Ending Canada’s opioid overdose crisis will likely require much more than sophisticated drug therapies. In fact, it might mean following the lead of First Nations health-care providers and transforming how we think about and deliver medical services.
First Nations people are dying of opioid overdoses at three times the rate of the general population. Hidden in that data are Canada’s most-neglected victims — Indigenous women.
Unlike in the general population where men comprise 80 per cent of the victims, Indigenous women are as likely to overdose or die as their brothers, fathers, husbands and sons.
They are eight times more likely to overdose than other women, and five times more likely to die from an overdose.
It’s not really surprising, says Dr. Evan Adams, the First Nations Health Authority’s chief medical health officer. The terrible numbers track other devastating indicators of how their health and longevity diverge from those of other Canadians.
“A lot of First Nations women who have substance-use disorders are exploited women. They are women who are victimized by the sex trade. They’re victimized by their partners,” said Adams, who worked for five years in Vancouver’s notorious Downtown Eastside, the epicentre of Canada’s opioid crisis.
What the opioid crisis highlights for him is the endemic problem of the western medical model, where people go passively to doctors’ offices and say, “Heal me.”
“Our (First Nations) model is that the doctor gives you a chance to get better. But, you make yourself better,” he said. “It’s your family that does most of the work of helping you get better, not that doctor who you visit for 15 minutes every week, if you’re lucky.”
Unlike in the western model, healing and wellness in the traditional Indigenous way involve mind, body and spirit. For First Nations men and women to achieve wellness, Adams said they require much more than medicine.
“They need healers who can do ceremony. Maybe they need love. They need justice.
“How can a woman recover from opioid use disorder when you won’t let her see her children? It’s disgusting,” he said.
The day Adams and I met, the FNHA offices were being “swept” by a group of elders carrying cedar boughs and candles using traditional ceremonies to restore the spirits of the people who work there.
“Some people would say an elder is less trained in opioids than an addictions physician,” Adams said. “But wouldn’t it be nice to have both?”
It’s not that FNHA rejects modern medicine. It continues to expand access to opioid agonist treatments such as methadone and Suboxone, which quell cravings, making it available at all FNHA nursing stations and at four of the nine FNHA-funded residential treatment centres. FNHA reimburses treatment fees charged by private clinics and has spent $2.4 million in grants to 55 communities for harm-reduction programs.
Yet, for Adams and his staff, drug therapies are only a small part of what he calls harm reduction’s suite of services.
“Harm reduction is not just, ‘Let’s make sure you don’t overdose.’ It’s the whole person that you have to treat, not just this one aspect of the person that is craving opioids.”
To incorporate First Nations wisdom into other programs, FNHA created two peer coordinator jobs at the Crosstown Clinic in the Downtown Eastside. Its compassion inclusion initiative has engaged another 144 Indigenous people with lived experience across B.C., and its Indigenous wellness team has taught indigenous harm-reduction and wellness programs in 180 communities.
“Opioid use disorder is everyone’s business. It’s yours and it’s mine and it’s everyone around us. It’s not just the domain of physicians with 24 years of training,” he said. “Why can’t Grandma help, or a family member?”
What concerns Adams about the response to the opioid crisis that is heavily grounded in the medical model is that it could widen the gap between his people and mainstream Canadians.
Indigenous people don’t necessarily trust health providers who don’t look like them or where there is no acknowledgment of the historical trauma they have suffered and their unique experiences in the world.
That’s just one more reason why the FHNA, which is unique in Canada, is so adamant that it must transform the way health care is delivered to its people so that they are empowered to help in their own healing within their own circles of trusted friends, family and elders.
This current crisis is rooted in the western medical model. The seeds were sown by an aggressive marketing campaign by Purdue Pharma, which falsely promoted its Oxycodone as being non-addictive. What followed was an epidemic of opioid over-prescription by physicians and other health-care professionals that eventually created a demand for synthetic opioids on the black market.
With so many deaths and no end in sight, this might be the time for all of us to reconsider whether the best responses to this crisis ought to be done within a much broader context of healing and an expanded understanding of what wellness really means.