Increasing opioid dependency in the aboriginal community has been on a steady rise for years. Researches and academics are wondering what the possible cause for such high levels of prescription drug misuse could be caused from. However, if we look at the aboriginal community’s history of mistreatment and abuse such high levels would not be so absurd but understood well. When trying to understand an issue such as this we must consider all determinants of health.
The problem of substance abuse in Canada among the Aboriginal population is concernedly high in comparison to the overall Canadian population. Globally speaking, Canada has one of the highest levels of prescription opioid misuse, morbidity, and mortality (Cayley Russel, et al.). My main purpose in this paper is to dissect why this is, as well as to discuss already implemented preventions and precautions to help eliminate this issue within the population, and to moreover to discuss why they aren’t working.
Historically speaking the aboriginal community has suffered a great deal at the hands of the colonials. Their history, surrounding the confederation of Canada, is filled with trauma, systematic and individual racism, generational abuse – which is all by way of colonial structures and involvement. Experiences, such as the residential school system, have been linked to detrimental mental and physical health outcomes, and may have indirectly contributed to the elevated substance use/abuse rates we are currently seeing among this population (Russel, et al.). For example:
In the 19th century the Canadian government took it upon themselves to educate and “care” for the aboriginal population. They thought their best chance of succeeding was for this population to learn English, adopt Christianity, and Canadian customs. The hope was to eradicate native traditions within a few generations. The Canadian government did this though implementing federally run residential schools in many aboriginal communities with mandatory attendance. In these institutions students weren’t allowed to speak their native language or practise any of their native traditions; and if caught punishment was quite severe. Students who attended these schools experienced physical, mental, and sexual abuse; most attended schools far away from their parents for 10 months of the year, and some all year round. Correspondence to parents from children were written in English, which many couldn’t read (CBC). Students in these schools were also involuntary subject to a variety of experiments without their parents’ consent as well (Leslie Young).
According to the Canadian Journal of Psychiatry prescription drug abuse among adolescent teens (grades 7-12) is high especially those who identify as First Nations, Metis, or Inuit. This data is summarized from individuals living across all 10 provinces in Canada. Males more often report the use of stimulants to get high, while females were more likely to use pain relievers, sedatives, or tranquilizers. Researchers hypothesize that school connectedness is an important preventative factor for this population. However, when we talk about school connectedness we must consider exactly what that means. To be connected in school means to be connected within your community; so, what is going on within aboriginal communities that members of this population feel disconnected? We define school connectedness as “the extent to which students feel personally accepted, respected, included and supported by others in the school social environment” (Rebekah L. Chapman, et al). In adolescent behaviour, school connectedness has been pinpointed as a critical factor in development, as well as linked to elevated levels of school retention, improved emotional health and wellbeing, and a reduction in problem behaviour (Rebekah L. Chapman, et al). School connectedness is gained through factor such as attitudes toward school, school commitment, involvement, and school related activities. Within the aboriginal community those who don’t have a high school diploma form 32% of the Aboriginal population (Wilson, et al). This number is twice the rate than in non-Aboriginal Canada (15%). My point here being that how can individuals within this population form school connectedness when many of these individuals don’t complete school in the first place?
Besides colonization and low education rates among the Aboriginal population, there are other determinants of health that could be linked to high prescription drug misuse such as unemployment, marginalization, general abuse and trauma, cultural suppression, and poverty. Misuse of prescription opioids has been found to vary by province and region. However, in the nation of Nishnawbe Aski 50-80% of the adult population, and up to 50% of the youth misuse prescription opioids. In 2012, the Matawa First Nation estimated that 2000 people, of a population of 4912 were addicted to prescription drugs. Individual reserve communities have witnessed an increase in drug use as well. First Nation communities such as Cat Lake declared a ‘state of emergency’ because an estimated 70% of community members, age 11 to 60 years, are abusing prescription drugs creating a mass of social disruption, which included crime, child neglect, loss of employment or economic functioning at a community level (Cayley Russel, et al).
In my field the methods used for the studies were obtained both quantitatively and qualitatively. There are numerous approaches for this type of research but the patterns I noticed were as followed: for articles from the Rural and Remote Health journals their data was collected via scientific literature databases, such as Google Scholar, ProQuest, Pub Med, etc., in addition to that, experts on the field were sought to provide extra references and sources. This was done to expand the scope of the study. The second article from this same journal deals more with numbers in that it is quantitative research. The context of this journal is focused on the Canadian patterns of opioid abuse: the extraordinary rise of opioids followed with the decrease in heroine use, as well as how rural and remote First Nation communities that have been hit particularly hard by the increase in narcotics abuse.
The term “geographical imaginations” is defined as the “specialized cultural and historical knowledge that characterizes social groups” (Derek Gregory, 1993). When you think about aboriginal peoples what kind of characteristics comes to mind? For many, initial thoughts may be negative. Recent surveys regarding stereotypes about Indigenous Peoples found that “just over one in ten expresses his or her first impression of Aboriginal peoples in clearly negative terms pertaining to special treatment or negative attributes” (Indigenous Corporate Training INC.). This includes, but not limited to, mention of tax breaks, reliance on welfare, feelings of laziness/lack of societal contribution, or just overall negative feelings. By now, you may be asking yourself “why?”. Well, to get a better understanding perhaps look at Canadian/Aboriginal history: its riddled with genocide, colonization, stigmatization, racism, marginalization, you name it and the aboriginal people have been through it.
Geographical imagination matters because how we construct our health knowledge and carry out our health behaviour is contingent upon our view of ourselves; and our perception of ourselves can be tainted by others’ perception of us. Rural and remote First Nation communities have declared Northwestern Ontario’s prescription drug abuse to be an epidemic, a crisis, and a state of emergency. Some populations have incurred an addiction rate of 70% (Hancock et al.). What kind of suffering could possibly be going on within this population that some communities have an addiction rate of 70%?
Therapeutic landscapes, introduced first by William Gesler in 1991, is an interesting concept. Gesler defines it as a “geographic metaphor for aiding in the understanding of how the healing process works itself out in places”. However, initial studies done on therapeutic landscapes was mainly concerned with places with a reputation for healing, such as Lourdes in France, or Bath in England. The evolution of the therapeutic landscape concept in health geography continued as geographers pursued such ideas. Soon health geographers became focused on how to create everyday living spaces as therapeutic landscapes, such as hospitals, homes, parks, etc.
The Canadian governments approach at addressing the opioid crisis is aimed at physicians and their prescribing practices, increasing the availability of naloxone – an opioid antagonist, or introducing a prescription monitoring system for narcotic drugs. The Natural Opioid Use Guideline Group presented some recommendations, however most of these recommendations came of as softly phrased suggestions, and almost all recommendations had little direction about when to not prescribe and/or limit doses or duration of opioids (Jumah, et al.). Furthermore, evidence supporting long-term chronic pain using opioids is weak and insufficient (Jumah, et al.). If we look at epidemiological studies at the population level in North America we would see a strong correlation between levels of opioid dispensing and opioid-related deaths (overdoses), and that the dispensary of prescription drugs has been on a steady increase since 2001 (Jumah et al).
The Canadian government has implemented some solutions to reduce the effects of prescription drug misuse in the population; but these solutions don’t seem to be working. Opioid related deaths continue to rise, especially within indigenous population; however, it has been established that these rising levels are due to long-lasting affects of colonization. I strongly believe this population is using drugs as a method of coping and to truly stop this epidemic from worsening we must go into these spaces and create a healthy living environment, tailored to their cultural needs. This takes us back to the concept of therapeutic landscapes: how is healing supposed to work itself out in spaces and places that need healing themselves?
There’s many factors to contribute to the problem of prescription drug misuse within the aboriginal population, however the one of focus in this paper is the lasting affects of colonization. Early settlers in Canada disrupted the native populations way of life through lying, stealing, genocide, and deception. The aboriginals were left with memories of residential schools, developed for the sole purpose of eradicating Native customs and traditions. Survival of the Europeans during early settlement in Canada was aided by the indigenous peoples, who helped them endure harsh winters and maneuver through unknown terrain. To have a group of people, whom you trusted and cared for, turn their back on you and your community is hurtful. To have your land stolen, your people killed, your children taken from you to be put in schools thousands of kilometers away without proper forms of communication is detrimental. And any group of people whose ancestors have gone through anything similar, with still very obvious forms of racism would be going through the exact same thing. In light of my research I do wonder how such communities, living in areas as remote as they are, are able to get their hands on prescription drugs, especially when transporting goods and services such as milk, bottled water, etc., is difficult. Getting health care providers to these communities is nearly impossible…but that transportation of drugs is not. What can the Canadian government do to control the movement of drugs and provide more sustainable resources to such vulnerable populations?
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