Canadian doctors often make a serious — and potentially deadly — mistake when they treat Aboriginal patients. Many prescribe dangerous and highly addictive painkillers such as codeine and morphine for cases of emotional distress and minor physical pain, instead of finding more benign ways of helping.
Alika Lafontaine is a former president of the Indigenous Physicians of Canada, which advocates on behalf of First Nations doctors and patients. He says for patients with sleeping problems, mental health issues, or pain without a clear source, “all paths lead to opioid or benzodiazepine medications.” A 2014 Lancet article explains that for communities “long-plagued by poverty, high unemployment, overcrowded housing, polluted drinking water, and some of the highest suicide rates in the world, the prescription opioid disaster adds yet another layer of suffering.”
Ontario’s Non-Insured Health Benefits, which provides benefits to Aboriginal people, reports that 898 opioid prescriptions were dispensed for every 1,000 First Nations patients in 2007. That’s far higher than the 591 per 1,000 for the general population.
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The consequences of opioid misuse can be devastating: many who become dependent on the painkillers overdose and die. In the Nishnawbe-Aski Nation in northern Ontario, more than 50 per cent of residents misuse opioids. As far back as November 2009, community chiefs declared a prescription drug abuse state of emergency.
Ontario is not alone. An Alberta government report published last August confirmed that opiates are prescribed to First Nations people at twice the rate of other population groups. “It really hurts to see these numbers,” says Amelia Crowshoe, communications coordinator for the Alberta First Nations Information Governance Centre. “It doesn’t paint a positive picture of our community.”
Lafontaine says doctors reinforce Aboriginal peoples’ dependency on opiates by assuming patients are just looking for painkillers. Some of Lafontaine’s own patients were previously given opiates for “joint pains” instead of being sent for X-rays or lab tests, or guided toward alternative approaches such as physiotherapy. All too often, he says, patients with chronic pain end up addicted to opiates.
So, too, do many Indigenous patients coping with emotional trauma. Vicky Stergiopolous, chief physician at the Centre for Addiction and Mental Health, says “emotions are embodied in all of us — depression and anxiety have physical manifestations.” It’s the same with trauma. Stergiopolous explains that we all experience trauma differently. In many cases, it can present as pain, anxiety, and sleeping problems.
Cynthia Wesley-Esquimaux, Indigenous chair on truth and reconciliation at Lakehead University, says many Aboriginal people remain traumatized by events of the past — even those that happened to their ancestors. Some of that trauma comes from the horrors of the residential school system, and this legacy is passed from generation to generation. Wesley-Esquimaux adds that “doctors look at what patients are presenting with, but they are not trained to look at Aboriginal trauma.”
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The Gladue report, based on a 1999 Supreme Court case, requires judges to factor in Aboriginal trauma in sentencing. Wesley-Esquimaux says doctors should apply similar criteria to their patients. Instead of immediately reaching for the prescription pad, they should spend more time determining the root cause of their patients’ pain.
Mae Katt, a nurse practitioner who works with Indigenous patients in northern Ontario, says “people are using the pain medication to escape something that happened in their lives.” At a high school in Thunder Bay where she worked, Katt says 43 per cent of the students were regularly using opioids. Aboriginal youth have “been living in an environment where there’s been 20 years of a youth suicide crisis,” she adds. “They have also been overtaken by an environment of opium saturation.”
Katt says the students are often surrounded by parents and peers who use drugs. Her team started the first Canadian high school Suboxone program in 2011 and has treated 63 kids so far. (Suboxone, which contains buprenorphine and naloxone helps opiate-dependent people feel normal without using painkillers or heroin.) The students remain in school and can spend time with elders and participate in sports.
Wesley-Esquimaux says working with communities to develop their own solutions can replace opioids as healing tools. It can also help to address underlying trauma through positive reinforcement. Similar initiatives have worked for suicide prevention: following a spate of suicides between 1994 and 1998 in Igloolik, Nunavut, young people responded by starting a local crisis helpline and producing videos on suicide prevention.
“Instead of focusing on the pain, we need to fix the trauma,” Crowshoe says. That can be done through community initiatives, such as traditional smudging ceremonies (in which smoke from sage or tobacco is used to clear “negative energy”) or talking groups. But, Crowshoe cautions, doctors should not be the ones imposing them.
Sahil Gupta is a physician and a Munk fellow in global journalism at the University of Toronto.
Photo courtesy of Eric Norris and licensed for commercial use under a Creative Commons licence. (See the uncropped version.)
CORRECTION: This story has been updated to reflect the fact that "students are often surrounded by parents and peers who use drugs" — not "parents and teachers." We regret the error.