First Nations people bearing brunt of deadly drug crisis

Alberta’s Indigenous community is receiving a disproportionate amount of opioid prescriptions amid an epidemic of overdose deaths, according to the first detailed snapshot of substance use among First Nations compiled by the province since the opioid crisis began.

During a 15-month period beginning in January 2016, First Nations people died of opioid overdoses at a rate three times that of the rest of the provincial population.

A majority of the deaths occurred in Calgary.

The report noted First Nations people were twice as likely as other Albertans to be prescribed an opioid in the four-year period from 2013 to 2016.

And 61 per cent of First Nations people who died last year from an opioid overdose filled a prescription for an opioid within 30 days of their death.

“It’s absolutely shocking,” said Dr. Susan Christenson, a physician and Blood Tribe band member who works on the Kainai Nation in southern Alberta.

“If there is one silver lining to this tragedy, it’s that this type of information is coming out and I think it is making the medical community wake up and say, ‘whoa, maybe we need to do better.’”

Christenson said the stats are borne out by what she’s seeing among her patients — she estimates only 20 per cent began using opioids recreationally while the majority developed their addiction after being prescribed opioids by a doctor.

“These are people who unknowingly developed an opioid addiction,” Christenson said. “There is a lot of pain in this community, there’s a lot of physical pain and childhood trauma, and opioids help give you a short-term relief from all of that.

“It’s just been easier to address those issues with the Band-Aid rather than the comprehensive care that people need.”

There were 701 opioid deaths in Alberta from Jan. 1, 2016, to March 31, 2017. First Nations people, who represent just six per cent of the provincial population, accounted for 87 fatalities — about 12 per cent of all opioid-related deaths.

The report highlights other key differences in substance use and overdose patterns among First Nations compared with the rest of the provincial population.

The report points out that fentanyl, a synthetic opioid responsible for the vast majority of drug deaths in the rest of the province, was only the fourth most common substance causing deaths in the Indigenous community.

The three most fatal substances for First Nations in Alberta in 2016 were alcohol, benzodiazepines — sometimes called “benzos” — and codeine, an opiate commonly consumed in Tylenol 3 and 4.

Christenson said a lot of the addiction on the Blood reserve is fuelled by overprescribing and the diversion (the illegal sale) of prescription opioids.

“It’s common practice, you get your doc to give you a little bit more than you need, and each Tylenol 3 can be sold for around $1.50, so it’s kind of a source of income, too,” Christenson said.

Associate Minister of Health Brandy Payne said the report confirms the anecdotal evidence the province has been hearing.

“In overdose rates, EMS calls, emergency department visits and in legal prescription rates, First Nations people and communities are being hit hard by the opioid crisis,” Payne told Postmedia in a statement.

She said the government is taking steps to expand treatment, as well as distributing naloxone kits and creating supervised drug consumption services.

“We also support the work being done by the College of Physicians and Surgeons around appropriate prescribing,” Payne said.

A spokesperson for the College of Physicians and Surgeons said the college has implemented a monitoring system for all opioids and other drugs with the potential for misuse or diversion.

Physicians are also notified when their prescribing practises are out of sync with their colleagues.

“As an organization, we have a fair number of things in play to promote appropriate prescribing,” said Kelly E by of the CPS A .“But we have some work to do.”

Christenson said it would be disastrous for physicians to abruptly restrict the amount of opioids they’re already prescribing. Cutting the supply of opioids for a severely addicted person can drive them to seek out more dangerous and illegal sources of the drug.

Weaning a patient off opioids has to be done slowly and carefully, she said. And opioid replacement therapies such as suboxone and methadone are necessary for many.

Christenson said while a lot of progress is being made, she would still like to see more careful and deliberate prescribing.

“If somebody really needs to have an opioid or a risky drug on a daily basis, they probably should have to pick that medication up once a week rather then get a whole pile of pills, like a month’s worth, at a time.

“It’s just about managing it a little bit tighter.”

The report, compiled by Alberta Health and the Alberta First Nations Information Governance Centre and published online Monday, also contained some heartening statistics.

The number of First Nations individuals who received opioid replacement therapy drugs, such as Suboxone, or overdose reversal drugs, including Naloxone, increased by more than 3,000 per cent between 2013 and 2017.