Photo: flickr/Alan Cleaver

The first time I went to Sandy Lake, Ontario I was there to help administer a pilot project that aimed to reduce addiction in remote communities using an opiod replacement therapy: buprenorphine-naloxone, also called Suboxone.

Sandy Lake is part of the Sioux Lookout region of Northwestern Ontario. I was struck by the profound impact of buprenorphine in this community of 2,500. Within months, the program was freeing people from a life of servitude to oxycontin, heroin and other opioids. 

The drug is administered by a doctor or nurse. When used properly, buprenorphine is a long acting opioid replacement that stabilizes addicts without causing either intoxication or withdrawal. It also blocks the action of short-acting opioids if they are used. In addition, people who are prescribed buprenorphine must also be monitored for use of alcohol and other opiods, reducing overall substance abuse and preventing dangerous interactions.

One of my colleagues had already made two trips to this community and started over 16 people on the buprenorphine program. By the time I arrived, people were lining up to join this program. They saw that friends and relatives with addiction issues who were using buprenorphine were buying groceries, clothes and formula for their kids instead of spending their savings on Oxycontin pills that cost as much as $1,000 per dose.

The buprenorphine pilot project started in the fall of 2011. It was a joint effort between physicians from northern and southern Ontario, and local communities. The initial pilot program included 100 patients. It was successful enough that the Sioux Lookout Health Authority, the College of Physicians and Surgeons of Ontario, Ministry of Health and Long-term care Ontario, Health Canada and Department of Aboriginal and Northern Affairs joined the effort to expand the pilot to more communities. One of these communities was Sandy Lake where I worked. In Sandy Lake, a three month trial was funded for an additional 15 months.

Unfortunately, the success of these programs could unravel shortly if Health Canada and the Department of Aboriginal and Northern affairs do not renew their commitment to funding their share of this ground breaking made-in-Canada program. 

Unlike more traditional programs, this innovative program is the collaborative creation of these communities, their leaders and the Sioux Lookout First Nations Health Authority in response to the opiate crisis that has devastated these remote, fly-in communities. The community and patients design, run and administer these programs to meet their needs, and the program relies on local staff and volunteers for its day to day operations unlike more traditional treatment programs. Most importantly, participant in the program, can stay in their home community instead or being, where they are isolated from friends and family in unfamiliar surroundings while undergoing treatment.

This is much more effective than the standard abstinence-based treatment. The standard abstinence-based residential program costs an average of $2,000 a month per person and failure rates are upwards of 95 per cent compared to the upwards of 95 per cent retention rate in this pilot at a fraction of the overall cost. If steady funding for the existing level of service does not come through, it will be a major setback to a successful addictions treatment model that has profoundly changed the lives of these communities to “save costs.”

If Health Canada drops these programs to achieve “cost savings,” those “savings” will have a terrible human cost. Approximately ten per cent of individuals who go through untreated opiate withdrawal eventually commit suicide. Untreated opiod dependence leads to suicides, suicide attempts, trauma, arson, theft and other legal woes. These all have tremendous financial implications in other areas of health care from emergency room visits, medivacs ,which can cost up to $20,000 each, surgeries for fractures, HIV and hepatitis C infections from needle use, cardiac infections and law enforcement.

Untreated addictions are a major contributing factor to robberies and assaults. In addition, without a treatment program there are psychological costs — loss of hope, torn families and communities reeling from the emotional devastation.

We have asked about the results of our program. Doctors, patients and their communities report savings and success in these areas of health care usage. Program retention rates support their reports. In one fly-in community, after six months, all but one of 52 patients were still in treatment. 

Right now, hundreds of individuals are waiting for their turn to enter treatment for addictions in these remote communities. But without steady and consistent federal dollars to pay for the staff who administer the treatments and dollars to back the research we need, these programs could lose staff who are looking for long-term work, the health of the patients who are already on the program is at risk and the program may be denied to those who are desperately waiting. So far the Feds have only granted annual funding. 

My question is this: Will NIHB be committed to more than just this fiscal year, the one after or the next federal election when it comes to saving lives, saving dollars and supporting the well-being of these communities? Let’s hope so.

Chetan Mehta is a family physician who currently works at Central Toronto Community Health Centre.  He has worked extensively with people who suffer from addictions, mental illness,  and trauma ; this includes working folks, the homeless, refugees and immigrants, and youthToronto, ON

Photo: flickr/Alan Cleaver