4 CARACTERISTICAS Y PROPIEDADES DE LA YSZ:

between a range of individuals,

including clients, medical service

providers addiction workers, and

cultural supports to ensure that

clients get the care they need.

>> DeSCriPtion

Medications can be central to treating addiction issues and support addictions recovery. When appropriately prescribed and administered, they can increase the chance that a client with addictions will, over time, reduce their substance use or achieve sobriety. Prescription medica- tions are sometimes used in the treatment of addictions either as a substitute for the substance of abuse, or to help the person reduce or stop their abuse. Medications can also be central to treating mental health issues (see the Addressing Mental Health Needs section of this chapter for more information on the use of medications for mental health issues).

The correct use of pharmacotherapy can be a valuable part of treatment for those clients who need to include medication in their healing journey. Key components of pharmacotherapy include:

• Medical assessment; • Follow-up and monitoring; • Coordination of care; and

• Multi-disciplinary team approaches.

Service providers include individuals qualified to prescribe medication such as physicians, and in the case of some med- ications, nurse practitioners. Non-prescription medications may be recommended by various health care providers, including nurses and pharmacists, or specialized cultural practitioners. Community-based addictions workers can also have an important role for clients on medication by providing routine follow-ups and monitoring side effects.

>> key ComPonentS

Medical Assessment

The vast majority of assessments are done by primary care providers in the communities such as general phy- sicians and nurse practitioners. A medical assessment is required to determine a client’s need, suitability, and fit- ness for a particular medication. A client’s need relates to a review of the client’s symptoms and whether or not

symptoms could be relieved or controlled by medication. Suitability relates to a person’s tolerance of the medica- tion given their condition or diagnosis, and their fitness relates to whether they can safely take the medication without severe physical side-effects.

Follow-up and Monitoring

A person who is being prescribed medication needs to have ongoing follow-up with the appropriate health care provider. Symptoms and side-effects must be monitored and it is vital to determine the client’s tolerance level of medication to ensure proper dosage. This ongoing moni- toring by a health professional may also be an opportu- nity to determine what additional services are necessary.

Coordination of Care

Some clients may need to be stabilized on a medication so that they can enter treatment (e.g., clients experiencing mental health issues). In these cases, community-based ser- vices may need to offer strong case management support to clients and link them with appropriate services, and assist them with making well-informed choices. Coordination of care includes physicians that provide pharmacological aspects of service working with the client and/or other health care providers.

Medication can be coordinated with the client’s broader treatment plan to ensure they complement other approaches to healing such as traditional and complemen- tary medicine.

Multidisciplinary Team Approaches

A multidisciplinary team approach to care is often most effective when addressing all aspects of the client’s needs. This enables knowledge exchange between medical pro- fessionals and other service providers to ensure coordi- nated care plans, particularly for clients on medication. It facilitates long-term partnerships among physicians, advanced practice nurses, pharmacists, and communi- ties in supporting addiction workers as part of a holistic approach. It links continuity of care, follow-up supports, supervision, and consultation for the person’s day-to-day

care providers. It can also ensure that prescribing phy- sicians are aware if the client is using traditional medi- cines, so as to reduce possible drug interactions. A team approach also facilitates the inclusion of Elders and other cultural supports.

>> Current StAtuS

There is much sensitivity around the use of prescrip- tion medications in First Nations communities. Some is rooted in the history of colonization, dominance of medical thinking, language and treatment, and a poor understanding by the medical system of the complex issues faced by First Nations people, families, and com- munities; and the cultural processes needed to sup- port and empower them. This reinforces the belief that pharmacotherapy services are not always culturally safe. There is also growing awareness of the preventative and curative treatment value of Indigenous and comple- mentary medicines, (e.g., to ease stress, anxiety and depression, to help build coping skills, and build resil- ience). It is also recognized that not all approaches have to involve medication.

Pharmacotherapy, however, can be a useful addition to other forms of treatment, and certain prescrip- tion drugs can help people to resist urges during their first year of abstinence. Opiate replacement therapy, such as methadone and the buprenorphine/naloxone combination (Suboxone®_{), has been shown to be very} helpful to clients, their families and their communi- ties when there are clear management plans in place.

A client’s overall health can improve while on these medications because with symptoms or cravings con- trolled, clients may be more likely to access health services and live healthier lifestyles. Their risk for con- tracting diseases like Hepatitis C and HIV is lower and they are more likely to have better relationships with family and friends.

Both opiate replacement therapy, such as methadone and Suboxone®_{, and naltrexone (Revia}®_{, lowers a per-} son’s craving for alcohol), can be very useful in helping clients to complete an addiction treatment program. Completing a treatment program is one of the most important factors for long-term sobriety. Medications such as those listed above help clients dealing with withdrawal symptoms, support them to enter treat- ment at an early stage, and may increase the chance that they will complete treatment. For these reasons, it is recognized that medication is important for managing the physical aspect of addictions. Other aspects of treat- ment can address the emotional, spiritual and mental health needs to ensure a holistic approach.

Supports are limited for clients who are using medications and who also wish to access NNADAP treatment services.

• Treatment staff lacks specific training in how to deal with clients using medications as part of their addiction recovery.

• Treatment staff needs more support from physi- cians who have knowledge regarding addiction medications.