Opioid-Agonist Therapy (OAT) Treatment Protocols/Standards/Strategies for Community-Based and Residential Treatment Centres Who Serve First Nations Clients Who Misuse Opioids

PI: Carol Hopkins (Thunderbird Partnership Foundation, ON)

Leadership Group: Amy Bombay (Dalhousie University, NS); Chris Mushquash (Lakehead University, ON); Colleen Dell (University of Saskatchewan, SK); Julie Bull (CAMH, ON); Lindsey Farrell (University of BC, BC); Renee Linklater (CAMH, ON)

 Opioid misuse has become a public health concern in Canada and has emerged as a critical issue for First Nation peoples. As of 2017, Canada has the second highest population of opioid users in the world. For First Nation peoples, opioid misuse and other wellness challenges are a direct result of the lasting impacts of the attempted destruction of cultures, language, connection to land, and family (colonization); and, the trauma that has been facilitated through institutions of colonization such as the Indian Act, reserve system, Indian Agents, Residential Schools, and Child Welfare, that are passed down from grandparents to parents and to youth (intergenerational trauma). These factors combined with health and wellness access and availability barriers have the potential to put First Nation peoples at a greater risk than the general Canadian population for opioid misuse.

However, reconnecting with First Nation cultures has been proven to be a facilitator in the recovery from addictions (such as opioids) and improves overall wellness as measured through the balance of “ hope for their future and those of their families that is grounded in a sense of identity, unique Indigenous values, and having a belief in spirit; a sense of belonging and connectedness within their families, to community, and to culture; and finally a sense of meaning and an understanding of how their lives and those of their families and communities are part of creation and a rich history, and purpose in their daily lives whether it is through giving back to in their family/community, through education, employment, care-giving activities, or cultural ways of being and doing”.

From limited data using the Thunderbird Partnership Foundation’s (TPF) First Nations Opioid Survey, opioid misuse is becoming more complex in Indigenous communities and even more so with the pending legalization of recreational cannabis in Canada, a growing population of youth with little connection to their cultural identity or worldview and emerging, complex, concurrent mental health disorders and transmission of intergenerational trauma, and the influx of more harmful drugs, for example, injection drug use is reported as the first entry into drug use for some youth. There is a growing focus on implementing First Nations Community governed, harm reduction strategies for opioid misuse within a community development approach, as opposed to abstinence/prohibition only approaches. What is not well known or documented about these programs and can be explored through this project, are the following:

  • Who are the workforce and what resources are required to support such;
  • Who are the partners who support OAT – including addictions specialists and Elders / cultural practitioners, and how do they practice OAT in a First Nations environment;
  • What are the knowledge and skills needed to support OAT in a First Nations environment;
  • What are the additional cultural and psychological supports needed to address intergenerational trauma and at what point in treatment is this most effective;
  • What are the cultural protocols for supporting OAT
  • What are the indicators used to measure outcomes of OAT