Crystal meth is a colonial crisis and its root causes must be addressed

Alcohol.

Sniffing gasoline.

Super juice.

Opioids both prescription and non-prescription.

And now crystal meth.

Health organizations, politicians and the media have described the rises and falls in the harmful use of each of these substances as crises.

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The drugs alone are not the crisis and as long as we continue to focus just on the drugs, we will see one fall and another one rise up in in its place.

The real crises are the historic and current factors that place some populations at higher risk of harmful drug use than others.

A 2016 Peg report said the substance abuse rate among people age 10 and up in Point Douglas is 9.8 per cent, compared to 2.6 per cent in Fort Garry.

One of the key ways these neighbourhoods differ is in rates of poverty. The median income in Point Douglas is around $33,000 compared to $63,000 in Fort Garry.

Another is who lives in the neighborhood. Almost 30 per cent of residents of Point Douglas self-identified as Aboriginal on the last census, compared to 5.3 per cent in Fort Garry.

The Truth and Reconciliation Commission of Canada final reports released in 2015 called on us to understand the current state of Indigenous health is a result of previous government policy, and we need to understand harmful drug use in this context also.

Systemic roots

University of Washington professors Karina Walters and Jane Simoni have developed what they call an Indigenist Stress-Coping Model.

Their research explains that a person's health experience is determined by the balance between traumas or stressors (such as childhood apprehension, intergenerational impacts of residential schools, poverty and experiences of racism) and buffers (such as strong cultural identity, connection to family, community and culture, participation in traditional activities and ceremonies).

The disproportionately greater harm from substance use experienced by Indigenous people in Manitoba is not a drug crisis but a colonial crisis and a trauma crisis.

When there are more stressors or traumas than there are buffers, it is completely expected that a person or a population will experience more negative impacts to their physical and mental health, and is more likely to experience harmful substance use.

The Indian Act and related assimilationist policies systematically increased the trauma and stressors on Indigenous people through things like the residential school system, the Sixties Scoop and forced relocations, while at the same time making things like traditional ceremonies and certain cultural practices illegal.

Further, the gender discrimination in the Indian Act had proportionately greater impacts on Indigenous women, particularly by disconnecting them from their own identity, culture and language.

The disproportionately greater harm from substance use experienced by Indigenous people in Manitoba is not a drug crisis but a colonial crisis and a trauma crisis.

Four Pillars strategy

While our response has to include the appropriate treatment of harmful crystal meth use, if we want to prevent further crises we also have to focus on the root causes of trauma and colonization and provide spaces and programs where people can rebuild their connections, their meaning, their belonging, their purpose and their hope.

Cities in Europe and many parts of Canada have implemented a Four Pillars Drug Strategy focused on harm reduction, prevention, treatment and enforcement.

The strategy has brought reductions in the number of people using drugs on the street, drops in overdose deaths and reduced rates of infections that can be passed through sharing needles in places like Geneva and Zurich.

There is health evidence that affirms the importance of culture-based prevention and treatment programs to address harmful substance use in Indigenous communities.

What is missing from the mainstream implementation of these strategies is the recognition of the importance of Indigenous, community-based leadership and a focus on addressing the traumatic impacts of colonization.

The Native Youth Sexual Health Network has a Four Fires model of harm reduction, in which the four fires are cultural safety, reclamation, self-determination and sovereignty.

The fire of reclamation focuses on reclaiming cultural practices and connections that were disrupted by colonization.

A need for culture-based prevention

In addition to many diverse Indigenous worldviews and teachings that recognize strong cultural identity in the context of family and community as a core aspect of health, there is health evidence that affirms the importance of culture-based prevention and treatment programs to address harmful substance use in Indigenous communities.

These types of services are not widely or easily available in Manitoba, where most of the funding for substance use services goes to large mainstream organizations.

The fires of sovereignty and cultural safety have to do with providing safe, respectful services that are free of racism to people who use drugs, meeting them where they are at.

This can include hiring Indigenous community and peer workers who have specific training in culture-based harm reduction to make connections with people who use drugs, distributing supplies like sterile needs to reduce the potential harms from injecting drugs, and helping to navigate other aspects of the health-care system when people who use drugs want or need other services.

Increasing access to culture-based prevention, harm reduction and treatment programs that are delivered through Indigenous community-based organizations is an evidence-based strategy that would address the "crystal meth" crisis at its root.

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