Editor’s Note: The Northern Hoot acknowledges that methadone treatment has been a life changing and life-saving option for many people addicted to opioids. The narratives shared by the three First Nations women in this series reflects a different viewpoint about the methadone option. Their experiences may not speak for everyone who has used or loved a person that uses methadone, but these are their unique stories. *Names have been changed in the interests of privacy and job security.
In 2012 report from the Health Council of Canada highlighted the importance of considering and respecting culture in Aboriginal health care to offer “culturally competent care” in “culturally safe environments.” Empathy, dignity and respect: Creating cultural safety for Aboriginal people in urban health care focuses on two components of care. The first part defines “cultural competency and safety in the context of Aboriginal populations in Canada and explores the role of racism and the current health system in creating barriers to accessing health care, the second part details specific practices to promote cultural competency and safety and ensure sustainability.”
Lorraine is troubled by what she observes as a lack of holistic care for people on methadone. “When I look at people on the program I see people with deteriorating health. So who is taking care of this person to make sure that this persons whole endocrine, and cardio-vascular, and respiratory, and all of these systems are functioning as they should? To me I see it as being very careless. People are being robbed of their physical well-being as well because they’re not actually being helped to withdraw from this program too. There should be a safe way to wean a person off of methadone and it’s not being looked at.”
As a social worker, Lorraine believes that the Sault requires an in-treatment facility. “I believe that it should be a lengthy stay and cover life skills and various things that caused the person to go into the direction of drug use. What was it that they were trying to numb in the first place?”
In their paper, Treatment of prescription opioid disorders in Canada: looking at the ‘other epidemic’?, researchers note that methadone, a drug initially used as a harm-reduction tool for the most serious addicts is now being prescribed to people whose opioid misuse is not risky or intense. Researchers argue for a “stepped care” approach to treating people with opioid addiction and recommend that non-pharmaceutical interventions like detox and behaviour therapy are considered as a recovery alternative before methadone.
Researchers write, “Given the extensive prescription opioid-dependence burden combined with its distinct socio-demographic and clinical profile (e.g., involving many young people, less intensive or risky opioid use), an evidence-based ‘stepped-care’ model for PO dependence treatment ought to be developed in Canada where methadone maintenance treatment constitutes one, but likely a last resort or option, for treatment. Other, less intrusive treatment options as well as the best mix of treatment options should be systematically investigated and implemented.”
Researchers also note that methadone as a last resort reduces burden on the health care system writing, “While the methadone maintenance treatment -focused incentives have created a proliferation of methadone maintenance treatment clinics and patients in Ontario, there has been no commensurate investment in short- or mid-term treatment interventions, for example with abstinence, where possible, as a main goal for potentially suitable patient sub-groups. While these treatment interventions may potentially be more care effort- or management-intensive in the acute treatment phase, they be less costly for the system – yet also provide less income for opioid maintenance therapy providers or medications producers – in the long run.”
The message underpinned in this paper reminds us that the opioid epidemic was the direct result of haphazard prescribing, and that methadone, an important tool in harm reduction and an opioid-based treatment, should be prescribed with greater discrimination and caution.
Lorraine, like many, critiques a portion of the medical community that she believes is motivated by financial incentives that make the prescribing of methadone a too lucrative practice.
“Methadone has become the go to solution –a solution that cares very little about the holistic well-being of the individual, society and future generation. In fact a significant consequence of this program that lines the pocket of prescribers, is that they aren’t giving due consideration to the impact they are creating on the generations that have not yet arrived. A ‘drugee’ society is being created. And this is so far removed from what had been the good life of Anishnaabe people everywhere. This is just one portion of Western medicine that violates the best interests of an already struggling segment of society. I think prescribing practitioners have forgotten that they have a moral obligation to care for and protect all people. Sometimes I think they have forgotten they and their clients are human first. You don’t go to the grave with your money, but you do go with your conscience.”
*Several attempts were made to engage the prescribing medical community though time restraints or disinterest precluded opportunity for discussion. Through social media and through clinics, the Northern Hoot attempted to find candidates to interview who had positive stories about methadone treatment though no one came forward in time for this series.