Side Event: Working towards equitable access to treatment of problematic substance use for Indigenous peoples

Organized by Canada and New Zealand, and New Zealand Drug Foundation, Te Rau Ora Ltd and the Thunderbird Partnership Foundation.

Michelle Boudreau, Health Canada:

Welcome. Sincere thanks to organizers that did an tremendous amount work to prepare for this event. First Nations peoples experience extremely high levels violence and poverty and intergenerational trauma due to colonization, have contributed to disproportionate harms from alcohol and drugs.

Tracy Potiki, Te Rau Ora:

[Traditional Māori greeting performed]

My people greet you. We acknowledge the people here today. I greet you, I greet you all. I am guided by the four winds. My place is Aotearoa. My tribe is Te Rau Ora. I am a drug addict.

The barriers for my people to access treatment and heal is immense. When I was in a recovery program I was told not to see my family and just to focus on recovery. I would have preferred to have my arms cut off. Family is my life and integral to my culture.

We have entered into a partnership with New Zealand Drug Foundation to prevent methamphetamine harms in Māori communities. Currently methamphetamine is cheaper than cannabis in New Zealand. I want to explore the link between colonization, intergenerational trauma and drug related harms. Māori land ownership has been increasingly lost since signing of the Treaty of Waitangi in 1840 and the Crown has continue to breach the treaty up right up until the present day. Māori people are ‘Top of the Pops’ and we are the ‘stars’ of incarceration rates, poverty, drug related harms, and countless other indicators.

Māori knowledge and rights must be acknowledged in drug treatment programs. Why getting treatment so hard? I didn’t have a drug problem, I have a living life problem as Māori girl and women. I struggled with cultural differences, not drugs. For treatment to work it must in enhance indigenous identity, reduce stigma and discrimination and treatment must be holistic and taking into account indigenous knowledge. In closing I ask you to see us the solution, not the problem.

Marie Roberts, Ministry of Health, New Zealand:

We have a clear mandate to achieve equity of health. People have differences in health that require different resources for health outcomes. Situation with Māori is not equal at all. Māori are disproportionately affected by drug use and harm. Māori report use of amphetamines at frequency three times higher than other populations. Māori have high hospitalizations and incarceration for drug offences. Māori also have higher access of treatment. Given their higher burden of harm, this can be understood as a positive but it is not clear that treatment access aligns with level of harm. Determinants of health are relevant. Must understand approaches that Māori people need. Practices such as co-designing of services are vital. We cannot have “one design fits all” in treatment. Must occur across prevention, education, workforce development, justice system, etc. Entire government service need to reduce harms form drugs and be responsive to achieve equity. Many of the services that are designed by and for Māori include considerations of flexibility for cultural needs. Focused on enabling accessibility of these services. The way we fund and contract will make a different. Funding distribution allow Māori to access treatment how they want it. Northland region has an initiative called the Path to Wellbeing. Includes police and health resources. Large portion of our response to inquiry focused on health and social resources. Funding given in 2018 budget. Services include focus on the well-being of individuals. Lot of work to do to achieve equity of treatment, but we need to learn from our history and current situation to achieve equity. UN Declaration on Rights of Indigenous People is relevant. As international colleagues, let’s continue to collaborate on this very important goal.

Laurie York, White Earth Nation, Giizhawaaso – Indian Child Welfare:

[Greeting in Ojibwe language]

Hello my name is Laurie York, of the White Earth Nation, which is in Minnesota in the USA. In 2014 the White Earth Indian Child Welfare had seen 2 – 4 children born each month experiencing neonatal abstinence. As a result we developed a ‘MOMS’ program utilizing Suboxone for pregnant mothers. Six months later there were zero withdrawals among our children. This was a voluntary program and this is important to note, as it empowers our people to chose.

We didn’t stop with the the mothers. The fathers also need assistance so we implemented the medicated assisted treatment (MAT) program. Following this we started a new program to look after the children. Previously children were separated from parents that were using drugs, and this caused immense trauma.

Acknowledgement of our sovereign nation is key to our success.  We are able to provide culturally specific treatment programs that acknowledge our sovereign nationhood. There are nearly 300 children that remain with their parents who are addressing addictions. Traditional customs, and in particular child rearing, was interrupted by colonialism and crucial that families are not separated during the process of healing.

Carol Hopkins, Thunderbird Partnership Foundation:

Equity of access requires change in our thinking. Often not recognized of having an evidence base. We acknowledge in Canada culture-based practices for health services. Developed models in Canada emerging from conversations with First Nations across the country. Three models include “Honouring Our Strengths,” “First Nations Mental Wellness Continuum Model,” and “Indigenous Wellness Framework.” Indigenous peoples want to use culture as central to dealing with substance use. Family and community are central to our values. We are much more than our deficits. We are about our wellness. Must think about what creates wellness. We know that is important across the communities we have been talking with about using opioids in a harmful way. Relevance of histories of trauma. People need more relief from pain, emotional memories, and inability to cope. Experiences of the residential school systems transcend generations over time. History of attempts to end their lives by suicide. Communities are attending to the whole family. Importance of access to employment. Culture plays a role. Hard to imagine how sitting around a fire can help people deal with amphetamine issues, but it is important to their spiritual connection. People participating in these programs achieve a 33% increase in wellness overall.

Questions and Answers:

Q: Position on criminal justice reform? Relationship between decriminalization and reducing stigma?
A: When New Zealand decriminalized possession for use across all drugs, saw a drop in people entering the criminal system. Large correlation.

Decriminalization is necessary for Indigenous peoples in Canada. Indigenous peoples have very easy access to incarceration, appropriation of our children, and conditions put upon them. Criteria with requirements for abstinence to get their children back from child welfare system, but no treatment or wellness support for children or families. Even in the environment of legalized cannabis in Canada, First Nations still face barriers given requirements for abstinence. If we lack changes in the way we are supporting people, then parole and probation services lead them to serve longer and full sentences.

Out of home placement of children leads them often to end up in the criminal justice system. Need to ensure that there is access to treatment to avoid that cycle from continuing.

Q: Do you think there is a time and place for Indigenous peoples to help us?
A: When we are doing well, everyone will benefit.

Q: Mainstream services now employing Aboriginal elders. Seeing dramatic improvement in engagement. Has this happened in your countries?
A: Yes, workforce is changing. Questions about their credentials and compensation. Not an easy conversation, but we are having it and getting to the value of Indigenous based knowledge and practices. Happening in Canada and USA. Long way to go.

We provide elders with an honorarium. They are a vast resource. We gift them and provide an honorarium.

Sometimes elders put in positions that do not respect and honour them for who they are.

Q: How do you find the CND, particularly as Indigenous women? What can we do in Vienna to support you?
A: Thankful to have become aware of the CND and their work. Last CND, I was struck by where Indigenous people fit in here. Times when it is clear that resolutions can speak to Indigenous peoples, but the application of those is sometimes lacking. UN Declaration on Rights of Indigenous People has been noted in Canadian civil society’s briefing to the Canadian government. While we are here, opportunity to understand how policies are influenced and make sure we close the gap and translate discussion here to policies in our country. I believe there is a need for consistent and greater voice of Indigenous peoples.

Acknowledge New Zealand for bravery in bringing Indigenous peoples along to the CND.

Q: Indigenous Drug Policy Network launched in 2008. Hope we will continue to be involved at the CND.

Q: Speculate on Wetʼsuwetʼen protests in Canada and how it will progress?
A: Health of the land is the health of the people. Critical to equitable access of health. First Nations in British Columbia won a case in the Supreme Court that validated their right to significant amount of land in British Columbia. Established a health authority so First Nations people could govern their health and services with guaranteed funding relationships by government. Recognition of land is critical to equitable access to healthcare. Connection to land, lineage, and language are three critical factors that set mental health and wellness aside from non-Indigenous people. If they do not have access to our land, they lose part of their identity and this impacts health and wellness overall.

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