Drug abuse equals death for Indigenous youth

Indigenous young people who use drugs are 13 times more likely to die. @NightshiftMD looks at a serious problem.
Winnipeg has seen wave of crime and violence related to illicit drug use, poverty and mental health issues. (CBC)

Indigenous youth are one of the fastest growing segments of Canada's population. They're also near the top of the list of Canadians most likely to die.  A new study published in the Canadian Medical Association Journal gives one of the main reasons. 

The main factor causing the the increased death rate is drug use. That's the main conclusion of a study of Indigenous young people age 14 to 30 years who use drugs in Vancouver and other parts of B.C.. Researchers from Child and Family Services at Carrier Sakani Family Services and The Cedar Project — a community-based research project driven by a number of Aboriginal community partners — looked at the records of 610 Indigenous youth.  Between 2003 and 2014, 40 of the cohort of 610 died.  Overall, Indigenous young people in B.C. who use drugs are an incredible 13 times more likely to die than all Canadians the same age.*

The researchers looked at the causes of death in Indigenous youth who use drugs.  Overall, the leading cause of death was overdose. Illness was the second leading cause of death, followed by suicide. Many people who use intravenous drugs are infected with hepatitis C.  In the study, those infected with hepatitis C were more likely to die that those not infected. 

There were also some important gender differences. Women made up 80 per cent of young people who died by suicide, and 75 per cent of Indigenous young drug users who died by overdose or illness. The death rate among young Indigenous Canadians is high, but for women, it's even higher — double that of young Indigenous men.

A number of factors lead Indigenous people — and in particular women — to use drugs. The big factor is early childhood trauma and neglect. Less than 10 per cent of children in B.C. are Indigenous but account for 60 per cent of the kids in foster care. Children in foster care are nearly four times more likely to die of suicide, homicide and infectious diseases. Research by The Cedar Project has shown that having at least one parent who went to an Indian Residential School increases the risk of trauma in subsequent generations.

The authors of the CMAJ study speculated that deep-seated emotional trauma can last for generations, and can lead them to reject life itself.  Indigenous youth are more likely to have a history of childhood sexual abuse, which also increases the risk of drug abuse. 

As for why Indigenous women who abuse drugs are at higher risk of dying, the authors say Indigenous women are more likely than men to attempt suicide. Opioids are lethal drugs, and attempted suicide by opioids is more likely to end in death than if other drugs are used. As with alcohol, since women on average weigh less than men, a standard hit of narcotic will have a stronger effect on women.  Also, the women in the study had a higher prevalence of hepatitis C which in turn raises the mortality rate.

The health care system does a poor job of looking after the needs of Indigenous patients in general. There is a culture of racism towards Indigenous people, and it should be no surprise that there is discrimination towards Indigenous people in our health care system. 

Non-Indigenous health care providers hold certain myths and misconceptions about Indigenous patients.  For instance, it's widely held that the health problems of Indigenous youth can largely be chalked up to alcohol abuse. It's also widely believed that Indigenous people can tolerate pain better than non-Indigenous people. If they complain of pain, they must be scamming for drugs like opioids.  It's also widely believed that Indigenous youth are loners who are indifferent to their families and their culture. To the contrary, many have been ripped away from their families and have had their language and cultural heritage ripped away from them.

The authors say that Indigenous young people who abuse drugs as well as their families must have access to treatment that is consistent with Indigenous cultural practices.  They say that the youth continue to be affected by historical and present-day injustices and barriers to care.  The hope is that their traditions, culture and languages survive and can form the basis of resilience and healing for people who use drugs.  The people who work in the health care system need to take courses in cultural safety to dispel myths about Indigenous people and provide more sensitive and compassionate care. 

The need for change is urgent. Since the data from this study was submitted for publication, another 25 young men and women from the original 610 people have died.

Check out this infographic from CMAJ here.

* The comparison was incorrectly stated in a previous version of this blog.