Canada’s deepening wound: The Aboriginal health crisis and a call for culturally sensitive healthcare

Overdose is now among the primary causes of death in Canada. Specifically fentanyl, and other fentanyl analogues, are being found in roughly 70 per cent of all overdoses, and increasingly in samples of heroin and other street drugs. This number is up by about 45 per cent since 2016. One of the reasons behind the proliferation of these drugs is the significant benefits that opioids bring to users; they relieve both chronic and acute pain and come in many forms such as morphine, fentanyl, oxycodone, codeine, and medical heroin. A report by the Standing Committee of Health in Canada, published in 2016, reported Canadians to be the second highest users of opioids in the world. However, the dangers and increased accessibility of opioids arguably outweigh the benefits.

There is a wide disparity between the provinces in the number of deaths by opioid use. British Columbia is one of the most affected with over 1,100 deaths by overdose in 2017, while Quebec has one of the lowest rates. The Standing Committee report further emphasizes that these illicit drugs are making their way into Canada from China, and British Columbia has become the centre of this drug trade due to its many maritime ports. Among the communities most affected by addiction and overdose are the Aboriginal and First Nations communities in British Columbia and Alberta. A sample from the Blood Band of Blackfeet/Kainai community noted that approximately 28 per cent of its people between the ages of 20 and 30 were using opioids. In 2014, the number of opioid deaths in this community led it to declare a state of emergency.

Opioid use in Aboriginal communities may be so high because it offers an easy fix to the numerous problems facing overwhelmed, understaffed, and under-resourced health providers. Access to healthcare for Aboriginal peoples, both urban and rural, is a major issue and is affected by, what the National Collaborating Centre for Aboriginal Health refers to as, social determinants of health. Such factors include socio-economic status, cultural and political inequalities, and history. They are often overlooked when attempting to solve issues such as drug use, addiction, and depression within Aboriginal communities.

In late November 2016 the federal government issued a Joint Statement of Action to Address the Opioid Crisis. The statement outlines how both the federal and provincial governments are working together with health authorities to combat the crisis. Similarly, the Good Samaritan Drug Overdose Act, which became law in 2017, offers legal protection against charges of illegal drug use or possession of a controlled substance in cases of overdose. These measures help to ensure that individuals have no second thoughts about seeking emergency assistance if they find someone who may be overdosing. The Canadian government has also promoted the opening and use of supervised consumption sites where individuals are allowed to bring their own illicit substances and use them in a sterile, safe place. Such safe injection sites greatly decrease the risk of overdose, and exempt drug users from legal action by the state.

Despite these efforts by the government to reduce the number of opioid deaths, overdose numbers are still rising throughout Canada.

The First Nations Health Authority in British Columbia has published a report of preliminary findings to explain the high levels of drug abuse in Aboriginal communities. Opioid abuse can be linked not only to the history of colonial practices carried out against Aboriginal peoples, but also to the fact that Canada has done little in the way of actual reconciliation. While there have been verbal apologies for abuses and the erasure of culture, the mental, physical, and geographical conditions of many First Nations people remain largely unchanged.

A study by the Cedar Project Partnership of First Nations groups found that indigenous youth are five times more likely to die from a drug overdose than other drug users. While 76 per cent of opioid-related deaths in Canada are of men between the ages of 30-40, the majority of Aboriginal deaths, 65 per cent, during the time of the study were of women between the ages of 14-30. Both the Cedar Project study and the First Nations Health Authority find that childhood, intergenerational, and historical trauma are significant causes of drug use in Aboriginal communities. Many Aboriginal peoples report not trusting the healthcare systems to provide help in their times of need.

Aboriginal communities experience significantly higher rates of suicide, depression, alcoholism, and drug use. Their access to culturally appropriate medical services is often hindered by geographic distance, but in other cases, it is due to mistrust of the healthcare system. The government must therefore pursue culturally sensitive healthcare services along with preventive health measures for Aboriginal communities.

The Canadian government is at a critical juncture in terms of its reparations to Aboriginal communities. The opioid crisis is only one of the many faces of Canada’s failure at reconciliation. Unfortunately, the longer we wait, the deeper this wound will become.