Canadian Journal of Public Health

, Volume 109, Issue 2, pp 219–222 | Cite as

Community strengths in addressing opioid use in Northeastern Ontario

  • Kathryn DormanEmail author
  • Brittany Biedermann
  • Christina Linklater
  • Zahra Jaffer
Special Section on Substance Use: Commentary


The number of opioid-related deaths in Ontario is rising, and remote First Nations communities face unique challenges in providing treatment for opioid use disorder. Geographic barriers and resource shortages limit access to opioid agonist therapy, such as buprenorphine or methadone. However, attempts to rapidly expand access have the potential to overlook community consultation. Our experience in Moose Factory, Ontario, offers insight into the ethical questions and challenges that can arise when implementing opioid agonist therapy in Northern Ontario and provides an example of how a community working group can strengthen relationships and create a culturally relevant program. We call on medical regulators and the provincial and federal governments to invest in community-based opioid dependence treatment programs that incorporate cultural and land-based healing strategies and draw on First Nations teachings.


Opioid-related disorders Medicine Traditional Buprenorphine Naloxone drug combination 


Le nombre de décès liés aux opioïdes est en hausse en Ontario, et les communautés éloignées des Premières Nations font face à des difficultés uniques pour traiter les troubles de consommation d’opioïdes. Les obstacles géographiques et la rareté des ressources limitent l’accès au traitement par agonistes opioïdes comme la buprénorphine ou la méthadone. Les tentatives d’élargissement rapide de l’accès risquent toutefois de passer outre aux consultations communautaires. Notre expérience à Moose Factory (Ontario) nous a donné un aperçu des questions éthiques et des difficultés qui peuvent se poser durant la mise en œuvre du traitement par agonistes opioïdes dans le Nord de l’Ontario et nous a montré qu’un groupe de travail communautaire peut renforcer les relations et créer un programme culturellement approprié. Nous invitons les organismes de réglementation de la médecine et les gouvernements fédéral et provinciaux à investir dans les programmes communautaires de traitement de la dépendance aux opioïdes qui intègrent des stratégies de guérison fondées sur la culture et le territoire et qui puisent dans les enseignements des Premières Nations.


Troubles liés aux opiacés Médecine traditionnelle Association de buprénorphine et de naloxone 



We would like to thank members of the Opioid Dependence Treatment Program Working Group for their important contributions to the program.

We would also like to acknowledge and express gratitude for leadership from the Moose Cree First Nation and MoCreebec Eeyoud Council, support from the Weeneebayko Area Health Authority, and guidance from those with personal or family lived experience.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. Assembly of First Nations. (2011). The National Native Addictions Partnership Foundation Inc, and Health Canada. Honouring our strengths: a renewed framework for addressing substance use among First Nations people in Canada. Ottawa, ON: Ministry of Health Accessed on 1 July 2016.Google Scholar
  2. Dhalla, I. A., Mamdani, M. M., Sivilotti, M. L., Kopp, A., Qureshi, O., & Juurlink, D. N. (2009). Prescribing of opioid analgesics and related mortality before and after the introduction of long-acting oxycodone. CMAJ, 181(12), 891–896.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Gomes, T., Mamdani, M. M., Dhalla, I. A., Cornish, S., Paterson, J. M., Juurlink, D. N., et al. (2014). The burden of premature opioid-related mortality. Addiction, 109(9), 1482–1488.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Kanate, D., Folk, D., Cirone, S., Gordon, J., Kirlew, M., et al. (2015). Community-wide measures of wellness in a remote First Nations community experiencing opioid dependence: evaluating outpatient buprenorphine-naloxone substitution therapy in the context of a First Nations healing program. Canadian Family Physician, 61(2), 160–165.PubMedPubMedCentralGoogle Scholar
  5. Kelly, L., Guilfoyle, J., Dooley, J., Antone, I., Gerber-Finn, L., et al. (2014). Incidence of narcotic abuse during pregnancy in northwestern Ontario: three-year prospective cohort study. Canadian Family Physician, 60(10), e493–e498.PubMedPubMedCentralGoogle Scholar
  6. Kimber, J., Larney, S., Hickman, M., Randall, D., & Degenhardt, L. (2015). Mortality risk of opioid substitution therapy with methadone versus buprenorphine: a retrospective cohort study. Lancet Psychiatry, 2(10), 901–908.CrossRefPubMedGoogle Scholar
  7. Mamakwa, S., Kahan, M., Kanate, D., Kirlew, M., Folk, D., et al. (2017). Evaluation of 6 remote First Nations community-based buprenorphine programs in northwestern Ontario: retrospective study. Canadian Family Physician, 63(2), 137–145.PubMedPubMedCentralGoogle Scholar
  8. Mattick RP, Breen C, Kimber J, Davoli M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews; CD002207.Google Scholar
  9. Resolution 09/92. (2009). Prescription drug abuse state of emergency. Thunder Bay, ON: Nishnawbe Aski Nation.Google Scholar
  10. Rush B, Kirkby C, Furlong A. (2016). Northeast local health integration network addiction services review. Timmins, ON.Google Scholar
  11. Srivastava, A., Kahan, M., & Nader, M. (2017). Primary care management of opioid use disorders: abstinence, methadone, or buprenorphine-naloxone? Canadian Family Physician, 63(3), 200–205.PubMedPubMedCentralGoogle Scholar

Copyright information

© The Canadian Public Health Association 2018

Authors and Affiliations

  • Kathryn Dorman
    • 1
    Email author
  • Brittany Biedermann
    • 2
  • Christina Linklater
    • 3
  • Zahra Jaffer
    • 4
  1. 1.Department of Family and Community MedicineSt. Michael’s HospitalTorontoCanada
  2. 2.Moose Cree Health ServicesMoose FactoryCanada
  3. 3.Moose Factory Health CentreMoose FactoryCanada
  4. 4.Weeneebayko Area Health AuthorityMoose FactoryCanada

Personalised recommendations