Addiction, treatment issues remain high priority

by Nancy McDermid

M’CHIGEENG-In keeping with its role as a leader in drug strategy development, the M’Chigeeng Health Centre hosted a Knowledge Symposium on May 13 at the M’Chigeeng Community Complex with opiate addiction and recovery as its primary focus.

Following an opening ceremony, Chief Joe Hare welcomed the audience and professionals working in the field of addictions. He spoke of his own positive childhood experiences while growing up in M’Chigeeng compared to the cultural assault he endured during his years in residential school. Commenting on the impact of the teachings at the school he said, “We went into a mood of shame about who we are and about our community and the message was harmful.”

“Many people who went to residential school took up addictions,” he continued. “The way they lived their life went from bad to worse and it affected the entire family and whole community.”

The chief drew strength, he said, from learning about Anishnabe spirituality and teachings and believes the young people in the community who are engaged in drug use could benefit from the same. “We have to re-visit and re-learn those practices and beliefs so young people can be proud of who they are,” he said.

Keynote speaker Dr. Raju Hajela commented on this theme during his address saying that

the residential schools have left a legacy of social disruption and loss of meaning and purpose that is “something we have to live with.”

“Today’s kids are getting their drugs from their parents and grandparents just because the drugs are in the house,” he said.

In defining drug addiction, the doctor said that “it is a disease of wanting more.”

An addict wants to perpetuate a feeling of escape or euphoria. Dispelling the myth that psychiatric problems drive addiction, he said that “trauma does not cause addiction, but it may increase the risk for escape by the psycho-social use of substances.”

Opioids, one of the five categories of drugs which include stimulants, depressants, hallucinogens, and inhalants, impact the opioid receptor in the brain which are sites of activity for endorphins, said Dr. Hajela.

Opioid drugs include oxycodone, morphine, codeine, heroin and methadone.

According to symposium speaker Dr. Kevin O’Connor of the Manitoulin Central Family Health Team, oxycodone is the main prescription opioid of concern for doctors not only on the Island, but in North America as a whole. Affecting all income levels, it is a particular concern in Northern Ontario and some communities are in crisis due to its misuse, he explained.

“Over the last several years physicians have heard a lot of stories about prescription misuse from Native and non-Native people across the Island,” he said. “A lot of chiefs have spoken out about this issue, which is happening in high numbers and which can be described as a crisis.”

Used as a long acting pain medication for chronic pain, Oxycontin along with short acting drugs such as Percocet, have been over-prescribed by some doctors, Dr. O’Connor admitted.

“In a study completed in the last few months, family doctors who prescribe the most, prescribe 55 times as much as those who prescribe it the least,” said Dr. O’Connor.

“We have a responsibility not to enable addiction and diversion,” he said referring to his colleagues.

The goal of the Manitoulin Opioid Prescription Policy is to decrease the overall amount of opioid prescriptions for non-cancer pain in the doctor’s office or in the ER, the doctor explained.

“Statistics are being tabulated for the first year of the program with 3 out of 6 pharmacies reporting a decrease by 42 per cent of prescriptions for Oycodone on the Island,” he said.

The policy acknowledges that pain and drug abuse is a huge problem, and not just a medical one, with complex social, legal, family, cultural and spiritual problems associated with it. “It takes more than one doctor to solve the problem,” said Dr. O’Connor.

That theme is echoed by Dr. Hajela who stated that “recovery is everyone’s business.”

It takes the support of peers, family and friends to help someone recover from an addiction and everyone has to be educated about the topic.

“People are not addicts by choice,” Dr. Hajela insisted, dispelling a myth that many people believe to be true.

Addiction occurs when the relationship with the substance that is being abused takes precedence over any other relationship including one’s self, Dr. Hajela explained.

An addict’s self-deception leads to denial and lying, will power has no meaning and protection by others allows the disease to progress, the doctor continued. He added that anger by other people increases the resistance to healing.

“Resistance is part of the disease. If you encounter it, tell the person that ‘the door is always open’ and ‘this is what you need.'”

When a person accepts that they need to make changes, the doctor is adamant that recovery can work, but “without treatment or engagement in recovery activities, addiction is progressive and can result in premature death,” he said.

Quoting from the Srimad Bhagvad Gita, he explained how shame, anger and fear are held in the body and called for a combining of Aboriginal, Ayurvedic and Allopathic (western medicine) beliefs in order to further develop treatment options.

One aspect of recovery treatment is the use of methadone as a replacement for substance abuse and Little Current Methadone Clinic physician Dr. Brian Dressler spoke about the history of the drug and the importance of its use.

“Methadone is a valuable healing tool,” he said.

Developed as a synthetic painkiller during WWII by German pharmacists, it sat on the shelf following the war until the 1960s when heroin use in the US prompted its return, the doctor explained. It began to be used more frequently in Canada during the 1980s and today, in Ontario, 25-30,000 people are being treated with methadone, Dr. Dressler said.

“The problem with opiate dependence is that changes take place in the brain because of the drugs and it takes a long time to heal,” he said.

The doctor stated that only 15-20 percent of his patients come off of the methadone and are cured, but he feels that untreated opiate abuse is worse because it could take 20 years off the life expectancy of an individual.

Other speakers included psychiatrist Dr. Douglas Marr who gave statistics for mental health occurrences in the adult population. He also addressed problems specific to First Nation communities that may be contributing to their poor mental health such as isolation, unemployment, loss of cultural identity and transgenerational family trauma.

Nipissing University professor Peter Beaucage spoke about the value of returning to a traditional way of life as integral to healing, referring to recovery as a “miracle that has to come from within.” He stressed that “we all walk a human journey,” in asking for understanding in regards to addiction.

Several consumers spoke as well, sharing their own experiences which added a personal element to the topic of substance abuse.

A panel discussion ended the day with questions from the audience addressed to all the speakers.

Several people posed questions about the operation of the methadone clinic, including queries into urine drug testing and its effectiveness.

“Is there a way to prove a patient is taking the full dosage?” was one question that was asked, and Dr. Dressler answered that it is very difficult to prove. When asked whether the measures put into place regarding ‘carries’ (methadone doses that are carried away from the clinic) could be improved, the doctor answered “yes, they can be,” but stressed that there should be respect maintained for basic human rights. Dr. Hajela then emphasized the importance of the monitoring and supervision of methadone so that maximum safety can be achieved while respecting human rights.

Dr. Dressler was questioned about his willingness to confer with a patient’s primary physician and he answered in the affirmative. He encouraged those in the audience to call his clinic with their questions in keeping with Dr. Hajela’s quest for open communication.

Dr. Hajela believes that methadone treatment needs to be part of a comprehensive program where doctors and frontline treatment workers work together for results.

Offer supportive care, engender hope, display empathy, and encourage honesty are some of the suggestions he made during his keynote address. The doctor encourages a 12-step withdrawal management program and the appropriate pharmacotherapy if needed.

“Awareness comes through action,” he said. “Addiction is not a choice, but recovery is.”