Mamakwa Solomon, Kahan Meldon, Kanate Dinah, Kirlew Mike, Folk David, Cirone Sharon, Rea Sara, Parsons Pierre, Edwards Craig, Gordon Janet, Main Fiona, Kelly Len
Health Director for the Shibogama Health Authority in Sioux Lookout, Ont.
Associate Professor in the Department of Family Medicine at the University of Toronto in Ontario and is an advisor in addiction care to Sioux Lookout physicians.
Can Fam Physician. 2017 Feb;63(2):137-145.
To evaluate established opioid addiction treatment programs that use traditional healing in combination with buprenorphine-naloxone maintenance treatment in 6 First Nations communities in the Sioux Lookout region of northwestern Ontario.
Retrospective cohort study.
Six First Nations communities in northwestern Ontario.
A total of 526 First Nations participants in opioid-dependence treatment programs.
Buprenorphine-naloxone substitution therapy and First Nations healing programming.
Retention rates and urine drug screening (UDS) results.
Treatment retention rates at 6, 12, and 18 months were 84%, 78%, and 72%, respectively. We estimate that the rate at 24 months will also be more than 70%. The UDS programming varied and was implemented in only 1 community. Initially urine testing was voluntary and it then became mandatory. Screening with either method found the proportion of urine samples with negative results for illicit opioids ranged between 84% and 95%.
The program's treatment retention rates and negative UDS results were higher than those reported for most methadone and buprenorphine-naloxone programs, despite a patient population where severe posttraumatic stress disorder is endemic, and despite the programs' lack of resources and addiction expertise. Community-based programs like these overcome the initial challenge of cultural competence. First Nations communities in other provinces should establish their own buprenorphinenaloxone programs, using local primary care physicians as prescribers. Sustainable core funding is needed for programming, long-term aftercare, and trauma recovery for such initiatives.
评估安大略省西北部苏圣洛朗地区6个原住民社区中，将传统疗法与丁丙诺啡 - 纳洛酮维持治疗相结合的既定阿片类药物成瘾治疗项目。
回顾性队列研究。
安大略省西北部的6个原住民社区。
共有526名参与阿片类药物依赖治疗项目的原住民。
丁丙诺啡 - 纳洛酮替代疗法和原住民康复项目。
留存率和尿液药物筛查（UDS）结果。
6个月、12个月和18个月时的治疗留存率分别为84%、78%和72%。我们估计24个月时的留存率也将超过70%。UDS项目各不相同，仅在1个社区实施。最初尿液检测是自愿的，后来变为强制性的。两种方法筛查发现，非法阿片类药物检测结果为阴性的尿液样本比例在84%至95%之间。
尽管患者群体中创伤后应激障碍高发，且项目缺乏资源和成瘾专业知识，但该项目的治疗留存率和UDS阴性结果高于大多数美沙酮和丁丙诺啡 - 纳洛酮项目报告的结果。此类基于社区的项目克服了文化能力方面的最初挑战。其他省份的原住民社区应建立自己的丁丙诺啡 - 纳洛酮项目，由当地初级保健医生担任开处方者。此类举措的项目规划、长期后续护理和创伤恢复需要可持续的核心资金。
