You just have to have other models, our DNA is different: the experiences of indigenous people who use illicit drugs and/or alcohol accessing substance use treatment

Abstract

Objectives In Canada, and elsewhere, indigenous peoples who use illicit drugs and/or alcohol (IPWUID/A) commonly experience vulnerability and a disproportionate burden of harm related to substance use. In Vancouver, Canada, there are concerns that inequitable access, retention, and post treatment care within substance use treatment programs may exacerbate these harms. This study sought to understand the policies and practices with the potential to produce inequities and vulnerabilities for IPWUID/A in substance use treatment, situate the vulnerabilities of IPWUID/A in substance use treatment within the context of wider structural vulnerability of IPWUID/A, and generate recommendations for culturally safe treatment options. Methods This research employed a qualitative indigenous-led community-based approach using the indigenous methodology of talking circles to explore experiences with substance use treatment. Under the participatory research framework, community researchers led the study design, data collection, and analysis. Talking circles elicited peers’ experiences of substance use treatment and were audio-recorded and transcribed. Results The talking circles identified three key themes that illustrated the experiences of IPWUID/A when accessing substance use treatment: (a) barriers to accessing detox and substance use treatment; (b) incompatible and culturally inappropriate structure, policies, and procedures within treatment programs, such as forced Christianity within treatment settings; and (c) the importance of culturally relevant, peer-led substance use treatment programming. Discussion Our work demonstrates that some IPWUID/A have limited access to or retention in mainstream treatment due to excessive waiting times, strict rules, and lack of cultural appropriate care while in treatment. However, IPWUID/A narratives revealed strategies that can improve IPWUID/A access and experiences, including those informed by the diverse perspectives of IPWUID/A and those that include trauma-informed and culturally safe practices.

Having a voice and saving lives: a qualitative survey on employment impacts of people with lived experience of drug use working in harm reduction

“…In reaching vulnerable communities, however, they also detail the particular struggles experienced in their efforts to care for others who use illicit drugs, including material and pay inequities that factor into negotiation and navigation of the invisible boundaries that demark what constitutes a 'peer, ' and frought workplace policies regarding drug use/abstinence, as described by our study participants, and which remain unresolved [1,4,9,28,37,38]. Significantly, the involvement of people with lived experience of drug use has also resulted in increased diversity within many of these service settings, with socially and economically marginalized women and Indigenous people who use(d) drugs taking a particularly prominent role in emerging programming [31,[39][40][41][42]. This has potential benefits that have not been adequately examined, as most work on these approaches-amid the overdose epidemic and otherwise-has homogenized the roles of people who use(d) drugs rather than more broadly considering their diversity; a consideration highlighted by some survey participants that warrants further exploration.…”

Content Analysis of Preferred Recovery Pathways Among Urban American Indians and Alaska Natives Experiencing Alcohol Use Disorders

“…Finally, the importance of peer involvement was notable in participant responses. Recent meta-analyses have shown the effectiveness of peer support in recovery (Bassuk et al, 2016; Beaulieu et al, 2021; Eddie et al, 2019), and Indigenous peer support, more specifically (Lavalley et al, 2020). Thus, peer support should also be incorporated into treatment provision.…”

Experimental (Re)structuring: The Clinical Trial as Turning Point Among Medical Research Participants

“…In the realm of health and substance use, colonialist systems and discourses have resulted in a drug war and drug policies that disproportionately target and penalize Indigenous people, a greater burden of substance-related harm among Indigenous people, and pernicious stereotypes about substance use among Indigenous people (Marshall, 2015). Furthermore, Indigenous people seeking assistance for substance use–related concerns may encounter difficulties finding trauma-informed or culturally relevant treatment, as well as significant structural and logistical barriers (Lavalley et al, 2020). It should also be noted that Indigenous people, particularly in the Downtown Eastside, may feel over-researched and have previous negative experiences with research, which can result in skepticism or distrust toward researchers (Goodman et al, 2018).…”