This study allows us to listen to 16 First Nations members from a remote fly-in community to tell their story about recovery from opioid use. Participants give us insight into both their lives and what healthcare providers need to support their healing journey. We learned important lessons about the use of opioids, treatment with opioid substitution therapy, and what supports and barriers they experienced. The findings lead to a description of what is needed for community-led healing programs. The findings will inform other First Nations and non-Indigenous recovery program across Canada. The study was innovative and undertaken in collaboration with a First Nation community and the Sioux Lookout First Nations Health Authority. It aligned with principles of sovereignty and governance of First Nations research of “Ownership, Control, Access and Possession (OCAP). It can serve as a template for community consultation and partnership in research collaboration with First Nations communities.

Annual opioid-related deaths in Ontario have increase since 2016 and the rate of increase among First Nations is approximately four times higher than that of non-First Nations. Very little information is known about factors that support or challenge recovery from opioid use for First Nations people. The purpose of this study was to understand the experience of recovery from opioid use by 16 First Nations people living in a small northern remote community. This is the first qualitative study of its kind in the region. The study was conducted in a respectful cross-cultural manner. Extensive community consultation took place to ensure local acceptance of the study and permission for publication. Interview transcripts were reviewed and analyzed by Indigenous and non-Indigenous research team-members who conducted thematic analysis using immersion and crystallization. Participants described their opioid use as a form of self-management of trauma. Their recovery process was multifaceted and included developing self and cultural awareness. Motivation for change often arose from concern for family wellbeing and finances. Traditional cultural practices and time spent on the land were important wellness experiences. Barriers to healing included limited clinical and wholistic addiction services, particularly around dose weaning and OAT discontinuation. One participant shared: “You’ve got to find yourself, find your truth and stick by your truth that’s what I’ve been trying to do”. Despite being at various stages of recovery, participants indicated the reality of the long game: “I’m still on my healing journey. I don’t think that will ever stop for me, to learn about life.” We concluded that community based First Nations addiction programming needs to be robust, broad in scope and well resourced. It should include culturally appropriate addictions education, aftercare support, and land-based activities in the context of trauma-informed clinical and addiction care.

The Healing Journey: a qualitative study of recovery from opioid use by First Nations people. Madden S, Root A, Hummelen R, Suganaqueb MC, Duncan C, Gordon J, Meekis C, Sainnawap D, Poirier J, Sofea, Kelly L. Can Family Physician. 2023; in press