A northern Ontario nurse shared the success story of an innovative program in addressing opioid addiction, with Yukon health care providers Wednesday.

Mae Katt is an Ojibway nurse practitioner.

She helped launch a community-based substitution therapy program that has lead to profound results in addressing oxycontin misuse in northern Ontario First Nations communities.

She shared her experience at the Preventing and Managing Opioid Addiction/Misuse Through Innovative Models of Care conference at the Kwanlin Dün Cultural Centre.

Katt stressed the importance of culture and community as a means of intervention.

Treatment is “more than just putting a pill on someone’s tongue,” she said.

Along with substitution therapy they also use traditional land-based programs, grief and loss counseling, and work to repair families and help with employment and education.

Katt noted that taking people out of their communities for treatment doesn’t work and leads to relapse when they return.

Currently, there are 22 programs across northern Ontario with more than 2,000 clients.

They are all community owned and include band council authority.

The programs taper clients to low doses and eventually off medication as First Nations chiefs said they didn’t want life-long medical treatment that would require community members to move to a city.

Katt explained that many of the communities have been impacted by colonization and intergenerational trauma which had devastating effects during the opioid crisis.

There have been more than 500 suicides over the last 25 years, and 9,000 people from a population of 30,000 required treatment for opioid misuse.

“These communities were all traumatized by history,” Katt said.

“I haven’t been to one aboriginal community yet where you couldn’t put your finger on a traumatic event that changed that community.”

But there have been significant improvements because of the program.

Drug-related medical evacuations have fallen by 30 per cent, needle exchange dispensing decreased by 50 per cent, the nursing station has shifted from being a trauma centre to more primary health care focused, school attendance increased by 33.3 per cent, child protection cases fell by 58.3 per cent, and criminal charges dropped by 61.1 per cent.

Katt also spoke about the Suboxone program she runs at the Dennis Franklin Cromarty High School in Thunder Bay. The private school has 150 students from 19 communities. Katt said about 43 per cent of the students struggle with addiction and complex mental health needs.

This is the result of the fallout from the over 20 year suicide crisis, a sexual predator in the community who has been charged and “the overwhelming burden of unsolved grief among generations,” Katt said.

“These kids all have stories, but they have a better future,” she said.

The pilot program launched in February 2011 with 51 students. It found that tapering students to low doses of Suboxone was successful and led to maintenance success.

They now treat 63 students on low-dose short term treatment from 30 days to two years. And the program includes wrap around supports of elders, culture and grief counseling.

Katt noted that Suboxone is six times safer than Methadone and recommended as the first line of treatment for young people. It also doesn’t have the same side effects as Methadone including obesity, dental damage, and low testosterone levels.

From the program 14 students have now graduated from Grade 12 on harm reduction.

Hazel Booth, a nurse practitioner in Whitehorse, spoke about the need to focus on prevention over curative health.

“We need to shift the power to more primary prevention if we are to see progress in our health care system,” she said.

The opioid crisis is the health system crying for help, she said.

She also spoke about addiction as a chronic disease and how risky behaviours are responsive behaviours.

She noted that psychosocial determinants of health play an important role in contributing to addiction.

These include income, social status, education, genetics, socio-historical factors, access to health services, gender, physical environment, and social support networks.

Dr. Leo Elwell, a psychiatrist with Mental Health Services, spoke about resources and gaps in services in the territory.

Currently, there is only one methadone clinic in Whitehorse.

“It’s so 1970s. I think we’re past that now in terms of addiction medicine,” he said.

He noted that having a large number of opioid users in one room on one day is “a recipe for disaster.”

He said there is a need to use more urine drug screening, and that office-based treatment improves access to care.

“If methadone is done well, it works,” he said.

Karen Nicloux a member of the First Nation of Na-cho Nyak Dün who is celebrating seven years of sobriety, shared her story of recovery. She spoke about growing up in a community affected by colonization and trauma. She said the silence around abuse and no counseling supports led her to cope with alcohol and drugs to cope. She also showed the short documentary “Released” which details her journey to recovery.

Louise Hardy, a clinical counsellor with the Kwanlin Dün First Nation Health Centre touched on trauma-informed care.

She noted the universality of multi-generational trauma and how it can have dramatic long-term effects on the nervous system.

“It does go away but with care,” she said.

This care includes kindness, touch and listening, she noted.

“Trauma is transmitted through silence,” she said.

But she added that safe spaces like the inquiry into missing and murdered women, and therapy make it OK to talk about.

As a counsellor, Nicloux said, “I have to prove over and over that I can be in the silence but not complicit in it.”

Finally, Dr. Sharon Lazeo of the Taiga Referred Care Clinic spoke about the history and services of the clinic.

It started five years ago as a Yukon government pilot project with one physician and has since grown.

The clinic provides primary care for mental health and addictions. It recently obtained three-year funding and has expanded its staff and referral base.