As Canada begins to count overdose deaths, the scope of the problem among First Nations remains unknown
As Canada begins to track national drug overdose deaths for the first time, public health experts and First Nations leaders are calling for better data on the scope of the problem in their communities.
That amounts to an average of 12 opioid-related deaths per year.
Data on the crisis across Canada has been patchy and out-of-date partly because it’s up to the provincial and territorial coroners to compile their own, and the efforts are not in sync. When it comes to overdose death data on First Nations people specifically in Ontario, one of the only provinces that captures First Nations death data, the numbers very likely underestimate the actual scale of the problem, leaving community leaders guessing.
On Tuesday, the federal Public Health Agency of Canada released new numbers that estimate at least 2,458 Canadians died from an opioid-related overdose in 2016 — which amounts to almost seven such deaths every day. While the numbers are still incomplete, it’s the first time national data on this issue has been compiled on the crisis that’s been fueled by illicit drug supplies tainted with substances like fentanyl, and the overprescription of opioids.
According to statistics obtained by VICE News from the Ontario coroner’s office on opioid deaths of “Known First Nations People,” there were 48 such deaths from 2012 to 2015, which is the most current year available. And there were 28 such deaths that also involved alcohol within that time period. That amounts to an average of 12 opioid-related deaths per year, and an average of seven opioid deaths per year that also involve alcohol.
Fentanyl accounted for one death in 2012, and only four in 2015, according to the numbers. There were five opioid overdose deaths that involved alcohol counted in 2015, down from 10 in 2014.
But the data for 2015 is still preliminary and could fluctuate, and chief coroner Dr. Dirk Huyer said in an interview that the overall numbers are likely much higher, but his office has not been systematically collecting “ethnocultural data” on deaths.
“People are dying needlessly.”
“What we have done is that we have attempted to capture or identify all First Nations deaths we investigate, whether they be drug-related or not,” he said. “If we believe that the deceased person was First Nation, we have a code that we would enter.”
The reason why the numbers seem low, continued Huyer, is that there’s no specific process every coroner follows to ensure that the “ethnocultural background” of someone who is First Nations is entered into the system in every instance. He added it’s easier to verify when the deceased is First Nations if their address is located on-reserve, while it’s more difficult to collect this data from someone who is First Nations but lived in an urban centre.
First Nations leaders in B.C. are experiencing the same frustrations in a province that’s now been under a public health emergency for more than a year due to skyrocketing opioid overdose death rates. While it’s the only health jurisdiction in Canada with a province-wide First Nations Health Authority (other provinces have a number of different such groups), it’s taken months for it to cross-reference its data with that of the B.C. coroner.
Grand Chief Edward John told the Canadian Press in April that while he suspects their communities are disproportionately affected by overdose deaths, they don’t yet have the numbers to prove it.
“All I hear is the anecdotal information from communities where funerals are taking place,” he said. “People are dying needlessly.”
The roots of mental health and addictions issues common among Indigenous communities across the country are tied into the deep trauma experienced by those who were forced to attend government-sponsored residential schools.
A spokesperson for the B.C. First Nations Health Authority told VICE News in an email that it will be releasing its overdose death numbers publicly later this summer following an analysis of data from provincial government and health bodies.
“Our main interest is to disseminate Firs Nations overdose data in a manner that does not stigmatize First Nations who use substances,” the email continued.
The big issue currently in northern communities, she said, is overdoses involving cocaine that’s likely been tainted with fentanyl.
In the midst of its own declared health emergency last year, the ring of 49 northern Indigenous communities in Ontario known as the Nishnawbe Aski Nation committed to working with the provincial and federal health ministers on a plan to tackle, and collect data on, a host of health issues ranging from cancer and diabetes to drug abuse and youth suicides.
Data on overdoses and deaths are still not gathered in one place, said Alvin Fiddler, the Grand Chief of the NAN. “That’s something that we need to have … I think all of us know that it’s becoming more and more urgent,” he said an interview.
“We’re really concerned about the presence of more and more fentanyl … it would be helpful if we had a database to tell us the scope of the problem, because at this point, we can only guess.”
The Ontario Coroner announced last month it was drastically changing the way overdose death data is collected by the office that has typically been two years out of date. The faster process will help identify specific trends and demographics, said chief coroner Huyer, and will aim to collect data on the race and socioeconomic backgrounds of those who have died of overdoses.
“That way we will have broad death statistics…including [whether the person is] Jamaican-Canadian, caucasian, Asian, south Asian, etcetera,” Huyer said, adding that collecting race-based data on the dead used to be considered racist. “Ethnocultural background is now recognized as a determinant of health, so we’re trying to be broad in our data collection and understanding of deaths to help people look at proper interventions.”
Mae Katt, a nurse practitioner who has worked on addiction and harm reduction for First Nations communities in northern Ontario for 40 years, agrees that the Ontario coroner numbers are likely a fraction of the total overdose among the population in the province. “It seems awfully low,” she said. However, she said that the death rates in her experience have been on the decline since suboxone treatments, and the opioid overdose antidote naloxone or Narcan, became more widely available around 2011.
The big issue currently in northern communities, she said, is overdoses involving cocaine that’s likely been tainted with fentanyl. “Thankfully they are being saved with Narcan,” said Katt. “But what communities are asking for, which hasn’t been funded by either level of government, is land and culture-based healing programs. These improve people’s coping mechanisms, gives them skills, teaches them about drug education … if we use the land, then maybe when the next drug comes along, people won’t take it.”
Cover: Justin Tang/The Canadian Press