Community-led Recovery from the Opioid Crisis through Culturally-based Programs and Community-based Data Governance

Authors

  • Marion Maar Northern Ontario School of Medicine
  • Tim Ominika
  • Darrel Manitowabi

DOI:

https://doi.org/10.18584/iipj.2022.13.2.13792

Keywords:

addictions, opioids, Indigenous, culture-based treatment, data sovereignty, First Nations Mental Wellness Continuum Framework

Abstract

The opioid crisis is disproportionately impacting Indigenous communities in Canada. There is a need to evaluate practical approaches to recovery that include community-based opioid agonist treatment (OAT) and integration of cultural treatment models. Naandwe Miikan, translated as The Healing Path, is an OAT program that blends clinical and Indigenous healing concepts and providers in a community-based setting. Aside from OAT pharmaceutical treatment, clients work with Indigenous counsellors that integrate culture with treatment, such as land-based activities, that reconnect the community to Indigenous teachings and harvesting. In this paper, we present a case study showcasing community advocacy in creating innovative funding models and engaging with clinicians to provide a shared care OAT model with traditional Indigenous counselling, cultural programs, and data sovereignty. Policy needs are identified.

References

Anishinabek Nation. (2020). Health Transformation. https://www.anishinabek.ca/

departments/health-secretariat-2/health-transformation/

Belzak, L., & Halverson, J. (2018). The opioid crisis in Canada: A national perspective. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 38(6), 224–233. https://doi.org/10.24095/hpcdp.38.6.02

Brave Heart, M. Y. H., Chase, J., Elkins, J., & Altschul, D. B. (2011). Historical trauma among Indigenous Peoples of the Americas: Concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43(4), 282–290. https://doi.org/10.1080/

2011.628913

Bridges, A. (2020a, May 14). Decisions about Indigenous ceremonies lie with community leaders, says Trudeau. CBC. https://www.cbc.ca/news/canada/saskatoon/

indigenous-ceremonies-covid-19-federal-response-1.5570697

Bridges, A. (2020b, May 13). Sask. Premier says no exceptions to public health order for First Nations ceremonies. CBC. https://www.cbc.ca/news/canada/saskatoon/scott-moe-response-beardy-s-okemasis-sun-dance-ceremony-covid-19-1.5568799

Brogan, P., Hasson, F., & Mcilfatrick, S. (2019). Lessons learnt: Examining the use of case study methodology for nursing research in the context of palliative care. Journal of Research in Nursing, 24(6), 446–459. https://doi.org/10.1177/1744987119867737

Bruneau, J., Ahamad, K., Goyer, M.-È., Poulin, G., Selby, P., Fischer, B., Wild, T. C., & Wood, E. (2018). Management of opioid use disorders: A national clinical practice guideline. Canadian Medical Association Journal, 190(9), E247–E257. https://doi.org/

1503/cmaj.170958

Carriere, G., Garner, R., & Sanmartin, C. (2018). Social and economic characteristics of those experiencing hospitalizations due to opioid poisoning. Statistics Canada, Catalogue no. 82-003-X. Health Reports, 29(10), 23–28. https://www150.statcan.gc.ca/n1/

pub/82-003-x/2018010/article/00002-eng.pdf

Carroll, S. R., Garba, I., Figueroa-Rodríguez, O. L., Holbrook, J., Lovett, R., Materechera, S., Parsons, M., Raseroka, K., Rodriguez-Lonebear, D., Rowe, R., Sara, R., Walker, J. D., Anderson, J., & Hudson, M. (2020). The CARE principles for Indigenous data governance. Data Science Journal, 19(1), 43. http://doi.org/10.5334/dsj-2020-043

Centre for Addiction and Mental Health. (2016). Making the choice, making it work: Treatment for opioid addiction. https://www.camh.ca/-/media/files/guides-and-publications/making-choice-en.pdf

Cohn, S., Clinch, M., Bunn, C., & Stronge, P. (2013). Entangled complexity: Why complex interventions are just not complicated enough. Journal of Health Services Research & Policy, 18(1), 40–43. https://doi.org/10.1258/jhsrp.2012.012036

Creswell, J. W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). SAGE Publications. http://www.ceil-conicet.gov.ar/wp-content/uploads/2018/04/CRESWELLQualitative-Inquary-and-Research-Design-Creswell.pdf

Cribb, R. (2021, July 26). New ‘ultra potent’ opioids hitting Toronto streets in recent weeks as overdose deaths mount. Toronto Star. https://www.thestar.com/news/

investigations/2021/07/26/new-ultra-potent-opioids-hitting-toronto-streets-in-recent-weeks-as-overdose-deaths-mount.html

CRISM Ontario. (2016). Topic summary: Prescription opioid misuse and interventions in Northern Ontario and First Nations communities [Topic Summary]. http://crismontario.ca/SiteAssets/topic-summaries/PO_misuse_in_Ontario.pdf

Cronin, C. (2014). Using case study research as a rigorous form of inquiry. Nurse Researcher, 21(5), 19–27.

Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A., & Sheikh, A. (2011). The case study approach. BMC Medical Research Methodology, 11, 100. https://doi.org/

1186/1471-2288-11-100

Currie, C. L., Wild, T. C., Schopflocher, D. P., Laing, L., & Veugelers, P. (2013). Illicit and prescription drug problems among urban Aboriginal adults in Canada: The role of traditional culture in protection and resilience. Social Science & Medicine, 88, 1–9. https://doi.org/10.1016/j.socscimed.2013.03.032

Dell, C. A., Seguin, M., Hopkins, C., Tempier, R., Mehl-Madrona, L., Dell, D., Duncan, R., & Mosier, K. (2011). From benzos to berries: Treatment offered at an Aboriginal youth solvent abuse treatment centre relays the importance of culture. The Canadian Journal of Psychiatry, 56(2), 75–83. https://doi.org/10.1177/070674371105600202

Downton, M. J., Biondi, C., Fulwiler, D., Curtis, C., & Frederiksson, E. (2019). A culture of mattering: Building staff belonging, purpose and meaning at an Indigenous recovery centre. Master of Applied Positive Psychology (MAPP) Service Learning Projects, 27. https://repository.upenn.edu/mapp_slp/27

Dudgeon, P. P., Darwin, L., Hirvonen, T., Boe, M., Johnson, R., Cox, R., Gregory, L., McKenna, R., McKenna, V., Smith, D., Turner, J., Helle, S. V., & Garrett, L. (2018). We are not the problem, we are part of the solution: Indigenous lived experience project report. Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention, Black Dog Institute. https://www.blackdoginstitute.org.au/wp-content/uploads/2020/04/lived-experience-report-final-nov-2018.pdf

Dumont, J. (2005). First Nations regional longitudinal health survey (RHS) cultural framework. The First Nations Information Governance Centre. https://uploads-ssl.webflow.com/5b786757ee914c5f85ba8959/5b7f15660151a07eacefd2b6_5_developing-a-cultural-framework.pdf

Eibl, J., Morin, K., Leinonen, E., & Marsh, D. (2017). The state of opioid agonist therapy in Canada 20 years after federal oversight. The Canadian Journal of Psychiatry, 62(7), 444–450. https://doi.org/10.1177/0706743717711167

Erskine, M. (2017, January 27). Manitoulin ranked No. 15 in Ontario for opioid deaths. Sudbury.com. https://www.sudbury.com/local-news/manitoulin-ranked-no-15-in-ontario-for-opioid-deaths-521476

Fiedeldey-Van Dijk, C., Rowan, M., Dell, C., Mushquash, C., Hopkins, C., Fornssler, B., Hall, L., Mykota, D., Farag, M., & Shea, B. (2017). Honoring Indigenous culture-as-intervention: Development and validity of the Native Wellness Assessment. Journal of Ethnicity in Substance Abuse, 16(2), 181–218. https://doi.org/10.1080/

2015.1119774

First Nations Health Authority. (2020). COVID-19 advisory on Sweat Lodges and Potlatches. https://www.fnha.ca/about/news-and-events/news/covid-19-advisory-on-sweat-lodges-and-potlatches

First Nations Information Governance Centre (FNIGC). (2016). Pathways to First Nations' data and information sovereignty. In T. Kukutai & J. Taylor (Eds.), Indigenous data sovereignty: toward an agenda (pp. 139–156). Australian National University. http://press-files.anu.edu.au/downloads/press/n2140/pdf/ch08.pdf

First Nations Information Governance Centre. (2021). Our history. https://fnigc.ca/about-fnigc/our-history/

Flyvbjerg, B. (2006). Five misunderstandings about case-study research. Qualitative Inquiry, 12(2), 219–245. https://doi.org/10.1177/1077800405284363

Gomes, T., Kitchen, S. A., & Murray, R. (2021). Measuring the burden of opioid-related mortality in Ontario, Canada, during the COVID-19 pandemic. JAMA Network Open, 4(5), e2112865. https://doi.org/10.1001/jamanetworkopen.2021.12865

Gomes, T., Murray, R., Kolla, G., Leece, P., Bansal, S., Besharah, J., Cahill, T., Fritz, A., Munro, C., Toner, L., & Watford, J. (2021). Changing circumstances surrounding opioid-related deaths in Ontario during the COVID-19 pandemic. Ontario Drug Policy Research Network. https://odprn.ca/wp-content/uploads/2021/05/Changing-Circumstances-Surrounding-Opioid-Related-Deaths.pdf

Government of Canada. (2021). Guide for pharmacy benefits: Non-insured health benefits. https://www.sac-isc.gc.ca/eng/1576430557687/1576430636766#chp3_5

Government of Canada. 2021, August 6. Addressing Anti-Indigenous Racism in Health Systems: Federal Response. Retrieved March 3, 2022. https://www.sac-isc.gc.ca/eng/1628264764888/1628264790978

Greenhalgh, T., & Papoutsi, C. (2018). Studying complexity in health services research: Desperately seeking an overdue paradigm shift. BMC Medicine, 16(1), 95. https://doi.org/10.1186/s12916-018-1089-4

Health Canada. (2015). First Nations mental wellness continuum framework - summary report. https://www.sac-isc.gc.ca/eng/1576093687903/1576093725971

Heilbron, C., & Guttman, M. (2000). Traditional healing methods with First Nations women in group counselling. Canadian Journal of Counselling, 34(1), 3–13. https://files.eric.ed.gov/fulltext/EJ603067.pdf

Hobson, B. (2021, June 25). Advocates say in-person support crucial for residential school Survivors. CTV News. https://www.ctvnews.ca/canada/advocates-say-in-person-support-crucial-for-residential-school-survivors-1.5485167

Holkup, P. A., Tripp-Reimer, T., Salois, E. M., & Weinert, C. (2004). Community-based participatory research: an approach to intervention research with a Native American community. ANS Advances in Nursing Science, 27(3), 162–175. https://doi.org/10.1097/00012272-200407000-00002

ICES. (2021a). About ICES. https://www.ices.on.ca/About-ICES/Mission-vision-and-values

ICES. (2021b). Data & Privacy. https://www.ices.on.ca/Data-and-Privacy

Jones, W., Kurdyak, P., & Fischer, B. (2020). Examining correlations between opioid dispensing and opioid-related hospitalizations in Canada, 2007–2016. BMC Health Services Research, 20(1), 677. https://doi.org/10.1186/s12913-020-05530-w

Kalvik, A., Isaac, P., Murphy, L, Janecek, E., & Sproule, B. (2014). Buprenorphine for the treatment of opioid dependence. Pharmacy Connection, Winter 2014, 21–31. https://www.ocpinfo.com/library/practice-related/download/Buprenorphine%

for%20the%20Treatment%20of%20Opioid%20Dependence.pdf

Kanate, D., Folk, D., Cirone, S., Gordon, J., Kirlew, M., Veale, T., Bocking, N., Rea, S., & Kelly, L. (2015). Community-wide measures of wellness in a remote First Nations community experiencing opioid dependence: Evaluating outpatient buprenorphine-naloxone substitution therapy in the context of a First Nations healing program. Canadian Family Physician, 61(2), 160–165.

Loutfi, D., Law, S., McCutcheon, C., Carlin, R., Torrie, J., & Macdonald, M. (2018). Health planning for Indigenous populations: A rapid evidence review. The International Indigenous Policy Journal, 9(1). https://doi.org/10.18584/iipj.2018.9.1.7

Maar, M. (2006). From self-determination to community health empowerment: Evolving Aboriginal health services on Manitoulin Island, Ontario [Doctoral dissertation, McMaster University]. https://www.bac-lac.gc.ca/eng/services/theses/Pages/

item.aspx?idNumber=315044725

Maar, M., & Msheekehn Trudeau, R. (2019). Seven-Grandfathers. https://www.seven-grandfathers.ca/

Maar, M., McGregor, L., & Reade, M. (2020). What are the needs on Manitoulin related to COVID-19? Research team COVID-19 survey summary. Northern Ontario School of Medicine [Unpublished Report].

Maar, M., Connors, E., Fancott, C., Mussell, W. B., & Papadopoulos, D. (2022). Developing Relationships on a Shared Path to Reconciliation: The Core of Health Transformation and Safe Care for Indigenous People. Healthcare Quarterly 25(2), 16–24.

Mamakwa, S., Kahan, M., Kanate, D., Kirlew, M., Folk, D., Cirone, S., Rea, S., Parsons, P., Edwards, C., Gordon, J., Main, F., & Kelly, L. (2017). Evaluation of 6 remote First Nations community-based buprenorphine programs in northwestern Ontario: Retrospective study. Canadian Family Physician, 63(2),137–145. https://pubmed.ncbi.nlm.nih.gov/28209683/

Manitoulin Expositor. (2013, February 17). Methadone clinic closing in downtown Little Current. Manitoulin Expositor. https://www.manitoulin.com/methadone-clinic-closing-in-downtown-little-current/

Manitowabi, D., & Maar, M. (2018). Applying Indigenous health community-based participatory research. In D. McGregor, R. Johnston, & J. P. Restoule (Eds.), Indigenous research: Theories, practices, and relationships (pp. 238–260). Canadian Scholars Press.

Manitowabi, R. (2017). How positive psychology overlaps with a culturally-based Indigenous addictions treatment program. [Capstone Projects, 114, Master of Applied Positive Psychology (MAPP)]. http://repository.upenn.edu/mapp_capstone/114

Marsh, T. N., Coholic, D., Cote-Meek, S., & Najavits, L. (2015). Blending Aboriginal and Western healing methods to treat intergenerational trauma with substance use disorder in Aboriginal peoples who live in northeastern Ontario, Canada. Harm Reduction Journal, 12(14). https://doi.org/10.1186/s12954-015-0046-1

Mashford-Pringle, A., Skura, C., Stutz, S., & Yohathasan, T. (2021). What we heard: Indigenous Peoples and COVID-19 supplementary report for the Chief Public Health Officer of Canada’s Report on the State of Public Health in Canada. Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto. https://www.canada.ca/content/dam/phac-aspc/documents/corporate/publications/chief-public-health-officer-reports-state-public-health-canada/from-risk-resilience-equity-approach-covid-19/indigenous-peoples-covid-19-report/cpho-wwh-report-en.pdf

McBride, K. (n.d.). Data resources and challenges for First Nations communities: Document review and position paper. The Alberta First Nations Information Governance Centre [Document Review]. https://docs.fntn.ca/VC11512/Handouts/Data-Resources-Report.pdf

McCormick, R. (2000). Aboriginal traditions in the treatment of substance abuse. Canadian Journal of Counselling, 34(1), 25–32. https://files.eric.ed.gov/fulltext/EJ603069.pdf

McRae-Williams, E., Yamaguchi, J., Wilson, B., Schultz, R., Abbott, T., & Cairney, S. (2018). Interplay wellbeing framework: Community perspectives on working together for effective service delivery in remote Aboriginal communities. The International Indigenous Policy Journal, 9(1). https://doi.org/10.18584/iipj.2018.9.1.1

Morin, K. A., Acharya, S., Eibl, J. K., & Marsh, D. C. (2021). Evidence of increased Fentanyl use during the COVID-19 pandemic among opioid agonist treatment patients in Ontario, Canada. The International Journal on Drug Policy, 90, 103088. https://doi.org/10.1016/j.drugpo.2020.103088

Narbonne-Fortin, C., Rylett, M., Manitowabi, S., Douglas, R., & Gliksman, L. (2001). Achieving consensus for a policy action to reduce alcohol problems in the Unceded Indian Reserve of Wikwemikong: Wikwemikong alcohol policy consensus. The Canadian Journal of Native Studies, XXI(1), 161–177.

Ominika, T. (2018, May 24–26). The Anishinabe approach to recovery from the opioid crisis [Conference session]. University of Toronto Faculty of Medicine Indigenous Health Conference: Walking Together, Mississauga, Ontario. https://www.cpd.utoronto.ca/

|indigenoushealth/library/the-anishinabe-approach-to-recovery-from-the-opioid-crisis/

Pomerville, A., & Gone, J. P. (2019). Indigenous culture-as-treatment in the era of evidence-based mental health practice. In C. Fleming & M. Manning (Eds.), Routledge handbook of Indigenous wellbeing (pp. 237-247). Routledge. https://doi.org/10.4324/9781351051262-20

Pyper, E., Henry, D., Yates, E., Mecredy, G., Ratnasingham, S., Slegers, B., & Walker, J. (2018). Walking the path together: Indigenous health data at ICES. Healthcare Quarterly, 20(4), 6–9. https://doi.org/10.12927/hcq.2018.25431

Restoule, B. M., Hopkins, C., Robinson, J., & Wiebe, P. K. (2015). First Nations mental wellness: Mobilizing change through partnership and collaboration. Canadian Journal of Community Mental Health, 34(4), 89–109. https://doi.org/10.7870/cjcmh-2015-014

Richardson, L., & Crawford, A. (2020). COVID-19 and the decolonization of Indigenous public health. CMAJ: Canadian Medical Association Journal, 192(38), E1098–E1100. https://doi.org/10.1503/cmaj.200852

Ritland, L., Jongbloed, K., Mazzuca, A., Thomas, V., Richardson, C., Spittal, P., & Guhn, M. (2020). Culturally safe, strengths-based parenting programs supporting Indigenous families impacted by substance use—A scoping review. International Journal of Mental Health and Addiction, 18, 1586–1610. https://doi.org/10.1007/s11469-020-00237-9

Rowan, M., Poole, N., Shea, B., Gone J. P., Mykota, D., Farag, M., Hopkins, C., Hall, L., Mushquash, C., & Dell C. (2014). Cultural interventions to treat addictions in Indigenous populations: Findings from a scoping study. Substance Abuse Treatment, Prevention, and Policy, 9(34). https://doi.org/10.1186/1747-597X-9-34

Royal Commission on Aboriginal Peoples. (1996). Volume 5: Renewal: A twenty-year commitment. http://data2.archives.ca/e/e448/e011188230-05.pdf

Schultz, J. L., & Rainie, S. C. (2014). The strategic power of data: A key aspect of sovereignty. The International Indigenous Policy Journal, 5(4). https://doi.org/10.18584/

iipj.2014.5.4.1

Shield, D., & Martell, C. (2020, May 12). RCMP ‘had no understanding’ of Sun Dance Ceremony that was interrupted, dancer says. CBC News. https://www.cbc.ca/news/canada/saskatoon/beardys-okemasis-sun-dance-1.5566551

Sound, D., & Jones, A. (2021, June 23). As more unmarked graves are found, Indigenous communities face renewed trauma. CTV News. https://www.ctvnews.ca/canada/as-more-unmarked-graves-are-found-indigenous-communities-face-renewed-trauma-1.5483470

Sutherland, M., & Maar, M. (2019). Wiikwemkoong community response to support recovery from opioids: Results of the community service development sessions [Unpublished report].

Taylor, B., & Neustaeter, B. (2021, June 24). “Is he here amongst all these graves?”: Survivors recall abuse after hundreds of remains found near Sask. Residential school. CTV News. https://www.ctvnews.ca/canada/is-he-here-amongst-all-these-graves-survivors-recall-abuse-after-hundreds-of-remains-found-near-sask-residential-school-1.5483838

The Ontario Drug Policy Research Network, The Office of the Chief Coroner for Ontario/Ontario Forensic Pathology Service, Public Health Ontario, & Centre on Drug Policy Evaluation. (2020). Preliminary patterns in circumstances surrounding Opioid-related deaths in Ontario during the COVID-19 pandemic. https://www.publichealthontario.ca/-/media/documents/o/2020/opioid-mortality-covid-surveillance-report.pdf?la=en

Trevethan, S. (2019). Strengthening the availability of First Nations data. QMR Consulting. https://www.afn.ca/wp-content/uploads/2019/05/NCR-11176060-v1-STRENGTHENING_THE_AVAILABILITY_OF_FIRST_NATIONS_DATA-MAR_25_2019-FINAL_E.pdf

Truth and Reconciliation Commission of Canada. (2015). Truth and Reconciliation Commission of Canada: Calls to action. https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf

Uddin, F. (2013). Hope in Fort Hope: First Nations community is winning the battle against prescription drug abuse. Canadian Family Physician, 59(4). 391–393.

United Nations. (2007). United Nations declaration on the rights of Indigenous Peoples. https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf

Walker, J., Lovett, R., Kukutai, T., Jones, C., & Henry, D. (2017). Indigenous health data and the path the healing. The Lancet, 390(10107), 2022–2023. https://doi.org/10.1016/S0140-6736(17)32755-1

Wendt, D. C., Marsan, S., Parker, D., Lizzy, K. E., Roper, J., Mushquash, C., Venner, K. L., Lam, A., Swansburg, J., Worth, N., Sorlagas, N., Quach, T., Manoukian, K., Bernett, P., & Radin, S. M. (2021). Commentary on the impact of the COVID-19 pandemic on opioid use disorder treatment among Indigenous communities in the United States and Canada. Journal of Substance Abuse Treatment, 121(2021), 108165. https://doi.org/10.1016/j.jsat.2020.108165

Yang, J., Oviedo-Joekes, E., Christian, K. W., Li, K., Louie, M., Schechter, M., & Spittal, P. (2011). The Cedar Project: Methadone maintenance treatment among young Aboriginal people who use opioids in two Canadian cities. Drug and Alcohol Review, 30(6), 645–651. https://doi.org/10.1111/j.1465-3362.2010.00258.x

Yin, R. K. (2013). Validity and generalization in future case study evaluations. Evaluation, 19(3), 321–332. https://doi.org/10.1177/1356389013497081

Downloads

Published

2022-10-15