As a nurse practitioner in a high school in Thunder Bay, Mae realized that there was something bigger behind students’ runny noses and complaints of pain. When she talked to students, she found out nearly half were struggling with opioid addictions. The realization led her to petition the government to launch a treatment program right in the school. She spoke to Faces of Health Care about the opioid epidemic in Indigenous communities and why empathy has been her most important intervention.
“I’ve been working as a nurse practitioner in a Thunder Bay high school for about 13 years. I see the students for everything from throat and ear infections to rashes to sports injuries to mental health issues. The students come from 19 remote communities in the north.”
“Since about 2007, these communities have struggled with a large number of people being addicted to OxyContin. Our high school has 150 students and over 40% were having struggles with addiction. We saw this through restlessness, absenteeism, the inability to concentrate and stay on task.”
When I would see them in clinic, they would ask for something for generalized body pain, which is a withdrawal sign. They would be sitting there talking to you and their noses would be runny and they’d be sniffling; another sign of opiate withdrawal.
“I started making calls to local health organizations and I was kind of disappointed that the only option suggested was methadone treatment. These young people come from remote northern communities and methadone is a highly regulated substance, so that wasn’t an option. We searched the literature and were impressed with articles about the use of suboxone for opioid addiction. I wrote a proposal with the clinical team and got some funds to start a suboxone program. At the time, suboxone was not on any provincial or federal formulary so it took a bit of convincing.”
“We’ve treated 60 students since 2011. I think we’ve made a difference in their lives. Some were able to get off opioids and others weren’t. Opioid addiction sets up this craving that some students just couldn’t handle. It’s every day. They were thinking, ‘I need to feed whatever is calling me in my brain’. Low-dose maintenance suboxone allows them to think about other things. So in addition to the medication, we provide counselling to help them understand their behaviour, understand that they aren’t to blame for what’s happened to them and to help them make different choices.”
“We let the young people’s emotional needs steer our counselling. How did they handle disappointment? Frustration? Sadness? Interestingly, they were not good at labelling feelings. They just didn’t have the vocabulary. I have learned that vocabulary is very important.”
If they can’t label it and they can’t ask for help, it will come out as a physical symptom. They will say, ‘I have a headache. My stomach’s really sore.’ Then after two or three days of a sore stomach you think, ‘Okay, what’s really going on?’
“Sometimes, they would get angry but they wouldn’t be able to explain why. It would be an all-consuming emotion and it would trigger more craving for the opiate drugs. So, in our counselling we would intervene when we noticed things that were relapse triggers: when they were tired, hungry, had any kind of strong emotion, when they were lonely.”
“How do you help them deal with those feelings?”
“Mostly grief counselling. They come from an area where there have been hundreds of suicides. We ask them about childhood trauma, family issues, their use of drugs and alcohol, sexual abuse. They are so honest when they answer those questions. We use their history to focus our counselling. Helping them get through the loss of friends, of family members. Some of our students lost parents to suicide, and it totally derailed them. We try to help them have goals and aspirations and realize there isn’t anything they can’t overcome.”
“There’s something about adolescents in high school that just kind of grabs your heart. Sometimes you think, ‘What am I going to do with that young person?’ Maybe that day, they don’t want to talk to you, but in a couple of days they will, right? And you have to remember that they are dealing with many underlying things like their own fears or their mistrust.”
Empathy is an intervention. They are just starting out and are hitting some barriers or quicksand. If you don’t stretch out your hand and pull them out, some of them are not going to be here.
“I get a real charge out of seeing progression in adolescents. One of the things about high school that’s so cool is that you see them in Grade 9 and they are so frightened and scared. But you give them four years and watch their maturation process. You sit there and smile and think, ‘Oh my God! Two years ago, when I saw you, here’s what we talked about…’ When you talk to them about their progression and how they have overcome hurdles, it makes them feel like, ‘Yeah, it’s not so bad. It was bad then, but it’s okay now.’”
“It’s looking at a person’s own spirit and trying to help it get stronger. Most of these young people surprise us. They do some amazing things! They have been so wounded and so hurt and yet, they are still interested in academics. They are getting on the honour roll. One of the privileges of being on the honour roll is you get to take a trip somewhere. We just sent some kids to New York city and some went to Calgary. It’s how you reward good behaviour. We learn that as parents, right?”
“I think about how you bring a family unit together again. Our young people are not very proud of what they did to get their drugs. They had to obtain the money, perhaps by stealing or selling the possessions of other family members. So, we talk to them about how do you become a trustworthy person again. Because your family will take you back. I think that’s kind of universal right? In our culture and in our communities, people forgive.”
We have learned shame as aboriginal people – that’s historical. Don’t speak your language and don’t practice your traditions because we really want to assimilate you. But, I think you can take young people and give them tools to counter this shame.
“Those tools take time to impart because they are not just skills. They are the spirituality and the values that come from our culture. That’s an opportunity, right? How do we get people back out on the land? How do we get families together?”
“We’ve had some examples where this has worked well. One of the communities where I am working did a canoe trip. They took twenty some people on suboxone who hadn’t been in canoes for years and they paddled all the way back to their community. It took them three weeks. They talked about physically being able to feel the progression over the three weeks. Eating different foods and being nurtured by nature. I saw them before the canoe trip and about a month after, and what a difference! There’s an expression ‘lifting people’s spirits’. Young people who had been really struggling when they first started treatment had their spirits lifted by that trip. It certainly wasn’t just the drug they were putting under their tongues.”
“The earliest people who committed suicide were the victims of sexual predators. Lots of people were too ashamed to disclose and committed suicide.”
The federal government didn’t help the communities when they had the early suicides. I worked there in the early 90s as health director and there was never a response to the chiefs’ calls.
“People who had been really hurt by suicides discovered that OxyContin could bring some relief from the emotional pain. The uptake was so quick and widespread. In Thunder Bay you would pay $80 for an Oxy. That same pill in a northern remote community was a thousand dollars. And people were buying them at that price. Four people would split one Oxy and they would inject it. It was devastating socially. It was an addiction that was of a magnitude that we had never seen anywhere in Ontario before. Thousands of people were addicted and nobody really said too much about it.”
“I’ve lived in Ontario for many years and I don’t get the sense that most people want to know about those who live in the northern remote communities. The politicians and business people that do come up here, they just want the nickel, the chromium, the Ring of Fire. All of a sudden there’s an opportunity for mining companies to come and take from people who ten years ago they didn’t care very much about.”
As health practitioners, I really think we should be pushing our governments to learn more.
“I get on airplanes and go up there all the time. I learn about different communities, but I don’t have all the answers or know what the solutions should be. But I think if we engage the people who live there in a meaningful way, we will be able to overcome a lot of the health issues in the north.”