Legal drugs are misused as well

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While most of the focus on addressing addictions problems in Aboriginal communities has been on alcohol and street drug use, there is another type of drug addiction that hasn't received as much attention-addiction to prescription medication.

It is easier for prescription drug misuse to go unnoticed. Prescription drugs are legal, easy to access, and there is no social stigma attached to taking a drug prescribed to you by a doctor. However, as with street drugs and alcohol, people misusing prescription drugs can become dependent, and that dependence can have dire consequences.

Dennis Wardman is a community medicine specialist with a special interest in addiction medicine. She works for Health Canada's First Nations and Inuit Health Branch, Pacific Region. Wardman said the rate of prescription drug abuse on First Nations communities in Canada is about the same as it is in the general population, although it may be more of a problem on some specific communities. It's not until you begin to look specifically at First Nations people who already have an addictions problem that any increases in misuse rates can be seen.

"There was a study that I was involved with, it was published last summer, that considered prescription medication misuse among an addicted population, among people that basically enter into an alcohol and drug treatment program. And basically, it was a problem among that population, compared to the general population of addicts," Wardman said.

"So compare the population of people that go to AADAC (Alberta Alcohol and Drug Abuse Commission), versus the population that went to a Native treatment program in Calgary. It was about 50 per cent of the clients at the Native treatment centre that have misused medication. And when I say misuse, I'm referring to using the medication for purposes other than intended by a prescribing physician."

During 18 years as a social worker, Ellisa Loucks saw many of her clients battling addictions to prescription medication.

"I used to do therapeutic counselling with Aboriginal women, and a consistent issue was always overmedication," said Loucks, who now works as the Justice Co-ordinator-Corrections with the Native Women's Association of Canada.

One of the main reasons these women were being overmedicated, Loucks said, was because many of them had emotional issues, and the first reaction of the medical profession is to deal with those issues through medication.

"When we look at the women who were being medicated, most of them were on anti-depressants. That's the first thing that they tended to be stuck with. The major reason for all of that was because nobody could answer their questions around their sexual abuse. So what I found in doing my counselling was that the majority of people, in particular women, who were on medications, anti-depressants, mood altering, basically, was based on that, that there was no fundamental way of addressing their healing needs, " said Ellisa Loucks.

By 'stabilizing' their emotions, the medication creates a vicious circle, Loucks said, because it makes them emotionally flat, and therefore unable to deal with the emotional issues that led them to be medicated in the first place.

What makes the problem even worse is that many of these women see the prescription medication as their only way to cope, and so they over-medicate themselves by going to more than one doctor, and using more than one prescription at a time.

These women are not only harming themselves by overmedicating, Loucks said, but many of them are mothers and are teaching their children by example that over-medication is the best way to cope.

"So we're raising a whole new generation of people who not necessarily are into street drugs and alcohol, but are very comfortable and aware and familiar with medication that's prescribed. So even in our communities . . . I'm finding that a lot of the young men are into taking pills. So if you get a pain pill for your teeth, you ay, 'Oh, I lost the prescription.' You get it filled at one pharmacy, you get it filled at another pharmacy . . . and so they're taking them because it's like, 'OK, I don't need to deal with this.'"

One of the ways to tackle the problem of prescription drug misuse is education, Wardman explained. As part of the study he was involved in, Wardman looked at where people were getting the medication they were misusing, and most of it was coming from family and friends.

"So that says to us that the individuals, like family members, or community members, really ought to be educated that they shouldn't share their medication with people. And they actually should consider putting it in a secure location, so people can't get at it."

Another avenue to address the problem of prescription drug misuse is a legal one, Wardman said, because some of the people misusing prescription medication are buying it on the street.

"I think what this means then is this is really more of a community action. The community really has to take ownership and responsibility of this issue. Like having stricter bylaws for not allowing this. An example is the Siksika Nation did this, to have more consequences if a person is caught selling medication. Police enforcement, they need to crack down on the selling of illegal medication. And a lot of community members in general, they need to take this more seriously. I do recognize that it is family and friends that are selling the medication, and people are reluctant to report these people. But I hear all the time when I go to communities, people are upset that people are doing these wrong things. It's killing people," he said.

"The communities have to just take responsibility and say, if we're going to do something about it, this has to be done, action has to occur by everyone in the community. So they have to get tough on it.

Pharmacies and doctors must also play a role in addressing the problem, with pharmacies checking to make sure clients are not"double doctoring," getting the same prescription from more than one doctor. Doctors can prescribe smaller amounts at a time so their patients can't sell the medicine on the street.

While some might be quick to point the finger at doctors for the problem of prescription drug abuse, Wardman said the blame can't be placed so easily.

"Now it is true that some MDs may not be prescribing as well as people think they should in terms of not screening tightly enough, but there's a lot of issues here. I don't want to be blaming anybody, but physicians are busy, and in a rural practice maybe see 60 people a day. . .. So they're very busy and they don't have time to address a lot of the issues that patients come in with . . . the physical or the emotional pain."

One solution to this problem is to have a community health representative or NADAP (Native Alcohol and Drug Addictions Program) worker in the doctor's office to talk to the patients and find out about other issues, and then pass this information on to the doctor, Wardman suggested.

Aboriginal health professionals also have a role to play in the solution, Loucks said, by talking to other medical professionals and letting them know what is important to Aboriginal people.

Another part of the problem, Wardman said, is the attitude that prescription medication is the answer to all of life's ills.

"There seems to be a real attitude that if we have any pain, if we have any anxiety, or something is not right, we should take medication to make us feel better. So that attitude has to change as well. We need to be more aware of all the non-medication therapies that could be just as effective, such as relaxation techniques, stress management, exercising, support from family and friends and counselling."

Wardman would welcome inquiries from people wanting information on how to address the problem of prescription drug misuse in their communities. His e-mail address is dennis_wardman@hc-sc.gc.ca.