Item number nine in the letter to members of the Cat Lake reserve from the children in Grade Six is as blunt as it is painful.   

"It hurts us and shoomis and kokum (grandpa and grandma) when you're doing drugs and you're not at home."

Cat Lake is the epicentre of prescription drug addiction in Canada. Community leaders figure that between 70 and 80 per cent of the adults are hooked on narcotic pain killers OxyContin or Percocets.

Governments and local health authorities are slowly gearing up to deal with the runaway addiction that has slammed communities across the country, but especially First Nations.

But the help can't come quickly enough for the children of Cat Lake.

"We feel that we don't know what to do to help you stop doing Drug," the children wrote as "Point Number Five."

"We want you to stop because it hurts our family and we don't like it when we're angry," according to point number four.

The children in this lake-soaked corner of northwestern Ontario 400 kilometres north of Thunder Bay put together the list over the course of a few days in a workshop with the help of a local band member.

They are desperately yearning for ways to end to the crisis in their community that triggered waves of theft and left children hungry and bereft of the stability and support they crave.

Out of a population of about 700, local officials say they collect 500 needles a week through the needle-exchange program.

They have put 172 adults on their list of confirmed addicts, and another 250 are suspected. Almost everyone else is either a child or an elder.

Oxy, the highly addictive and extremely expensive little pill, has become a way of life here and in many reserves.

The drug is supposed to be taken for intense pain, by prescription only. It produces an instant high when crushed, snorted or injected and that high has triggered a massive demand for the drug across the continent. Some of the biggest profits are drawn from some of the poorest people in Canada.

In Cat Lake and other parts of northwestern Ontario, health care workers just assume most of their adult patients are using.

And yet, the narcotic pain killer is no longer being produced.

Purdue Pharmaceuticals has pulled it from the shelves, prompting First Nations leaders to warn of a pending crisis of withdrawal for which no one is well prepared.

Oxy addicts can build up a tolerance and require larger, more frequent doses to get high. But kicking the addiction, for many, is too punishing many to bear.

Abnormal sleeping patterns, violent shakes, diarrhea, headache and anxiety are common, for days on end. Relapses are frequent.

The dealers' stockpiles of the opioid are now dwindling and the price is climbing steeply. Authorities have been bracing for a withdrawal epidemic on reserves. 

Const. Kyle Brend of the Nishnawbe-Aski Police force in Cat Lake said the spike in price for the drug has forced users to reconsider their habits — but not always for the better.

A full-strength pill can sell for about $1000 and a quarter-dose for about $250. When a supply would come into the community, users would scour their houses for possessions to sell, hit up their relatives for cash, raid their savings, or gamble for cash, Brend said. There's a bit less of the door-to-door scavenging for drug money of late.

"You sell a digital camera for $60. You sell a couple things like that, you have money. It's getting harder nowadays with the prices."

Instead, addicts are looking for other ways to get high.

Rumours and internet chatter about how to abuse the new version of Oxycontin — called OxyNEO — abound. Health workers suspect increased usage of cocaine and especially morphine. Brend sees evidence of more booze, even though Cat Lake, like many reserves in the area, is supposed to be dry.

"Now it seems there's a lot of drinking to offset what they're not getting in the pills."

The police are cracking down as best they can on contraband. But even though Cat Lake has only one entry point — the airport — now that the winter road has melted, the community has only ever ejectedone person for dealing, Brend recalls.

The pills are easy to hide — in pockets, packages, even inside diapers or the lining of clothing. The entire community knows who is dealing, including the chief and council as well as the police, but authorities never catch them in the act because they are protected by tight-knit family and friends.

Struggling with addictions

In North Caribou Lake, another northwestern Ontario community struggling with addictions, a 20-something dealer stands out in the street in broad daylight, surrounded by a small group of band members. He melts away when anyone in authority casts a wary eye.

So instead of focusing on crime and punishment, community leaders focus on healing the addicted and convincing any remaining non-users to stay clean.

"STOP NOW!" reads an item on the children's list. "We want you to get help and get better."

Help on that front is on the way, but ever so slowly, and in small doses. Stopping right now is far easier said than done.

In North Caribou Lake, where about half the adults are addicted, the local nursing station is not yet set up with the medical treatment program that many health authorities believe is the most effective way to kick oxy addictions. The medical treatment, Suboxone, mitigates the horrible withdrawal symptoms. But the recovery program takes weeks and requires health authorities to monitor the patients very closely.

Many reserves in the region can only administer Suboxone in rare cases, under specific circumstances. The nurses in charge of the day-to-day health of remote communities aren't empowered to set up full-fledged treatment programs. That's changing, but ever so gradually.

In Sioux Lookout — a short flight to the south of Cat Lake and North Caribou Lake — the hospital just added a five-bed unit for mental health. The unit has quickly turned into an oxy treatment centre. But with thousands of addicts in the region, the beds are always full and the wait list is growing longer, now standing at four months.

In Cat Lake, Health Canada and band administrators are scrambling to start a Suboxone program that will combine a land-based recovery.

They had trouble finding space for a recovery centre, since housing and infrastructure are in severe short supply. They plan to convert an old building near the band office into a respite where Suboxone can be administered and patients can be monitored closely for a week.

Then, the recovering addicts will be sent out into the bush, with few supplies except the very basics. For several weeks, under the eye of a health professional, they'll set up camp, hunt, fish, soak in nature, and — hopefully — conquer their addictions.

The first intake of three people starts on April 30. The waiting list has 15 names on it. But it should have hundreds, says health director Valerie Spence.

Still, it's something.

"It's a relief actually. I can breathe," says Spence. "It was really hard seeing my family, my friends, all getting sick. I have a niece, she went to withdraw for about two weeks. I saw first-hand how it can effect people. She used to be normal. She's not the same any more.....She lost herself, I would say. She's slowly coming back."

But down in Sioux Lookout, the co-medical director of the First Nations Health Authority is not breathing any sigh of relief. Dr. Claudette Chase despairs over the lack of comprehensive plan that would, she believes, treat more people and prevent so many relapses.

Recovering addicts need a "seamless service", not just in regional centres, but in their own communities so that the help they receive stands a chance of sticking. 

"We've got the Cadillac service for three weeks, and (then) often people drop off the face of the earth, to nothing."

Some recovering addicts from Cat Lake seek out family and friend support in other communities so that they don't have to go back to the oxy-dominated society of their home reserve. But Chase has come to expect relapse.

"Most patients who have left the unit, not all, but most of them who didn't go on maintenance have eventually relapsed. Because often they go home, and the communities are trying very hard to build support services but it's early stages," she said.

Canadians need to ask themselves, however, why they and their governments are so willing to fund and support heart surgery or hospitalization for drug addicts in their final days, but won't embrace what's needed to control the crisis, she added.

"I do think that's an important question for us to ask ourselves. Why is this happening? Why won't we take this on? Because it is so far from rocket science," she said.

"It would be great to see Health Canada jump in with both feet."

That way, Chase said, the parents would stand a chance of making good on Item Number 11 of the children's list: "Please go for treatment and get HEALTHY!"