Question Period Note: Substance Use

• Our Government recognizes that substance use can have devastating effects on individuals, families and communities and their general health and well-being.
• We are currently investing $425 million annually for community-based services to address the mental wellness needs of First Nations and Inuit.
• This includes a recent investment of $200 million over five years to support prevention and treatment services for substance use.
• We remain focused on supporting long-term investments that improve the health and well-being of Indigenous peoples.

Indigenous communities across Canada are disproportionately impacted by the opioid public health crisis and in particular, First Nations in British Columbia, Alberta and Ontario. The Assembly of First Nations has reported that some First Nations communities are experiencing an epidemic, with as many as 43% to 85% of the communities’ population addicted to opiates (Assembly of First Nations Resolution no. 82/2016 and no. 68/2017). In spring 2017, the Department of Indigenous Services Canada started to track suspected opioid overdoses in 153 participating First Nations communities. The Department continues to work with partners from across the country to improve data collection and reporting, and to better understand how this crisis is affecting different populations

The Government of Canada has announced significant financial investments to help address the crisis. Budget 2018 is providing $200 million over five years (2018/19 to 2022-23) and $40 million per year ongoing to support new investments in substance use prevention and treatment services for First Nations and Inuit including funding to address the ongoing opioid crisis. The investment will support up to: an additional 25 opioid agonist therapy sites offering wraparound services; an additional 75 on the land activities; enhanced services across a network of 45 federally funded treatment centres; and, major renovations at over 20 of these centres. Indigenous Services Canada allocated this fiscal year over $425 million towards culturally relevant and community-based mental wellness supports for First Nations and Inuit that aim to: provide treatment, reduce risk factors, promote protective factors and improve health outcomes associated with mental wellness.

Indigenous Services Canada provides several services along the drug misuse continuum.

1. Through the Non-Insured Health Benefits (NIHB) Program, coverage is provided to registered First Nations and recognized Inuit for:
   • Methadone, buprenorphine/naloxone (i.e. Suboxone and generics), slow release morphine and injectable opioid agonist treatment (iOAT) for the treatment of opioid use disorder. To promote client safety, clients receiving these treatments are enrolled in the Client Safety Program.
   • Naloxone, used to treat overdoses, both Injection and nasal spray (Narcan);
   • Medical transportation benefits for clients to access supervised treatment for opioid use disorder (e.g. methadone, Suboxone). The client’s ongoing need for travel is reviewed every six months
   • Up to 22 hours of professional mental health counseling every 12 months, with additional hours as required.

2. In addition to coverage provided under the NIHB Program, in facilities where ISC provides primary care services in First Nations communities, naloxone injection is available for administration by health care professionals to reverse the effects of the overdose. There is also a limited supply of naloxone nasal spray (Narcan) in Nursing Stations that is available to community members at no charge. Injectable naloxone is listed in the Branch’s Nursing Station Formulary as a “must stock” medication.

Government of NWT announcing new substance abuse funding:

• Our Government works closely with the Government of Northwest Territories to address public health issues that affect First Nations and Inuit, including substance misuse.

• Recognizing the complex factors that contribute to substance use, including alcohol, Indigenous Services Canada has provided the Government of the Northwest Territories with $250,000 in 2018-19 and $1 million over five years, starting in 2019-20, to support the territorial alcohol strategy.

• We remain committed to working with partners to explore innovative ways to collectively address substance misuse issues in the North.
If pressed on COVID-19 and substance use:
• We recognize that many Indigenous communities face unique challenges in addressing COVID-19, some of which can lead to increased stress and substance use.

• The funding announced for Indigenous communities as part of Canada’s COVID-19 response can be used to support access to mental wellness services.
• The Hope for Wellness Help Line continues to offer crisis intervention services by telephone or chat, with surge capacity investments provided for additional counsellors.

• We are also working with Indigenous partners to promote additional resources for Indigenous youth, and to develop an online platform to support community-based mental wellness teams.
If pressed further on restricted access to First Nations communities during COVID-19

• Supporting mental wellness during and after the COVID-19 pandemic is essential.

• Substance use treatment, prevention, and aftercare services are continuing where possible while respecting COVID-19 public health physical distancing measures.

• Counselling, cultural supports, and other forms of treatment are available through telehealth and on-line platforms.

• Treatment centres and community-based programs are also ensuring medication availability for opioid agonist therapy (OAT).

• We will continue to work with partners to ensure mental wellness supports are available for communities.
If pressed COVID-19 & Mental Health Supports

• In August 2020, $82.5M was committed to support Indigenous communities during the next six months of the COVID-19 pandemic for surge capacity and adaptation of critical mental wellness services.

• We are working with partners to implement distance approaches to service delivery such as tele- and video-counselling for substance use services and other existing programs.

• The Hope for Wellness Help Line continues to offer crisis intervention services by telephone or chat, with surge capacity investments provided for additional counsellors.
Tracking of Opioid Use :
• Our Government recognizes that the opioid crisis continues to have devastating impacts on Indigenous communities nationally, and that quality data is an important part of a comprehensive approach to drug control.
• I know that there are significant data limitations on how Indigenous peoples are affected by this crisis and we are working with partners to overcome these limitations.
• We will continue to work with First Nations and Inuit, provincial and territorial partners to explore ways to collectively address opioid-related issues.