Thank you for this opportunity. I'm very much hoping this will be a meaningful consultation and not further history made with consultation that doesn't lead to action, because it is not extreme to say there are lives at risk on a daily basis because of the opioid crisis.
I am speaking to you today about what I'm most familiar with, which is how the crisis has impacted northwestern Ontario first nations. I work with a practice that serves remote first nations, and we were the first in the country, I believe, to start community-based treatment programs in partnership with the first nations who wanted help.
I want to make three key points today.
The first is that the communities have worked with their primary care providers to build locally run and community-based treatment programs. These are grassroots, they're innovative, and they are effective, effective if you measure them in terms of children coming back to their parents, people being able to return to work, and education. They provide a model that could be offered to indigenous people across Canada, and I say “offered”, not imposed upon. There are ongoing challenges, and I'll get to those, but I want to go through the key points first to make sure I have time for them.
Health Canada's response to this crisis can be measured along a continuum, with the low point being obstructionist and the high point being woefully inadequate. The nurses have been forbidden to work with clients in the addiction program for more than 30 days. If any of you know anything about chronic illnesses, we don't fix diabetes in 30 days and we don't fix addiction in 30 days, and there's abundant scientific evidence to prove that this is a chronic illness. Again, later, I'll speak to why this is problematic.
Number three, I think a key point is disrupting. Our Prime Minister has used the theory of disruption as a positive force, and I believe that. Disrupting the status quo of archaic colonial policies and embracing self-determination for first nations is key to ending intergenerational trauma. I think what this could look like is supporting people to develop the community healing strategies that they believe will work, and that means long-term support. It may also mean funding evaluation so that there is accountability, but I believe this is key.
I want to go back to the first point about the treatment programs and what the challenges are. The ongoing challenges include the lack of stable or adequate funding and little access to land-based treatment. The fuel prices are insane on reserve. We've seen over and over that when communities can commit to these programs, clients get better, but when they come back, especially because they're only on the land short-term, the relapse rate is high. I think that's something very concrete that you could offer to support, and it is something that the communities have asked for—for a long time.
There is no real addiction training or treatment of vicarious trauma for front-line staff. I tear up every time I think about this, because our workers are putting themselves on the line to hear the stories of incredible trauma. We have little funding to train them. These are community members who, because Health Canada has refused to step up, have stepped up themselves. They do this and they get traumatized daily, and I have little or no means to support them other than being their family doctor. It's not acceptable.
My sister worked at an Ottawa clinic for street-involved people. The training she received to work at Oasis was unbelievable. The debriefing was phenomenal. She was able to do it for 16 years. I don't think our workers are going to last 16 years.
I can elaborate more on Health Canada. I've told you that there is an actual policy. You can check with the FNIHB nursing branch about what they have directed nurses to do. I'm sorry that I didn't bring that document, but it has been circulated.
Nurses can help no more than 21 patients and for no more than 30 days, so what has happened is.... I hesitate to even bring this up, but lay people are now storing, administering, and counting buprenorphine/naloxone, which is a very powerful opiate that we use to treat narcotic addiction, and they're doing a fantastic job.
But it's not acceptable. I was a nurse before I was a doctor. We had so much training on how to be accountable around narcotics, and yet.... These community members are doing it and I don't want to undermine them, but it's not fair. It's not a service that would be provided down here—or a lack of a service, I guess. It's creating a divide between the communities and the nursing station. The communities say that this is their most urgent concern, and the nurses are being told by the FNIHB that they are not to be involved in this. It creates an artificial.... It creates conflict at the local level.
For the last point, about embracing self-determination, I've included the article by Chandler and his colleagues. I'm sorry, but it will be translated; it hasn't been yet. He speaks very strongly to what was a protective factor against suicide in aboriginal communities in British Columbia. He said that the in terms of the protective factors for the communities that had lower suicide rates than the dominant culture, they weren't based on economics. They were based on self-determination and attachment to their culture. Those are concrete things that you have the opportunity to support to save lives.
I have a story—it's an all too familiar story for us—of a woman who started snorting Percocets because she had been sexually abused as a child and also as an adult. Her marriage fell apart. She went from Percocets to Oxy, and from snorting to injecting. Luckily, she escaped hepatitis C, which many of the people in the community I serve have contracted. Three of her five kids went into care.
She joined our program in 2011. Her husband joined six months later. To be honest, I thought she would never make it, from what I had seen. Then one day her husband said to me that he was getting better and was back with his wife. He said that she was really strong. I asked who his wife was and he mentioned this woman who I had presumed would not make it. She has proven her strength. She has all her children back. Her marriage is back together.
She and her husband are working, but her children have multiple needs, including for the trauma they suffered when they were apart from their parents. I have no access to family therapy for them. The children need testing. I have no access to get them tested. This is not acceptable care. My colleague, Dr. Mike Kirlew, presented on the lack of services to children in isolated reserves.
These are concrete things you can change.
Thank you very much for your attention.