How a small First Nation is treating addictions close to home

This story is part of a series by CBC Cape Breton examining the use of street drugs on the island.Click here toread more stories in this series.

A small First Nation in Cape Breton has taken the lead in treating addictions by keeping its residents close to home.

In Wagmatcook, if you're struggling with an addiction, you don't have to leave the community. In fact, for some, you only have to go to one building the Wagmatcook Health Centre.

The centre's holistic approach means patients can see a physician, community health nurse, social workerand dietitian, all in one place.

"I call it one-stop shopping. You can come in and see one person and you can be transferred to the next person all on the same day," said Elaine Allison, the director of the health centre.

"We're all in the circle of care together, so we're able to work together and make the best for that client to help them through these times."

That's a sharp contrast to how many residents were getting help in the past. Residents often had to travel more than hour to Sydney or North Sydney to access services related to addictions.

No travelling

The centre focuses on primary health care to treat people with addictions. That means patients get to see a family doctor that they know and get treatment for addiction as well as whatever other ailments they may have, like asthma or arthritis.

If a patient is struggling with other aspects of their life, they can see a social worker who can help with things like family issues.

Providing the services all in one place helps eliminate barriers, according to Dr. David Martell, the centre's physician.

In other communities, if a physician feels a patient needs the help of a specialist, or a certain program, they might need to travel a long distance to get that help.

"And that falls apart fairly quickly when either you don't have a licence or don't have money for gas,there is no public transit," said Martell."That's fragmentation of care. I think that kind of takes away from how effective it is."

Nova Scotia's health authority offers an adult addictions day program in the eastern and central health zones. People in Wagmatcookwho want to access that program have to travel more than an hour to Sydney.

Patients can also access mental health services through the mental health intake line, but there can be long wait times depending on the urgency of the patient's case and where they live.

Martell's presence in the community means residents no longer need to get transportation to North Sydney to see a psychiatrist for a prescription for long-lasting synthetic opioids like methadone. Martell can prescribe and patients can pick them up in nearby Baddeck.

Treating people the same

Another barrier people with addictions face is not having a primary care provider or not having one the patient knows and trusts.

Martell is a physician in Lunenburg. He spends several days a month in Wagmatcook and does virtual appointments when he's back in Lunenburg.

As a family physician, he slowly began to specialize in treating people with addictions. Martell recalls a time when treating a young man in Lunenburg, he recommended the man seek help in a bigger, more urban centre.

"On reflection, I thought that was a very shameful thing to say and it was a very poor reflection on our system. So I took the emotion and energy from that and I poured it into learning how to do it myself."

He said treating people with addictions doesn't have to be complex, but some primary care providers often don't feel equipped to do it and then send people further afield to get help. Martell believes doctors should leave stigma and preconceived notions at the door and treat addictions like any chronic illness.

"Even if we did nothing more than just treat people with addictive disorders the way we treat everybody else, we'd go a long way to helping solve the problems that they have," he said.

"I think my mission is one day people think nothing more of helping somebody with a substance use problem than they would helping somebody who has diabetes."

Solving problems over tea

Allison said the model in Wagmatcook isn't just about accessing services in an easy fashion, it's about having support from the Mi'kmaw community.

"We have a chief and council that's very, very supportive of this program ... and at any time the clients can speak to the chief and council or the elder council."

The idea for this supportive model, she said, came from a program the health centre provided for several weeks back in 2017.

Back then, patients dealing with a substance abuse disorder often had to go to Sydney or North Sydney for treatment.

"They spent their whole day traveling, which was no good. They couldn't get on with their lives, they couldn't go, they couldn't hold down a job because they were traveling to Sydney."

When those patients returned, former chief Mary Louise Bernardwould spend time with them as a group, cooking, having coffee and tea, going into the woods, discussing dreamsand holding sacred ceremonies like smudging.

"My mother and my godmother, they solved everything over a cup of tea and that was kind of my motto of the time," Bernard said.

Bernard said the health authority's day-program was helpful, but the participants sometimes found it rigid. Bernard would meet participants afterward and let them tell her what they needed and wanted to talk about. Sometimes that included having their homes smudged or even doing tasks together like going to the dentist.

• More stories from CBC Cape Breton's examination of street drug use on the island

Measuring success

Allison said the health centre's methods have helped curb crime driven by opioid addiction in the community.

"At its peak, there was a lot of crime, people were scared, they weren't going to open their doors because people were looking for stuff and trying to steal," she said. "Police say there's little crime in the community now."

But the proof of the centre's success can be seen in the patients themselves, said Allison.

"So many of them have jobs now, they've got their children back. It's a really wonderful program. It's really wonderful what they've been able to accomplish."

Allison wrote the proposals to get funding for the health centre's services. Shehopes to one day offer even more in the community, including a space for residents to detox. Right now, there are eight beds for detoxing in Cape Breton. All of them are in Sydney.