Prescription drug crisis rocks reserve
Deaths spark state of emergency, up to 60 per cent of adults addicted
The three First Nations bands near Morley are in a crisis situation over extremely high rates of prescription drug addictions and overdoses among members.
With addiction rates surging as high as 60 per cent among adult members of the reserve, Stoney Nakoda has declared a state of emergency.
“We had something like 139 deaths attributed to opiates within a two-year period on the nation,” said Lindsay Blackett, CEO of the Chiniki band, one of three that Stoney Nakoda comprises. “There’s only 6,000 people on the whole reserve, so that’s a significant number vis-à-vis the population.”
He said fentanyl is the No. 1 culprit on the reserve — the same deadly drug that is devastating communities across Canada. More than 270 Albertans died from fentanyl overdoses last year, with at least 20 deaths on the southern Blood reserve alone since the summer of 2014. A prescription painkiller, fentanyl is up to 100 times more potent than morphine and is often passed off as a new form of OxyContin.
“A lot of people are abusing it. And once you’re hooked, that’s a jealous mistress. Once it hooks you, it wrecks your life,” said Blackett.
“It’s not a reflection on one particular community. It’s not like we’re the only ones dealing with it. It’s widespread and not just in the native population. It’s just more pronounced in the native population.”
Blackett noted that the opiate crisis is just part of a larger drug and alcohol challenge on the reserve.
Health Canada officials say they have been working with First Nations’ chiefs and administration and the Alberta government to support the communities and address complex issues of mental illness and suicide, addictions and chronic disease, and improving access to quality health care.
On June 17, federal Health Minister Jane Philpott announced new actions to address opioid misuse, which includes better prescribing practises and treatment options, reducing easy access to unnecessary opioids and improving the national evidence base.
Health Canada funds $86 million annually for addictions support for First Nations and Inuit communities through the National Native Alcohol and Drug Abuse Program and the National Youth Solvent Abuse Program. Through these programs, a network of 43 treatment centres is supported, as well as drug and alcohol prevention services in the majority of First Nations and Inuit communities.
Alberta Health Minister Sarah Hoffman says the province has been working with First Nations in responding to the fentanyl crisis, with addictions treatment and education. Government officials are also sharing electronic data to help First Nations roll out immunization programs.
“We know that First Nations peoples are struggling with higher rates of diabetes, addictions and poverty — all of which contribute to poorer health outcomes.”
The high number of addicted adults on the Morley-area reserve is anecdotal at best, as actual numbers are not known.
Prescription opioid addiction numbers are not tracked, nor are deaths unless they are related to fentanyl — a drug that appeared on the streets in 2012 and has become the single-largest public health threat in Alberta.
“We really do a poor job on surveillance of opioid overdose deaths and that’s a good way to measure addictions,” said Alberta addictions specialist Hakique Virani.
“We don’t count it unless it’s fentanyl. Until we do that, we don’t have a handle on numbers.”
Virani was not surprised by the suggestion that 50 to 60 per cent of Stoney Nakoda residents are prescription addicts. In fact, he suspects the number is higher in the adult population.
Blackett said lack of tracking of addictions and overdoses is part of the problem in dealing with it.
“That’s why we can only say fentanyl (is being abused) with any degree of certainty. Which is sad because it may be 80 per cent ... and the other 20 per cent we don’t know what the hell it is, and we’re not making the public aware of what it is. When you go in blind like that with something so toxic and deadly as that, that’s a cause for concern.”
Asked how people can repeatedly get drugs prescribed, sometimes for years at a time, Virani said it often happens because no one asks questions. Or they’re ill-equipped to deal with the fallout.
“(The patient) may not even be complaining of anything wrong. When doctors inherit patients with prescription addictions, often they’ll just perpetually refill it because there may not be any complaint of side-effects.
“Even if they are demonstrating signs of dependency, would the best thing be to cut them off? No,” said Virani, who treats patients at an Edmonton methadone clinic and teaches at the University of Alberta. He has been critical of the government’s handling of the fentanyl drug crisis.
“It’s a difficult dilemma. It is dangerous to keep prescribing, but in the absence of safe and effective treatment for dependency, what do you do?”
Treatment for prescription opioid drug addiction includes stabilizing patients with other long-acting medications such as methadone or Suboxone.
Counselling for underlying issues is also needed, as is more advanced therapy for psychiatric or psychological trauma.
But methadone and Suboxone can be dangerous medications, so use of them requires following monitoring protocols, which can be difficult to do in remote areas or First Nations reserves with limited access to health clinics and doctors.
“It’s unfortunately not a unique situation for First Nations in Alberta, it’s not a unique situation for some towns in Alberta. An entire provincial problem is poor access to treatment. And it’s not changing near fast enough,” said Virani.
He said Alberta needs to rethink how local practitioners are supported.
He pointed to a project that is working well in Slave Lake, where the province partnered with First Nations bands to provide telemedicine in co-operation with practitioners on site.
“If we’re creative and committed to addressing this problem, we can do it. Until we accept it’s a public health emergency, we’ll continue to bail out a sinking ship with a spoon.”
A program started in 1986 monitors the use of medications prone to misuse and abuse.
The Triplicate Prescription Program (TPP) is administered by the College of Physicians & Surgeons of Alberta and includes agencies such as Alberta Health, Alberta College of Pharmacists and Alberta Dental Association.
The program collects prescribing and dispensing data for a range of drugs including fentanyl, methadone and Oxycodone.
With Alberta physicians being the highest prescribers of code ine-containing medications in the country, according to the CPSA, painkillers containing codeine and two widely used anti-anxiety drugs, Ativan and Valium, were added to the watch list in 2015.
If the TPP system detects certain parameters, such as clients using more than one pharmacy or doctor, or getting more than a certain amount of drugs, a letter is sent to the prescribing physician.
Last year, 3,277 warning letters were sent.
“There are very specific flags that would result in a letter being sent,” said Donna Call, a media spokesperson for the College.
An adviser meets with the physician to discuss the treatment plan and, where necessary, provide more education and resources to improve prescribing practices.
Call said discipline would only be considered if a physician is found to be engaging in criminal behaviour or refuses a recommended intervention.