title: Evaluation of 6 remote First Nations community-based buprenorphine programs in northwestern Ontario: Retrospective study.
abstract: OBJECTIVE
  To evaluate established opioid addiction treatment programs that use traditional healing in combination with buprenorphine-naloxone maintenance treatment in 6 First Nations communities in the Sioux Lookout region of northwestern Ontario.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Six First Nations communities in northwestern Ontario.
  
  
  METHODS
  A total of 526 First Nations participants in opioid-dependence treatment programs.
  
  
  METHODS
  Buprenorphine-naloxone substitution therapy and First Nations healing programming.
  
  
  METHODS
  Retention rates and urine drug screening (UDS) results.
  
  
  RESULTS
  Treatment retention rates at 6, 12, and 18 months were 84%, 78%, and 72%, respectively. We estimate that the rate at 24 months will also be more than 70%. The UDS programming varied and was implemented in only 1 community. Initially urine testing was voluntary and it then became mandatory. Screening with either method found the proportion of urine samples with negative results for illicit opioids ranged between 84% and 95%.
  
  
  CONCLUSIONS
  The program's treatment retention rates and negative UDS results were higher than those reported for most methadone and buprenorphine-naloxone programs, despite a patient population where severe posttraumatic stress disorder is endemic, and despite the programs' lack of resources and addiction expertise. Community-based programs like these overcome the initial challenge of cultural competence. First Nations communities in other provinces should establish their own buprenorphinenaloxone programs, using local primary care physicians as prescribers. Sustainable core funding is needed for programming, long-term aftercare, and trauma recovery for such initiatives.
authors.affiliation: Health Director for the Shibogama Health Authority in Sioux Lookout, Ont.
authors.forename: Solomon
authors.initials: S
authors.lastname: Mamakwa
authors.affiliation: Associate Professor in the Department of Family Medicine at the University of Toronto in Ontario and is an advisor in addiction care to Sioux Lookout physicians.
authors.forename: Meldon
authors.initials: M
authors.lastname: Kahan
authors.affiliation: Chief of North Caribou Lake First Nation in Round Lake, Ont.
authors.forename: Dinah
authors.initials: D
authors.lastname: Kanate
authors.affiliation: Assistant Professor in the Division of Clinical Sciences at the Northern Ontario School of Medicine (NOSM) in Sioux Lookout and is a community physician for Wapekeka First Nation.
authors.forename: Mike
authors.initials: M
authors.lastname: Kirlew
authors.affiliation: Assistant Professor in the Division of Clinical Sciences at NOSM and a community physician for North Caribou Lake.
authors.forename: David
authors.initials: D
authors.lastname: Folk
authors.affiliation: Addiction specialist at St Joseph's Health Centre in Toronto and visits the North Caribou Lake community regularly.
authors.forename: Sharon
authors.initials: S
authors.lastname: Cirone
authors.affiliation: Researcher with the Anishinaabe Bimaadiziwin Research Program in Sioux Lookout.
authors.forename: Sara
authors.initials: S
authors.lastname: Rea
authors.affiliation: Electronic Medical Records Technologist for Sioux Lookout First Nations Health Authority.
authors.forename: Pierre
authors.initials: P
authors.lastname: Parsons
authors.affiliation: Researcher with the Anishinaabe Bimaadiziwin Research Program.
authors.forename: Craig
authors.initials: C
authors.lastname: Edwards
authors.affiliation: Chief Operating Officer for the Sioux Lookout First Nations Health Authority.
authors.forename: Janet
authors.initials: J
authors.lastname: Gordon
authors.affiliation: Family medicine resident at NOSM in Sudbury, Ont.
authors.forename: Fiona
authors.initials: F
authors.lastname: Main
authors.affiliation: Researcher with the Anishinaabe Bimaadiziwin Research Program. lkelly@mcmaster.ca.
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
mesh_terms: D000328:Adult; D001569:Benzodiazepines / Q000652:urine; D002047:Buprenorphine / Q000627:therapeutic use*; D003042:Cocaine / Q000652:urine; D003153:Community Health Services / Q000458:organization & administration; D003376:Counseling; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000652:urine; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009864:Ontario; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000208:ethnology; D010098:Oxycodone / Q000652:urine; D015397:Program Evaluation; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration; D015813:Substance Abuse Detection; D013405:Suicide / Q000639:trends; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D009292:Narcotic Antagonists; D001569:Benzodiazepines; D009270:Naloxone; D002047:Buprenorphine; D009020:Morphine; D010098:Oxycodone; D003042:Cocaine