title: Prescription opioid prescribing, use/misuse, harms and treatment among Aboriginal people in Canada: a narrative review of available data and indicators.
abstract: Prescription opioid (PO) misuse and related harms are high in Canada, and a major public health challenge. In Canada, 1.4 million individuals (4.3% of the total population) self-identify as Aboriginal, among whom substance use and related harms are elevated. While there are reports of PO use and associated problems among Aboriginal groups, no comprehensive data review currently exists.
  
  
  
  A review of available data sources (ie journal publications, public reports and 'grey' literature) was conducted following principles of a scoping review. Information and data were identified, extracted, and organized into major indicator categories:PO prescribing/dispensing,use/abuse,morbidity/mortality harms and treatment, and narratively reported.
  
  
  
  Data suggest that PO dispensing, use and misuse levels among Aboriginal populations are high and/or rising in select settings when compared to the general Canadian population. High levels of PO-related dependence and pregnancy harms exist (mainly in Northern Ontario); there is some indication of elevated opioid mortality among Aboriginals. Vast discrepancies in availability and access to interventions exist; some recent pilot studies suggest improved care.
  
  
  
  Data regarding PO use and harms among Aboriginal people are limited, even though elevated problem levels are indicated; improved monitoring, and more effective yet culturally and contextually appropriate interventions for this acute problem are needed.
authors.affiliation: Centre for Addiction and Mental Health,Toronto, Ontario, Canada. cayley.russell@camh.ca.
authors.forename: Cayley
authors.initials: C
authors.lastname: Russell
authors.affiliation: Centre for Research on Inner City Health,Toronto, Ontario,Canada. FirestoneM@smh.ca.
authors.forename: Michelle
authors.initials: M
authors.lastname: Firestone
authors.affiliation: Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ontario, Canada. lkelly@mcmaster.ca.
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
authors.affiliation: Department of Pyschology and Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario, Canada. cjmushqu@lakeheadu.ca.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mushquash
authors.affiliation: Centre for Addiction and Mental Health, Toronto, Ontario, Canada. bfischer@sfu.ca.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Fischer
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D062787:Drug Overdose / Q000209:etiology*; D005260:Female; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000208:ethnology*; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid
keywords: Alcohol and Drug; Epidemiology; Health Promotion; North America; Pharmacology/Drugs; Public Health