RESUMO
OBJECTIVE: To document the development of unique opioid-dependence treatment in remote communities that combines First Nations healing strategies and substitution therapy with buprenorphine-naloxone. DESIGN: Quantitative measurements of community wellness and response to community-based opioid-dependence treatment. SETTING: Remote First Nations community in northwestern Ontario. PARTICIPANTS: A total of 140 self-referred opioid-dependent community members. INTERVENTION: Community-developed program of First Nations healing, addiction treatment, and substitution therapy. MAIN OUTCOME MEASURES: Community-wide measures of wellness: number of criminal charges, addiction-related medical evacuations, child protection agency cases, school attendance, and attendance at community events. RESULTS: The age-adjusted adult rate of opioid-dependence treatment was 41%. One year after the development of the in-community healing and substitution therapy program for opioid dependence, police criminal charges had fallen by 61.1%, child protection cases had fallen by 58.3%, school attendance had increased by 33.3%, and seasonal influenza immunizations had dramatically gone up by 350.0%. Attendance at community events is now robust, and sales at the local general store have gone up almost 20%. CONCLUSION: Community-wide wellness measures have undergone dramatic public health changes since the development of a First Nations healing program involving opioid substitution therapy with buprenorphine-naloxone. Funding for such programs is ad hoc and temporary, and this threatens the survival of the described program and other such programs developing in this region, which has been strongly affected by an opioid-dependence epidemic.