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Visions Journal

Rigorous Evidence for Rural Health Care Planning

Understanding Outpatient Substance Use Treatment for British Columbia’s Rural and Remote First Nations

Jude Kornelsen, Christine Carthew, and Nicholas Lloyd-Kuzik

Reprinted from the "Rural, Remote and Northern Communities" issue of Visions Journal, 2020, 16 (1), p. 8

Mental wellness and substance use are top-priority health concerns for British Columbia First Nations, particularly in rural settings, where access to mental health and substance use services may be limited due to a lack of local providers and financial, social and geographical challenges associated with travelling to services outside of the community.1 Together, the Assembly of First Nations, the National Native Addictions Partnership Foundation and Health Canada have identified remoteness from health services as a barrier to addressing problematic substance use and associated mental health issues among BC First Nations.2

BC’s First Nations Health Authority (FNHA) is committed to addressing and supporting mental wellness and problematic substance use among BC First Nations. This is reflected in their policy on mental health and wellness, where the FNHA describes its goal to “ensure that all First Nations people have access to a culturally safe, comprehensive and coordinated continuum of mental health and wellness approaches that affirms, facilitates and restores the mental health and wellness of our people, and which contributes to Reconciliation and Nation rebuilding.”3

To move this vision forward, FNHA and the Centre for Rural Health Research are working in partnership to explore best practices for outpatient substance use care among rural and remote First Nations in BC. (Patients receiving outpatient care do not need to stay overnight at a hospital, clinic or doctor’s office.) The Centre for Rural Health Research at the University of British Columbia is currently conducting a review of the international literature on this subject.

Our preliminary findings point to the importance of culturally embedded and community-based treatment programs for substance use care among rural Indigenous populations.4-7 Community-based substance use programming can eliminate the need for those living in rural and remote areas to leave their communities to access care.7,8 Culturally embedded approaches to care are grounded in Indigenous spirituality, language and culture.4 They consider the impacts of colonization, displacement and continued racism on substance use among Indigenous peoples.4

Challenges to the delivery of substance use care in rural settings must also be considered for the development of successful treatment programs. These include, for example, recruiting and retaining qualified care practitioners and staff,5,9,10 geographic barriers (such as a community’s remote location or an individual’s isolation)9,11 and language and cultural differences.9

Finally, current research highlights the importance of providing supportive (or “wraparound”) services,12,13 embedding treatment within a system of integrated care14 (for example, substance use care integrated and coordinated with physical and mental health services), and securing long-term, sustainable funding 6,7,15 for substance use care among rural and remote Indigenous populations. Wraparound services are designed to improve an individual’s access to care and to help them stay in care.13 They address barriers to receiving treatment, such as needs for adequate child care, transportation, housing, legal services and employment assistance.13

In the coming months, the results of our literature review will be available on the Centre for Rural Health Research website at crhr.med.ubc.ca.

About the author

The authors are part of Centre for Rural Health Research, Department of Family Practice, University of British Columbia

Footnotes:
  1. Kornelsen, J., Carthew, C., Míguez, K. & Taylor, M. (2020). An investigation of rural citizen-patient priorities for health planning. In progress.
  2. Assembly of First Nations, National Native Addictions Partnership Foundation & Health Canada. (2011). Honouring our strengths: A renewed framework to address substance use issues among First Nations people in Canada (executive summary). http://nnadaprenewal.ca/?page_id=409#summary.
  3. First Nations Health Authority. (2019). FNHA’s policy on mental health and wellness (p. 4). www.fnha.ca/WellnessSite/WellnessDocuments/FNHA-Policy-on-Mental-Health-and-Wellness.pdf.
  4. Skewes, M., Hallum-Montes, R., Gardner, S.A., Blume, A.W., Ricker, A. & FireMoon, P. (2019). Partnering with Native communities to develop a culturally grounded intervention for substance use disorder. American Journal of Community Psychology, 64(1-2), 72-82. doi: 10.1002/ajcp.12354.
  5. Mamakwa, S., Kahan, M., Kanate, D., Kirlew, M., Folk, D., Cirone, S., Rea, S., Parsons, P., Edwards, C., Gordon, J., Main, F. & Kelly, L. (2017). Evaluation of 6 remote First Nations community-based buprenorphine programs in northwestern Ontario: Retrospective study. Canadian Family Physician, 63(2), 137-145.
  6. Kanate, D., Folk, D., Cirone, S., Gordon, J., Kirlew, M., Veale, T., Bocking, N., Rea, S. & Kelly, L. (2015). Community-wide measures of wellness in a remote First Nations community experiencing opioid dependence: Evaluating outpatient buprenorphine-naloxone substitution therapy in the context of a First Nations healing program. Canadian Family Physician, 61(2), 160-165.
  7. Jiwa, A., Kelly, L. & Pierre-Hansen, N. (2008). Healing the community to heal the individual: Literature review of Aboriginal community-based alcohol and substance abuse programs. Canadian Family Physician, 54(7), 1000-1000.e7.
  8. Webster, P.C. (2013). Indigenous Canadians confront prescription opioid misuse. Lancet, 381 (April 27), 1447-1448.
  9. Benavides-Vaello, S., Strode, A., & Sheeran, B.C. (2013). Using technology in the delivery of mental health and substance abuse treatment in rural communities: A review. Journal of Behavioral Health Services & Research, 40(1), 111-120.
  10. Howland, R.H. (1995). The treatment of persons with dual diagnoses in a rural community. Howland, R.H. (1995). The treatment of persons with dual diagnoses in a rural community. Psychiatric Quarterly, 66(1), 33-49.(1), 33-49.
  11. Dorman, K., Biedermann, B., Linklater, C., & Jaffer, Z. (2018). Community strengths in addressing opioid use in Northeastern Ontario. Canadian Journal of Public Health, 109(2), 219-222. doi: 10.17269/s41997-018-0055-4.
  12. Graham, V.E. & Clough, A.R. (2019). ‘Need everyone helping to keep off because everyone helping to keep on’ – Reducing harms from cannabis use in remote Indigenous Australian communities involves more than just users. Substance Use & Misuse, 54(5), 699-712.
  13. Ducharme, L.J., Mello, H.L., Roman, P.M., Knudsen, H.K. & Johnson, J.A. (2007). Service delivery in substance abuse treatment: Reexamining “comprehensive” care. Journal of Behavioral Health Services & Research, 34(2), 121-136.
  14. Westermeyer, J. (2008). A sea change in the treatment of alcoholism. American Journal of Psychiatry, 165(9), 1093-1095.
  15. Jumah, N.A., Bishop, L., Franklyn, M., Gordon, J., Kelly, L., Mamakwa, S., O’Driscoll, T., Olibris, B., Olsen, C., Paavola, N., Pilatzke, S., Small, B. & Kahan, M. (2017). Opioid use in pregnancy and parenting: An Indigenous-based, collaborative framework for Northwestern Ontario. Canadian Journal of Public Health, 108(5-6), e616-e620.

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