A Call to Action: The Disproportionate Effect of the Opioid Crisis on Indigenous Peoples in British Colombia

Written by Olivia Novosel 

Opioid-related hospitalizations have been on the rise in Indigenous communities across Canada, with British Columbia experiencing the highest burden. Compared to all Canadians, First Nations people in British Columbia were five times more likely to experience an opioid-related overdose and three times more likely to die from opioids. In 2017, the Canadian government reported a national mortality rate of 10.94 deaths per 100,000, whereas British Columbia First Nations reported 73.91 deaths per 100,000. If the opioid crisis is labeled a health epidemic by the Canadian government, then where is the support for Indigenous Canadians?
Although a multilayered and nuanced crisis, many experts have postulated that the overprescription of opioids due to workplace injuries is fueling the Indigenous opioid crisis. The unemployment rate of Indigenous peoples in B.C. is 16.6%, compared to 7% Canada-wide. Unemployment is correlated to poor government policies for welfare, education and workplace harassment/racism towards First Nations. There are scarce economic opportunities on reserve lands due to geographical isolation, and commuting to offsite jobs may be financially unfeasible. Due to these barriers, Indigenous peoples are more likely to take hazardous jobs prone to injury; such as construction and forestry in British Columbia. These injuries are often treated with opioids, as non-opioid therapies are unavailable to remote communities. Consequently, First Nations are twice as likely to be prescribed opioids than the rest of Canada. 
An additional cause attributed to the opioid crisis is the intergenerational trauma of Indigenous people. Colonialism, specifically manifesting in the residential school system, has contributed to Indigenous oppression and poor mental health. Within British Columbia, there were 22 residential schools, the second-largest provincial total in Canada. In these schools, Indigenous youth were subjected to abuse and neglect, cultivating a deep sense of mistrust and insecurity. This trauma was then passed on to subsequent generations, as the inability to create a nurturing environment as parents can instill poor coping and mental health in children. Incidences of poor mental health lead to increased drug and substance abuse, leaving Indigenous populations more susceptible to the opioid crisis.
Another alarming contributor to the opioid crisis is limited access to healthcare. First Nation communities are often of low socioeconomic status with poor food security and housing. A vicious cycle of health injustice has led to the isolation of communities; geographically and economically. To this date, Indigenous communities are underfunded and underserved for healthcare, employment, and infrastructure. Indigenous people also have lower access to harm reduction programs, as they must travel to off-site treatment centers. There is also a stigma within First Nations communities about methadone as a treatment due to the strong distrust of government healthcare. First Nations individuals using methadone have even experienced discriminatory behaviours within their community because of the use of medication-assisted treatment. This displays the incompatible and inadequate healthcare currently available to Indigenous communities. 
However, due to public outcry, steps are finally being made to support Indigenous Canadians during this crisis. Although historically, Indigenous funding has been insufficient to meet the needs of the people, the Canadian government is looking to invest in potential Indigenous opioid-related health interventions. This funding can amend barriers related to the cost of implementation. Furthermore, by incorporating traditional ways of healing and counseling Elders, Indigenous-specific interventions may overcome the challenge of distrust experienced by these populations and increase treatment compliance. There is also support within First Nations communities, as Indigenous youth and Elders in British Columbia have used their voice to advocate for opioid education and awareness. 
Although initiatives centred on Indigenous wellbeing and harm reduction have begun, it is not nearly enough as numbers continue to rise. The opioid crisis stems from systemic issues deeply ingrained within our country and politics. The problem will not truly be resolved until all underlying political and social determinants of health are addressed. Sadly, the opioid crisis has  only further showcased the inadequacy of Indigenous healthcare in Canada and the desperate need for action.