Weaponize Wastewater Monitoring to Stop Opioid Deaths

In 2022, Yukon declared a substance use health emergency in the territory. Earlier that year, three members of the Carcross/Tagish First Nation died from toxic drug overdoses within the span of six days. Despite efforts to address the problem, mortality rates remain surprisingly high, with 23 deaths recorded in 2023 and three so far this year.

But the opioid crisis in Yukon is not just a statistic, it is a devastating reality that continues to claim lives at an alarming rate. Yukon faces Canada’s highest per capita death rate from illicit drugs. The territory’s First Nations are disproportionately affected by the crisis, taking an irreversible toll on individuals, families and entire communities.

To date, solutions to address the crisis have been reactive and focused on providing resources such as naloxone to reverse overdoses, drug testing kits, and food and mental health support. When opioid use is monitored, we can implement specific interventions. The sad thing about the opioid epidemic, like infectious diseases, is that it often causes deaths that were preventable. The problem needs to be addressed head-on, and the answer could lie in your bathrooms.

Wastewater sampling is a process that involves collecting, testing and analyzing multiple samples every few days. Wastewater samples for analysis are taken from one source where they are all mixed so that monitoring the water for opioids is always anonymous. Because we don’t know whose stool we’re testing, we can respect people’s privacy while also collecting data on opioid use in the community.

During the pandemic, One Yukon Coalition, an emerging health-focused community organization led by First Nations, successfully used wastewater monitoring as an early warning system. In February 2022, we developed and piloted a wastewater monitoring program with the Public Health Agency of Canada, the National Microbiology Laboratory, the Champagne and Aishihik First Nations, and the Village of Haines Junction. The data we collected showed communities whether there was an increase in COVID-19 cases before it showed up in home test kits. This allowed communities to assess risk and act quickly, whether by allocating resources or encouraging mask-wearing.

Wastewater monitoring results are fast and accurate. Today, communities can see if there is an increase in respiratory illnesses in the area and share the information with community members, giving Yukoners the information they need to make decisions about their health. Wastewater monitoring has the potential to be an invaluable tool for tracking the prevalence of substances of potential abuse, including opioids, in communities. This knowledge can save lives by providing citizens with the right resources in advance.

Yukon First Nations have the right to self-determination. Proactively collecting anonymous, community-owned data also helps build resilience to emerging health issues and gives us the knowledge to care for each other.

Now more than ever, we need innovative, Indigenous-focused solutions to address this pressing issue head-on. Wastewater monitoring can provide a path out of the opioid crisis, but it cannot work in isolation. Addressing the root causes of substance use disorders requires a holistic approach that addresses the social, economic, and historical harms caused by colonialism. This includes shifting focus from a binary view of health to one that focuses on physical, mental, emotional and spiritual well-being.

It requires us to find innovative, flexible solutions that respond to the unique needs of communities and are not tied down by bureaucracy. By harnessing the power of Indigenous knowledge and perspectives, we can develop comprehensive strategies that promote healing and resilience within our communities.

Yukon’s opioid crisis needs to be addressed, and the answer may lie in residents’ bathrooms, writes Math’ieya Alatini @one_yukon @yukongov @GovCanHealth

A brilliant example

Southcentral Foundation Nuka Care System is a successful, award-winning example of a people-centred, Indigenous-led healthcare system.

For 50 years, the indigenous people of south-central Alaska received health care as “beneficiaries” of the Indian Health Service’s native hospital. Disappointed by long wait times, lack of primary preventive care, and disconnect between physical and mental health, patients began advocating for a voice in program planning and service delivery.

In 1999, Alaska Natives were no longer “beneficiaries” of a government-run system, but instead chose to become self-determined “customers” as well as “owners” of their tribally managed health care. They could now make informed decisions about their health care system and work to maintain it for future generations.

Policymakers, health professionals and community leaders across Canada must prioritize Indigenous-focused solutions in our efforts to combat the opioid crisis. Yukon is at a pivotal point with the timely creation of a health authority, Shäw Kwä’ą, that will integrate First Nations ways of knowing and being into a person-centred approach to well-being.

By taking the best of both worlds, we can create a brighter, healthier future for the Yukon, built on a foundation of empowerment, resilience and hope.

Math’ieya Alatini is CEO and President of One Yukon Coalition and Chief Strategist of GSD Strategies.

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