Decolonizing Addiction through Indigenous Harm Reduction

Above: Participants and staff at the FNHA Indigenous Wellness team's Not Just Naloxone Training session on Snuneymuxw territory in Nanaimo.

On June 5-7, the Indigenous Wellness Team hosted a Not Just Naloxone training session on Snuneymuxw territory in Nanaimo. Over 20 participants were on hand to build on their skills and knowledge around substance-use and overdose prevention, as well as share their wisdom with attendees and staff in the room for the benefit of their communities.

"The facilitators are perfect…it's hard work and they're willing to help. So why not take the training? We need more people to be aware of this," said Milly Price, who was attending from the Kwakiutl District Council. "The Indigenous Harm Reduction training is so awesome going back to community, because it's our approach as opposed to the Western approach. It's really important that we continue to do this work."

Above: Milly Price from the Kwakiutl District Council.

Milly expressed that there is a fear of harm reduction in some communities because it is thought to be more harmful but she described the concept as being about connection and saving lives. Milly shared that the Kwakiutl District Council has a number of staff sitting on a harm reduction committee and that they are able to strategize and implement harm reduction solutions locally. 

Evolving the response

In response to an increase in overdose events and deaths in First Nations communities, FNHA's Indigenous Wellness team has crisscrossed all five heath regions in BC offering Naloxone training to increase community capacity to slow and stop the rate of accidental overdose. A new Not Just Naloxone workshop is aimed at shifting the focus to the deeper roots of this crisis.

 "Not Just Naloxone: Talking about Substance Use in Indigenous Communities" is a train-the-trainer workshop that arose from the reality that, while Naloxone is an essential part of the current response, there is a greater need to expand on a holistic response to the crisis. This response uncovers and addresses the roots of addiction, acknowledges the roots of community connection, and empowers First Nations communities to design their own response to the issue—all while celebrating community and individual resilience.

The Indigenous Wellness team includes Janine Stevenson, Andrea Medley, Andrea Derban, Len Pierre and Sarah Levine. As the Indigenous Wellness team describes, by understanding the broader context of addiction, substance use, and harm reduction, the Naloxone training session has a greater reach.

"Not Just Naloxone, like Indigenous Harm Reduction and Decolonizing Addiction, is a framework to have mindful-judgment and honest conversations about substance use and overdose through a First Nations lens," said Len Pierre, Indigenous Wellness Cultural Designer with the FNHA Indigenous Wellness team. "We really want to showcase the great work already taking place in communities across the province. In a way, we can see the greater transformation of health services here in this work."

The three-day workshop supports participants to develop practical, community-based strategies and services that engage people who use substances, and how to recognize and respond to an overdose—all through the lens of cultural sensitivity and trauma-informed care. Other topics covered include background on the opioid overdose emergency, how to implement peer engagement, low-barrier cultural techniques as protective factors, and more. After two days of trainings, attendees are given tools to facilitate their own engagement through group work. 

The Indigenous Wellness team has traveled throughout BC for the last two years, creating opportunities for dialogue on these concepts. The team has trained First Nations communities, Indigenous and non-Indigenous partners in how to use Naloxone, a medication used to temporarily reverse overdose events. The team is the first to acknowledge that the learning goes both ways when visiting First Nations and Indigenous communities and partners.

"All of the curriculum we have is formed from what we have heard from communities," said Andrea Medley, Indigenous Wellness Educator with the FNHA. "We always humble ourselves as learners over teachers or 'experts' … we do just as much listening and learning as we do 'teaching'."

Above: Facilitator Len Pierre and participants offering closing reflections at the Vancouver Island Not Just Naloxone training session.

Western approaches to substance use, like health care, don't always work for Indigenous people and communities. Indigenous Harm Reduction is built on the foundation that reducing harm is not a new concept to Indigenous communities. Coming from a foundation of care and support, many communities have already been practicing harm reduction, as they work to include and involve the people that they care for who are using substances.

"Many communities are already practicing harm reduction - the Indigenous Harm Reduction workshop offers an opportunity to map out this work together. Facing this public health crisis can at times feel insurmountable and the issue may seem alien," said Andrea Medley. "When communities are given the chance to see all of the work that has been done, it makes a dark situation hopeful, and helps make an unfamiliar topic relatable. Reducing harm during the overdose emergency can only happen when there are options for understanding why people use substances, providing education and reducing stigma, and having space for people to talk about substance use, addiction and harm reduction."

Andrea added that a key piece of the work is involving people who use substances in the work and encouraging them to use in a safer way. This includes new ways of looking at the issue, such as exploring options for low-barrier cultural activities, as well as incorporating essential harm reduction public health programs and services, such as having sterile syringes, availability of sharps disposal containers, and having access to supervised consumption sites.

Clinicians Gabor Maté and Bruce Alexander have separately documented the impacts childhood trauma and addiction, and the dislocation of society as a root cause of addiction respectively.

The FNHA Indigenous Wellness team's concept of Decolonizing Addiction in some ways is supported by this work, coming from the voices of community - illustrating that for some Indigenous peoples, the roots of addiction can be found through the numerous historic and ongoing impacts of colonization.

Above: Roots of Addiction and Roots of Connection. Credit: FNHA Indigenous Wellness team

"I'm impressed with the knowledge I've learned here and I appreciate how they honour the knowledge of the group. I've got a lot from this workshop," said Irene Robinson, from Tseshaht. She commented that using the concepts of decolonizing language with people who use substances really resonated with her. "They are so friendly and they acknowledge people with warmth and acceptance, and a sense of humour. Glowing remarks."

Irene said the work of the Indigenous Wellness team validates and respects the knowledge of Indigenous Elders, honouring those who carried this knowledge when it wasn't safe to share during colonial experiences like residential school.

Between June 2017 and June 2018 the Indigenous Wellness team trained 63 First Nations communities and 12 organizations across the province in the Not Just Naloxone program—for a total of 93 participants.

The next phase of this work includes 'Community-to-Community' training sessions for people who have participated in the Not Just Naloxone training session. The Community-to-Community sessions will bring communities together to discuss the public health emergency, decolonizing addiction, harm reduction, and community resources.

"My Elders have shared that even if it's one person showing up, it's not just one person - they can go share this information with their family, with their community," said Len Pierre. "We need more and more Indigenous Harm Reduction champions in our communities. It's about expanding our circle - this is one circle of many circles."

The FNHA recently partnered with Vancouver Coastal Health to develop the 'Taking Care of Each Other' video series. The series features community champions, health service providers, and peers from across the province discussing Indigenous perspectives on harm reduction, resisting stigma, and hopes for the future. The 'Taking Care of Each Other' video series is a teaching tool intended to stimulate conversations about Indigenous harm reduction and is located here http://www.fnha.ca/what-we-do/mental-wellness-and-substance-use/overdose-information/harm-reduction

For more information about attending a Community-to-Community training session, email STBBI@fnha.ca