After surviving the oxycontin crisis, Eabametoong First Nation in northern Ontario braces for fentanyl
CBC News, by Nicole Ireland, on Feb 22, 2017
It’s a bitterly cold February morning in Eabametoong First Nation in northern Ontario and the chairs in the hallway of the community health centre are full.
Some people chat while others, wearing headphones, slouch in their seats.
They’re waiting to get their daily dose of a medication many say has given them their lives back.
When their number is called, these clients move to a table in the next room and take a seat across from Lucy Atlookan.
Atlookan, a community member certified to dispense suboxone, takes each client’s pre-packed dose out of a metal case and slides the tablets into a little cup.
Priscilla Wapoose takes her pills and places them under her tongue. She’s among several clients who say the program has changed their lives.
“It took me a while to come here,” Wapoose admits. Her three-year-old daughter, Addison, climbs on her lap and slurps from a juice box as her mother waits for the tablets to dissolve.
Before she started taking suboxone more than a year ago, Wapoose says she was addicted to “all sorts” of street drugs. She decided to get herself “straightened out” for the sake of her five children and three grandchildren.
But Wapoose realized she couldn’t kick her drug addiction on her own, so she turned to the prescription drug addiction program at Eabametoong’s health centre.
The program gives patients suboxone, a medication that stops the agonizing withdrawal symptoms that plague someone trying to quit opioids, and reduces their cravings for illicit drugs.
“I haven’t touched nothing ever since I’ve been on this program,” Wapoose says.
And that fact has had a big impact on her family.
“I’ve been more like a mother than I used to be,” Wapoose says, smiling at Addison as she giggles happily.
About 100 people come to the health centre every day to get their suboxone pills. As she dispenses each client’s dose, Atlookan is the picture of professionalism. She talks and laughs with those who seem to need that interaction, and sits patiently until it’s time to check under their tongues to make sure the suboxone tablets have been absorbed.
She knows first-hand what they’re going through. That’s because she takes suboxone daily to treat her own addiction to percocet and oxycontin.
About six years ago, oxycontin triggered an opioid crisis across Canada. Dealers turned huge profits as the painkiller became a popular street drug, and oxy eventually made its way from cities into remote communities and First Nations.
Staggering numbers of people descended into the throes of addiction — in some First Nations, close to half the population was affected.
Indigenous leaders declared states of emergency in an attempt to get enough medical and psychological resources to stop the scourge.
The federal government, which is responsible for funding Indigenous health care, recognized the problem and has supplied the community with suboxone.
But that’s just the beginning of a solution. The other, equally crucial part is support and counselling, which can give addicts lasting tools to avoid a relapse and prevent a future opioid epidemic.
The residents of Eabametoong say mental health resources provided by the government are woefully inadequate, which is why members of the community have largely taken it upon themselves to try to keep opioid addiction at bay.
And in many cases, that means addicts helping other addicts.
These community members “show such courage every single day,” says Dr. Claudette Chase, a Thunder Bay-based family physician who works with patients in Eabametoong.
“Most of them have not been trained in how to work with people who live with addictions.”
A desire to ‘feel human’
People in Eabametoong, which is located about 400 kilometres north of Thunder Bay, Ont., and is also called Fort Hope, have long struggled with hardship.
But the oxycontin crisis was a particularly dark time.
“It really destroyed families. It destroyed the morale of our community,” says Sid O’Keese, supervisor of clinical services at the First Nation’s health centre.
O’Keese remembers going on home visits and seeing “nothing inside the home” because the residents had sold their furniture and other household belongings to get money for drugs.
“They didn’t care anymore,” he says. “They did street deals right in front of you.”
This desperation to buy more pills led to a rise in crime and children being taken away from addicted parents and put into care.
Substance abuse in Eabametoong was not new. As with many First Nations, the community’s remoteness has not protected it from an influx of alcohol and drugs. Often, it’s addicts who bring in drugs from cities like Thunder Bay, keeping some for themselves and selling the rest so they can buy more.
The roots of drug abuse run deep. Trauma suffered by many Indigenous people has contributed to a cycle of mental health issues and addiction. The legacy of residential schools has resulted in many parents passing the psychological damage to their children. Suicide rates among Indigenous people are much higher than in the general Canadian population.
And then you have the day-to-day living conditions in places like Eabametoong. Crowded housing, high unemployment, low high school graduation rates and a 16-year-long boil-water advisory contribute to the problem, says Eabametoong band councillor Louie Sugarhead.
He says many people turn to drugs and alcohol just to “feel human.”
A similar desire fueled Lucy Atlookan’s opioid addiction. After years of depression and anxiety following her mother’s death, Atlookan says she was “really broken.”
When she first tried percocets in 2009, “it felt good” and made her psychological pain go away, Atlookan says.
Soon, she had moved on to the “stronger” oxycontin.
Things “went downhill” in February 2012 when Atlookan overdosed. She had also lost a lot of weight and noticed her kids were acting out and slacking off in school. The birth of her first grandson shook her into realizing she had to be there for him, just as her late mother had been for her kids.
“I had to just stop,” Atlookan says.
The first step was suboxone.
In an emailed statement to CBC News, Health Canada said Eabametoong is one of 46 Indigenous communities across Canada receiving funding “to establish access and support services” for suboxone “where it is not otherwise available to community members.”
Suboxone is the brand name for a mixture of buprenorphine, which is an opioid itself, and naloxone, an opioid antidote. Unlike with methadone, a common drug used to combat heroin addiction in urban centres, physicians don’t require a special licence to prescribe suboxone, making it much easier for remote communities to access.
According to the Health Canada statement, when the suboxone program began in 2011-12, “it was intended to be a short-term measure.” But the department recognized that “like methadone, it is a substitution therapy for most people who use it.”
It’s been about five years since Atlookan turned to the suboxone program. Not only did she overcome her addiction, she almost immediately started working with Eabametoong’s health and social services program, eventually becoming a suboxone dispenser.
But counselling has been a big part of Atlookan’s recovery. Therapy has helped her deal with past traumas, including suicides in her family. But to see a mental health professional she trusts, she has to fly to Thunder Bay once a month — and she says that’s not frequent enough.
About 170 people out of the 1,300 people living in Eabametoong First Nation are now taking suboxone, and the ones who want professional counselling all face the same challenge.
Some, like Atlookan, fly out about once a month, while others see a therapist who comes in from Thunder Bay for about one week every month.
There is another option: Health Canada funding for Eabametoong’s mental health and support services includes training for local residents to act as counsellors. The idea may look good on paper, but people who work in the program say it’s flawed.
Despite assurances of confidentiality, people in the small community don’t want to “express their deepest secrets to somebody they see every day,” says O’Keese, who supervises the local mental health team.
“If you come into my office, you’re spilling, you’re telling everything… then I see you on the street 10 minutes later. I see you at the coffee shop, I see you at the store.”
That means a great desire for therapy from outside psychologists and social workers — and the supply simply can’t meet the demand.
A session once a month is nowhere near what’s needed to properly do the family and cognitive-behavioural therapy “that will help people move along,” says Dr. Claudette Chase, who helped start the suboxone program there.
Suboxone obviously has its use, but what proper counselling can do is help clients resolve the issues that “drove them to hide in an oxycontin fog” in the first place, she says.
“The quality and the amount of the mental health services available needs to be stepped up.”
On the front lines
Wanda Sugarhead has been fighting for years to step up those services to help Eabametoong help itself.
Now the head of the community’s prescription drug abuse program, Sugarhead pulled herself out of alcohol and drug addictions that forced her to live on the streets of Thunder Bay and even led to a suicide attempt.
Like many people we spoke with, it was ultimately her love for her children that made Sugarhead realize she had to break out of a cycle that was destroying their lives.
Sugarhead was so determined to get well that she packed up her two young sons and left Eabametoong to attend a bible college in Wisconsin. While there, she went through vigorous counselling to confront the pain, including childhood abuse, that led to her addiction in the first place.
She came back to Eabametoong and worked as a counsellor while getting her social services diploma and graduating with honours from Confederation College in Thunder Bay.
Now, Sugarhead is a voice of hope and encouragement for many people struggling with addiction in her community.
She desperately wants her clients to get the same degree of help that she did.
“We need [more] professional counsellors,” she says. “We don’t have the resources, we don’t have the money, we don’t even have the human capacity of healthy people in our community.”
Even those who have had the most success with suboxone know the consequences of going off it without the necessary support.
More than five years after suboxone helped him stop taking percocets and oxycontin, Frederic Meeseetawageesic has gone from being an addict so consumed with supporting his high that he would have trouble feeding his kids to a loving father with a job.
“I feel more alive,” he says. “I have things that I never thought I would have,” including a truck, a boat and, most importantly, precious time with his sons out in the bush.
With his life going well, Meeseetawageesic stopped taking the medication. But he relapsed into using percocets after the death of his mother, who had been a daily voice of support.
It was his son Jacob who urged him to go back on the program. Meeseetawageesic did, but he hopes it’s not forever.
“I got one more thing to do: Get off suboxone,” Meeseetawageesic says. “I’d like to have a clean life, start over. You know, just never mind drugs at all.”
Sugarhead shares that vision — not only for Meeseetawageesic, but for all of her clients.
“If they have the right resources and the right support, I believe it can be done,” she says.
Health Canada says it provides Eabametoong First Nation with more than $915,000 a year “for a wide range of mental health and addictions programming, that targets prevention, life promotion, addictions counselling, cultural and land-based healing.”
The department has also approved more than $933,000 in prescription drug abuse funding for Eabametoong from 2015-16 to 2017-18, it said in a statement to CBC News.
“We will continue to work with the community of Eabametoong (Fort Hope) First Nation to ensure they have the supports they need for their long-term recovery and that enable them to stop taking suboxone.”
Right now, Sugarhead says her clients don’t have what they need to do that.
“I wouldn’t want them to come off [suboxone] today. I wouldn’t want them to come off next week, or in a month,” she says. “As long as I know that they’re at the edge of a cliff and there’s no safety net for them, I’m not going to be the one to push them off.”
Until there’s adequate funding for mental health support and cultural healing that helps entire families deal with the issues underlying addiction, Sugarhead says her clients are at risk of a relapse if they go off suboxone.
“I can’t get a client to come in here, wean them [off suboxone]… and then promise them that everything’s going to be OK,”Sugarhead says.
“They go home to a house that has two, three families in there and then maybe three or four out of those people that are in there are still using [drugs]. That’s like feeding him to the wolves.”
Along with counselling, members of Eabametoong have suggested a healing lodge that would bring families out on the land together.
The availability of that kind of healing is more urgent than ever, Sugarhead says, with the threat of fentanyl on the horizon.
Much more potent than oxycontin, the relatively cheap-to-make opioid has been increasingly mixed into other street drugs, killing hundreds of people in British Columbia and Alberta.
It’s only a matter of time before fentanyl, like oxy, reaches Eabametoong, Sugarhead says.
The prospect is so scary that many community members don’t even want to talk about it, she says. But people need to understand the danger they’re about to face if they’re going to avoid another opioid crisis.
“If we’re not trying to get prepared for it, then we might as well start putting money away for coffins.”