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As a nur–practitioner working at Dennis Franklin Cromarty High School in Thunder Bay, the city that rves as
鸡翅膀的做法the gateway to Ontario’s northwestern hinterland, Mae Katts thought she knew it all about substance misu among Aboriginal adolescents.
Cannabis, alcohol, LSD, and ecstasy were the mainstays—crack cocaine and heroin far lesr problems. So, a few years ago when numerous students began returning from their summer holidays agitated, anxious, and complaining of headaches and sore
muscles, she wondered what was going on. “The kids emed to be showing signs of opioid withdrawal”, she recalls.As it turned out, she was right: in
ssions with health counllors, many
成功的例子
students admitted they were abusing
prescription opioid drugs, especially oxycodone, a highly addictive painkiller that has been widely prescribed and heavily misud in Canada over the past decade. Katts knew that surveys indicate 15% of teenagers in Ontario take prescription opioid drugs for non-medical purpos. But Katts quickly became convinced the misu levels were even higher among Aboriginal students in her school—especially among tho who spent the summers in isolated rural communities along the subarctic shores of Hudson Bay. “Prescription opioid dependency was exploding”, Katts recalls about the situation in 2009, when she fi rst began investigating it.
In a ries of exploratory visits to some of the student’s remote home communities in 2010, Katts confi rmed that many of the rural Aboriginal villages were awash with prescription opioid drugs. “The surveys I did suggested that around 40% of Aboriginal teens in the school in Thunder Bay had opioid dependencies”, she explains. “But the communities where they came from had even higher rates.”
In the Nishnawbe Aski Nation, which encompass most of Ontario’s northern land mass, with a tota
l Aboriginal population of around 45 000 in 49 communities, more than 50% of the adult population are prescription opioid drug misurs in need of treatment, according to a 2011 asssment prepared for the Nishnawbe Aski chiefs. A study that year by rearchers from the Northern Ontario School of Medicine found that 17% of 482 pregnant Aboriginal women from northwestern Ontario misud prescription opioid drugs during pregnancy, with a substantial percentage of expod newborns experiencing opioid withdrawal symptoms. Faced with increas in family and child neglect, crime, and violence due to opioid misu, in 2011 the Nishnawbe Aski Nation chiefs formally declared a “state of emergency” and urgently requested assistance from the Governments of Canada and Ontario.
The roots of this crisis, Katts explains, lie partly in the health-care
system managed by the Government of Canada, which is responsible for Aboriginal and Inuit health care throughout the country. Many Aboriginal people addicted to drugs, she explains, trace their addiction
to prescriptions written by “fl
y-in” physicians working on short-term contracts for Health Canada, the federal department that adm
inisters
Aboriginal health care. According to Health Canada, 898 opioid pres-criptions were dispend per 1000 Aboriginal individuals aged 15 years or older in Ontario in 2007. “The drugs were dispend very generously”, says Benedikt Fischer, an expert on Canada’s
prescription opioid crisis at the Simon Frar University in Vancouver, who agrees that the Nishnawbe Aski Nation now face a vere emergency. “The government has facilitated this problem, and the medical system is also implicated. But their respon has been
very hesitant and slow.”In an environment where visiting physicians ldom maintain steady contact with patients for more than a few months, Katts and Fischer believe overly generous opioid prescribing helped trigger widespread addiction. Tho who develop dependencies, and are then unable to renew their prescriptions, often turn to illicit sources where pills costing just a few dollars each over the counter at pharmacies trade for up to CAN$1200. For communities long-plagued by deep poverty, high unemployment, overcrowded housing, polluted drinking water, and some of the highest suicide rates in the world, the prescription opioid disaster adds yet Nur-practitioner Mae Katts has been working to solve the opioid addiction crisis
“...surveys indicate 15% of
teenagers in Ontario take
prescription opioid drugs for
non-medical purpos.”
P a u l C W e b s t e r
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another layer of suff ering, explains Elijah Moonias, who rves as the elected chief for the Marten Falls First Nation in Ogoki Post, a community of 300 people about 400 miles north of Thunder Bay.
Moonias estimates 90% of adults are dependent on prescription opioid drugs in his community. “A lot of the time, the money for the opiates comes from welfare cheques intended to help families with children to feed”, he says. “The adults in the families cannot work becau of their addictions, and their children are not getting food and clothes. It is horribly destabilising.”
In a 35-year career spanning long periods as a nur–practitioner both in community health ttings as well as in management—including a 6-year tenure as the director of Aboriginal health care in Ontario for Health Canada—Katts says prescription opioid dependency is the toughest health-related problem she’s ever encountered. To underline the verity of the crisis, Katts explains that the standard treatment for prescription opioid addiction in Canada is the same as it is for heroin addiction—long term methadone substitution therapy. Thanks primarily to patients with prescription opioid dependence, the number of people in methadone maintenance treatment in Ontario has doubled to more than 28 000 in recent years. But becau methadone therapy must be medically supervid, Katts explains, it is not available in remote communities without resident physicians. Instead, Aboriginal people addicted to prescription opioid drugs are obliged to move to towns and cities where methadone programmes have been established. Katts estimates that at least 9000 Aboriginal individuals addicted to the drugs have gathered in Sioux Lookout, a small city that acts as a hub for northwestern Ontario.
After realising that dozens of teenagers in her school were opioid-dependent, in 2010 Katts began scouring the medical literature for treatment options that off ered more hope than methadone, which was
unavailable to her teenage patients in
Thunder Bay, and unavailable in their
communities back home. She soon hit
upon an experimental approach using
Suboxone—a tablet that combines two
drugs ud for opioid drug addiction—
buprenorphine and naloxone.
After veral months of experimental
treatment, Katts obrved substantial
success with a 30-day programme
in which Suboxone dosages were
gradually reduced and in some
曾国藩书法cas eliminated following which
her teenaged patients were cloly
obrved and off ered counlling
and care for 12 months. “It worked
astonishingly well”, Katts says bluntly.
“From February, 2011, to now we’ve
had 50 students in treatment and all
have had good success. Many have
now completed 12 to 15 months of
maintenance and have been weaned
药店春联
off Suboxone—and still remain
opiate-free.”
Enthud by this success in the school
tting, in late 2011 Katt persuaded the
Nishnawbe Aski Nation chiefs to allow
her and a team of academic rearchers
and clinicians supported by the
Canadian Institutes of Health Rearch,
the Public Health Agency of Canada, the
Ontario Ministry of Health, and Long-
Term Care and the Centre for Addiction
and Mental Health in Toronto to stage a
pilot study involving 22 adults addicted
to prescription opioid drugs in a small
Aboriginal community in northwestern
Ontario, which has not been identifi ed
抽筋舞to protect the identities of the study
participants.
Starting with initial small dos,
the participants (who had misud
prescription opioid drugs for a健康英语怎么说
mean duration of 3·7 years) received
increasing amounts of Suboxone
daily under direct obrvation at
the treatment site on an outpatient
basis. Suboxone tapering began
8 days later. At the end of the 30-day
tapering-down period each patient was
assd individually for a personalid
treatment aftercare plan, including the
potential need for continued low-do
Suboxone maintenance. The aftercare
programming, Katts explains “consisted
of veral weeks of individual and
group counlling focusing on relap
prevention, incorporating motivational
enhance m ent, health education, and
spiritual support”.
While the primary objective of the
treatment programme was opioid
abstinence at the end of the 30 day
tapering-down pha, only one
participant was comfortable being
completely tapered offof Suboxone.
For the others, the rearch team
concluded, opioid dependence may be
a chronic condition requiring long-term
Suboxone maintenance. But by off ering
Aboriginal people addicted to opioid
drugs a treatment option that allows
them to remain in their communities,
explains chief Moonias of the Marten
Falls First Nation in Ogoki Post, “the
Suboxone treatment reprents an
extremely important step towards
helping our communities recover.”
At Simon Frar University in
Vancouver, Benedikt Fischer, who
worked with Katts on designing and
implementing the Suboxone pilot
study, says the approach could at last
help resolve the problem with lack of
treatment in remote communities,
which he describes as a legacy of
discriminatory government policies
that denied methadone treatment
while refusing to fund alternatives for
Aboriginal people living in their home
communities.
Blossom Leung, a spokeswoman for
Health Canada, says the government
is now taking a range of steps to
address Aboriginal prescription drug
misu, including the development
of a national strategy to cope with
the overall crisis of prescription drug
misu in Canada in consultation with
Aboriginal experts. Health Canada is
拥抱情人节
also asssing ten treat m ent projects
琴棋书画指的是什么including Katts’ to help Aboriginal
communities “identify best practices
and refi ne their local prescription drug
abu programmes”, says Leung.
Paul C Webster
