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Prescription Drug Abuse Backgrounder for DGC Mike Metatawabin Political/Media Campaign on NAN Prescription Drug Abuse State of Emergency

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Prescription Drug Abuse Backgrounder for DGC Mike Metatawabin Political/Media Campaign on NAN Prescription Drug Abuse State of Emergency Prescription Drug Abuse Backgrounder for DGC Mike Metatawabin Political/Media Campaign on NAN Prescription Drug Abuse State of Emergency To: DGC Mike Metatawabin From: Leesa Wabasse, Health Policy Analyst Date: February 11, 2011 cc: NAN Executive Council; David Fletcher, Executive Director; Amy Harris, Director of Communications; and Health Policy and Planning Department staff ISSUE SUMMARY In November 2009, the Nishnawbe Aski Nation (NAN) Chiefs declared a Prescription Drug Abuse State of Emergency as a result of the prescription drug abuse crisis in NAN First Nations. The NAN Executive Council has been mandated to secure government commitment to address the epidemic in the NAN First Nations. BACKGROUND Prescription Drug Abuse is a current issue that is affecting Nishnawbe Aski Nation (NAN) communities and encompasses areas such as health, social, law enforcement, legal, child welfare and education. This problem is undermining the physical, mental, spiritual and emotional well‐being of NAN First Nation members and communities. Prescription Drug Abuse has been recognized as a NAN‐wide problem through resolutions 06/54 (NAN‐Wide Strategy to Address Drug & Solvent Abuse); 08/40 (Key Assumptions for Prescription Drug Abuse Strategy); 09/09 (NAN Prescription Drug Abuse Task Force); and have endorsed the Chiefs’ Forum on Social Issues, Answering the Call for Help: Reducing Prescription Drug Abuse in Our Communities, ‘Mamow Na‐Ta‐Wii‐He‐ Tih‐Sowin: Healing Together declaration. DGC MIKE METATAWABIN CORRESPONDENCE: 1) December 14, 2009 correspondence from DGC Metatawabin to: Dr. Valerie Gideon, Regional Director, FNIH‐OR; Leigh Jessen, A/Regional Director, INAC Ontario Region; Deb Matthews, Minister of Health and Long‐Term Care Deputy Grand Chief Mike Metatawabin PDA Backgrounder (MOHLTC) and; Minster Rick Bartolucci, Minister of Community and Safety and Correctional Services (MCSCS). The December 14th, 2009 correspondence was a follow‐up to the Prescription Drug Abuse State of Emergency that was declared by the NAN Chiefs in November 2009 (Resolution 09/92). The letter advocated for discussions specific to: enhanced community‐based programming, including trained workers NNADAP, Mental Health, Addiction Specialists and others as determined by the First Nations; resources for security and; Land‐based programming. 2) Dr. Valerie Gideon, Regional Director, FNIH‐OR letter of response (December 18, 2009) proposed the following: Identify multidisciplinary professional support team members to assist communities in developing their strategies. NOTE: FNIH‐OR contracted three individuals to collect data from four (4) NAN communities in the Sioux Lookout Zone to demonstrate there is a problem with prescription drug abuse. The Community Wellness Team was established unilaterally by FNIH‐OR and did not involve NAN in the process. Reports by the Community Wellness Teams have not been shared with NAN and/or obtained directly from the First Nations. Review and finalize an “Addressing Prescription Drug Abuse and Misuse at the Community Level” tool. NOTE: This document was finalized in January 2010; available on the Ontario Prescription Drug abuse website that is hosted by K‐Net. Contact K‐Net to develop a website and consider options for a toll‐free information line. NOTE: The Ontario Prescription Drug Abuse website was launched in March 2010; to date, no toll‐free information line has been set up. Coordinate multi‐agency meetings to discuss how to establish a continuum of support services for individuals and communities. PDA Background v.6 ‐ Revised November 21, 2011 2 Deputy Grand Chief Mike Metatawabin PDA Backgrounder NOTE: FNIH‐OR coordinated multi‐agency meetings with SLFNHA/Meno‐Ya‐Win (and others?); NAN made numerous requests to be invited to the multi‐agency meetings with no success. Develop an evaluation framework to assist communities in tracking progress on community‐based strategies and; NOTE: Status not known. To participate, as required, in the Chiefs of Ontario coordinated approach to the development of the Ontario First Nations Prescription Drug Abuse Strategy. NOTE: The Ontario Prescription Drug Abuse Strategy was completed in November 2010. All PTOs and Independent First Nations in Ontario received funding to consult First Nations on the draft COO PDA Strategy. In addition to the above, Dr. Valerie Gideon, FNIH‐OR coordinated conference calls and two face‐to‐face meetings with INAC, Ministry of Health and Long‐Term Care (MOHLTC) and the Ministry of Aboriginal Affairs between January 2010 to November 2011. With the exception of FNIH‐OR and INAC committing to cost‐share (50%) a NAN Prescription Drug Abuse Coordinator position for a total of $100,000, no other significant milestones were achieved and/or major commitments/decisions made. NOTE: During meetings, MOHLTC representatives repeatedly stated that they do not have jurisdiction on‐reserve. It should also be noted that MOHLTC was largely focused on Bill 101: Narcotics Safety and Awareness Act which received Royal Assent in November 2010. The five (5) key elements of the Narcotics Strategy are as follows: Proposed narcotics tracking system (and supporting legislation) Partnering with the health care sector to educate on appropriate prescribing Partnering with the health care sector to educate on appropriate dispensing Educate to prevent excess use of prescription narcotics Addictions Treatment PDA Background v.6 ‐ Revised November 21, 2011 3 Deputy Grand Chief Mike Metatawabin PDA Backgrounder 3) Response from INAC, MOHLTC and MCSCS on NAN Prescription Drug Abuse State of Emergency correspondence: No formal response received from INAC and MOHLTC. Minister Bartolucci, MCSCS response stated that the issues raised fell under the jurisdiction of MOHLTC despite the prescription drug abuse issue crossing many sectors, including on‐reserve Policing. NOTE: MCSCS provides 48% of funding for the NAPS agreement and 52% is funded by the Federal government. 4) December 14, 2009 correspondence from DGC Metatawabin to: Royal College of Physicians and Surgeons of Canada; Ontario College of Pharmacists and; Ontario Medical Association. The correspondence recommended policies to be developed to: Reduce accessibility to Opioid prescription drugs for non‐medical use by completing a thorough screening process; to establish treatment plans; to educate on the risks/benefits; periodic reviews to determine other treatment methods that would benefit patients; referrals to chronic pain/addiction specialists and; to implement a tracking system such as triple scripting to identify double doctoring and; to increase physician, pharmacist, and patient accountability. In addition to the above, assistance and expertise was sought in developing best practices and policies that are aimed at improving the health of NAN First Nation members, as well as cooperation in bringing together relevant sectors to work collectively in addressing the prescription drug abuse epidemic. 5) March 19, 2010 Letter of response from Dr. Rocco Gerace, Registrar, College of Physicians and Surgeons of Ontario (CPSO): Acknowledged NAN Prescription Drug Abuse State of Emergency and agreed that the complexity of the issue requires the collaboration of many stakeholders. Invited NAN to forward complaints and/or concerns of individual doctors regarding professional misconduct or incompetence. PDA Background v.6 ‐ Revised November 21, 2011 4 Deputy Grand Chief Mike Metatawabin PDA Backgrounder Dr. Gerace acknowledged : some CPSO members could benefit from greater education and guidance on the appropriate use of opioid drugs for the treatment of chronic non‐ malignant pain; there may be some reluctance by some physicians to prescribe opioids due to its status as a narcotic and; physicians may not appropriately manage drug‐seeking individuals and/or those engaging in double doctoring. Provided information on the National Opioid Use Guideline Group (NOUGG), which was formed in November 2007 in response to: Physicians and other stakeholders seeing guidance regarding safe and effective use of opioids; A growing concern about opioid misuse creating patient and public safety issues and; The lack of systematically developed national guidelines on opidid use for chronic non‐cancer pain. NOTE: The NOUGG was comprised of a research team and national panel that included pain specialists, family physicians, addiction experts and pharmacists. The Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non‐ Cancer Pain was completed on April 30, 2010; the guideline is a tool to promote the appropriate use of opioid drugs across Canada. 6) January 4, 2011 correspondence from DGC Metatawabin to Dr. Valerie Gideon, Regional Director, Health Canada FNIH‐OR: Re: NAN Chiefs’ resolution 10/63 Health Canada Non‐Insured Health Benefits Suboxone Approval demanding that the NIHB program approve the use of Suboxone for the medical detoxification of NAN members that request the medication. The letter argued: 1) Methadone is not available in remote NAN First Nations and that NAN First Nations have expressed an interest in using Suboxone to better support individuals who wish to overcome their addiction to Opiate drugs; 2) that NAN sees the drug, Suboxone in stabilizing First Nation members/communities in a more humane way. PDA Background v.6 ‐ Revised November 21, 2011 5 Deputy Grand Chief Mike Metatawabin PDA Backgrounder Requested for Nursing Stations to be adequately stocked with ancillary drugs, i.e., Clonidine, Trazadone, NSAIDS
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