programs on the reserve — in part because it “may impact the length of time for other community members in obtaining and appointment for nursing services.”

In other words, nurses are too busy.

In a letter sent to all First Nations, Inuit and Aboriginal Health nurses in the region, a Health Canada official said the measure is an interim one “until the region can develop policy options to address the role.”

To make matters worse, there is a serious shortage of nurses throughout the North, something the federal government says it is addressing. In northwestern Ontario it is estimated that there are 40 per cent fewer nurses than needed. The ones on the job are extremely busy.

But First Nations officials say it makes no sense for Health Canada to tell their nurses to step away from the drug abuse crisis by not participating in the detox programs, given that OxyContin addiction is the most urgent public health issue.

Health Canada says Suboxone has been recommended for people with life-threatening reactions to methadone, which is the criteria it uses under its Non-Insured Health Benefits program. Exceptions, it says, will be considered individually. This effectively rules out community drug treatment on remote reserves where Suboxone is used. But Health Canada says it is supporting a number of community-based projects where prescription drug abuse is a concern and will assess them in the new year “to learn from each other as promising practices emerge.”

In the meantime, NAN continues to run Suboxone treatment programs. It is currently putting addicted students at a First Nations high school in Thunder Bay, most of whom come from remote reserves, through detoxification programs while they attend school. The addiction rate among students at the school is 42 per cent; some of them arrived from their reserves already hooked on OxyContin. So far, 30 students have been through the detox program.

Kitts says students at the school are the “cream of the crop” from remote First Nations communities and will have promising futures if they can get out of the grip of drug addiction.

“I am proud to be on Suboxone, I don’t know what I would do without it,” a Grade 12 student in the program said recently. Since starting the detox program in October, she said, her grades have improved, she is about to graduate from high school and is thinking about the future. “I didn’t want to lie to my parents any more. I didn’t want to be sick anymore. I feel good now.”

“I like to think it is saving our kids. We are giving them their lives back,” said Colleen McCreery, a nurse at Thunder Bay’s Dennis Franklin Cromarty High School, where the program has run as a pilot project since last February. “Oxy gets such a hold on them that it runs their life.”

NAN also runs detox programs in the community of Kingfisher Lake, whose residents were evacuated to Ottawa after a forest fire last summer, as well as Marten Falls, Webequie, Kasabonika Lake and Fort Hope, all reserves hundreds of kilometres north of Thunder Bay.

So far, 153 people have been through the detox programs. That leaves thousands who need it. With more support, says Kitts, “we could treat the masses,” and have a better co-ordinated approach to the problem.

In some ways, the response to the addiction epidemic is a good news story. NAN has made it a top priority and is developing strategies that will help communities with similar problems in other parts of the country. The programs being undertaken and researched at reserves in northwestern Ontario could act as models for other First Nations communities. And, while band and First Nations leaders acknowledge they have to take responsibility for the crisis, they just wish they had a little more support.

“I don’t think we have people breaking down the doors scrambling to help northwestern Ontario. If help is going to come, we’ve got to do it ourselves,” said Kitts.

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Posted by on Jan 6 2012. Filed under Oxycontin. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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