**Indigenous Communities Face Opioid Crisis Amid Treatment Challenges**

Niibin Pahpeguish's journey through addiction and treatment highlights a growing crisis in Ontario. After nearly a decade of battling an addiction that began with prescribed painkillers and escalated to street opioids, Pahpeguish entered a treatment program in 2009. At a facility in Brantford, Ontario, she was prescribed methadone, a medication used to ease withdrawal symptoms and reduce cravings. This medication is part of Opioid Agonist Therapy (OAT), which is crucial for many individuals struggling with addiction.

Initially, Pahpeguish was told she might need to stay on methadone for life. However, after two years, she began to feel that the treatment was causing her more harm than good. She experienced liver damage, bone density loss, and gastrointestinal issues that affected her heart rate. These complications led to frequent hospitalizations, which she attributes to the combination of her opioid treatment and other medications. “I said, ‘I want to be off of this now,’” she recalls.

Pahpeguish's experience is part of a broader crisis affecting Indigenous communities in Ontario. A new report from the Chiefs of Ontario, in collaboration with the Ontario Drug Policy Research Network (ODPRN), reveals that OAT treatment among Indigenous people is 15 times higher than among non-First Nations individuals. The report also states that the opioid-related death rate among First Nations people is nine times higher than that of non-First Nations people.

The search for effective treatment options for Indigenous populations is urgent. The federal government has committed approximately $768 million annually over the next few years to support mental wellness services in Indigenous communities, which includes $28.3 million for additional services for those receiving OAT treatment. In 2021, the Ontario government pledged $36 million to enhance mental health and addiction support in Indigenous communities.

The report links the high rates of opioid-related harm among First Nations to generational trauma, which is often associated with mental health issues and substance use. Dr. Chetan Mehta, an addictions specialist at Anishnawbe Health Toronto, emphasizes the importance of medication in treating opioid withdrawal. “Up to 10 percent of people, if they have to go through opioid withdrawal, would consider committing suicide if it’s not treated with medication properly,” he said. “Opioid therapy helps to relieve that.”

Despite the life-saving potential of OAT, questions remain about its effectiveness in meeting the long-term needs of First Nations people. Tara Gomes, the lead researcher on the report, notes, “Clearly there’s disproportionate harm among First Nations People, clearly they are accessing treatment, but perhaps not always in the best way or a way that is supportive of them.” She stresses the need to listen to the requests of First Nations communities and develop services tailored to their specific needs.

First Nations leaders acknowledge the importance of OAT in addressing opioid addiction but point out the unique challenges faced by remote communities. The Fort William First Nation, located south of Thunder Bay, has been particularly hard hit by the opioid crisis, prompting a state of emergency in the summer of 2024. A coroner’s report from 2024 revealed that the opioid mortality rate in the Thunder Bay District, which includes Fort William, was the highest in Ontario, at five times the provincial average.

In response to the crisis, the Fort William community has taken steps to support individuals seeking treatment. They purchased an off-reserve facility where people, including those who have completed detox, can stay while waiting for treatment, which can take up to eight weeks. This initiative reflects the community's commitment to addressing the opioid crisis and providing necessary support for those in need.