Feasibility and Outcomes of a Community-Based Taper-to-Low- Dose-Maintenance Suboxone Treatment Program for Prescription Opioid Dependence in a Remote First Nations Community in Northern Ontario

Abstract

<p>Objective: Non-medical prescription opioid use (NMPOU) is a major health problem in North America and increasingly prevalent among First Nations people. More than 50% of many Nishnawbe Aski Nation communities in northern Ontario report NMPOU, resulting in extensive health and social problems. Opioid substitution therapy (OST) is the most effective treatment for opioid dependence yet is unavailable in remote First Nations communities. Suboxone (buprenorphine and naloxone) specifically has reasonably good treatment outcomes for prescription opioid (PO) dependence. A pilot study examining the feasibility and outcomes of a community-based Suboxone taper-to-low-dose-maintenance program for PO-dependent adults was conducted in a small NAN community as a treatment option for this particular setting.</p><p>Design: Participants (N = 22, ages 16–48 years) were gradually stabilized on and tapered off Suboxone (provided on an outpatient and directly-observed basis) over a 30-day period. Low dose maintenance was offered post-taper to patients with continued craving and relapse risk; community-based aftercare was provided to all participants. Results: Of 22 participants, 21 (95%) completed the taper phase of the program. Fifteen (88%) of 17 participants tested by urine toxicology screening had no evidence of PO use on day 30. No adverse side effects were observed. All but one of the taper completers were continued on low-dose maintenance. Conclusion: Community-based Suboxone taper-to-low-dose-maintenance is feasible and effective as an initial treatment for PO-dependence in remote First Nations populations, although abstinence is difficult to achieve and longer term maintenance may be required. More research on OST for First Nations people is needed; existing OST options, however, should be made available to First Nations communities given the acute need for treatment.</p>

Prevalence and key covariates of non‐medical prescription opioid use among the general secondary student and adult populations in Ontario, Canada

“…However, this may be influenced by the facts that neither survey included Aboriginals residing on reserves, thus missing highly marginalised population segments, and that analytical power regarding this subpopulation was limited. Given other reports of high levels of NMPOU and PO‐related morbidity and mortality, for example, in remote Aboriginal populations in Ontario, other data sources need to be considered in order to adequately assess the extent of this issue in this important subpopulation . Furthermore, our analyses also did not detect independent associations between psychological or physical health as predictors of NMPOU in either study population, even though previous analyses found such associations ; power limitations may also be an issue here.…”

Prevalence and correlates of nonmedical prescription opioid use among a cohort of sex workers in Vancouver, Canada

“…A growing body of literature documents trends in increasingly problematic PO use and street-level availability in Canada: data indicate that rates of NPOU are rising in general adult and student populations (Boak, Hamilton, Adlaf, & Mann, 2013; Health Canada, 2013) and NPOU is emergent among key marginalized populations, including street-drug users (Popova, Patra, Mohapatra, Fischer, & Rehm, 2009), First Nations/Aboriginal people (Dell et al, 2012; Katt et al, 2012), and correctional populations (Johnson, MacDonald, Cheverie, Myrick, & Fischer, 2012). Local Vancouver studies of youth and adults who use drugs have seen a marked rise in the availability of POs, particularly oxycodone and hydrocodone, in street-level drug markets between 2006 and 2010, despite the high and stable availability of other illicit drugs (Nosyk et al, 2012), and injection and non-injection PO use has surpassed heroin use among some drug-using populations in Canada (Fischer et al, 2006; Leclerc, Morissette, & Roy, 2010).…”

Seven Core Principles of Substance Use Treatment System Design to Aid in Identifying Strengths, Gaps, and Required Enhancements

“…National frameworks, such as the one developed in Canada, support relevant policy and workforce development (Health Canada, 2011, 2015), and new governance models that give control over health care resources to Indigenous communities can provide crucial infrastructure (Government of British Columbia, 2013). Many clinical tools and protocols have been developed with a strong cultural base (e.g., Fiedeldey-Van Dijk et al, 2017; Katt et al, 2012; Mamakwa et al, 2017; Rowan et al, 2015), with research and evaluation methods adapted accordingly (Baskin, 2016; Kanate et al, 2015; LaFrance et al, 2012).…”