Governments have thrown tens of millions at First Nations drug treatment. People are still dying

The treatment meant to save Niibin Pahpeguish’s life began to feel like a prison.

After almost a decade battling an addiction that began with prescribed painkillers and later escalated to street opioids, she entered a treatment program in 2009. There, at a facility in Brantford, Ont., she was put on methadone, a drug prescribed to ease withdrawal symptoms and reduce cravings.

Part of a drug class called Opioid Agonist Therapy (OAT), methadone is a critical and life-saving way to address addiction for many. Pahpeguish says doctors told her she could be on it for the rest of her life.

But after about two years, she felt like the drug was causing its own harm. Her body, she says, was breaking down. She suffered liver damage, bone density loss and gastrointestinal issues that affected her heart rate. These complications led to frequent hospitalizations and were linked to the mix of her opioid treatment and other medications.

“I said, ‘I want to be off of this now,’ ” she recalls.

Pahpeguish’s story is part of a devastating and costly crisis unfolding across Ontario, where OAT treatment among Indigenous people is 15 times higher than among non-First Nations people, according to a new report to be released today by the Chiefs of Ontario in partnership with researchers at the Ontario Drug Policy Research Network (ODPRN).

The opioid-related death rate among First Nations people is nine times higher than among non-First Nations people, the report says.

Finding the best possible treatment approach for First Nations people comes with high stakes.

Governments have thrown tens of millions of dollars at the ongoing problem.

The federal government has projected an annual investment of about $768 million over 2025-26 to support mental wellness services in Indigenous communities, including  $28.3 million for extra services to support those receiving OAT treatment.

In 2021, the Ontario government announced a $36-million commitment to mental health and addictions support in Indigenous communities across the province.

The report connects the higher rates of opioid-related harm among First Nations to generational trauma, given its link to mental health struggles and substance use.

The alternative to funding access to OAT can be devastating.

“Up to 10 per cent of people, if they have to go through opioid withdrawal, would consider committing suicide if it’s not treated with medication properly,” says Dr. Chetan Mehta, an addictions specialist at Anishnawbe Health Toronto. “Opioid therapy helps to relieve that.”

But Pahpeguish’s experience illustrates a key question: While OAT treatment kept her alive, questions remain about how effectively it is addressing the long-term needs of First Nations people.

“Clearly there’s disproportionate harm among First Nations People, clearly they are accessing treatment, but perhaps not always in the best way or a way that is supportive of them,” says Tara Gomes, lead researcher on the report and principal investigator for the Ontario Drug Policy Research Network (ODPRN), an academic research group.

“I would say that the most urgent steps needed are to listen to what First Nations people are asking for, and develop community-specific services that will meet their unique needs.”

First Nations leaders say that while OAT is an important element of opioid addiction care, the unique challenges of living in remote communities make the solutions more complex.

Fort William First Nation, just south of Thunder Bay, has been under siege from an opioid crisis that triggered a state of emergency in the summer of 2024. A 2024 coroner’s report found that the opioid mortality rate in the Thunder Bay District — which encompasses Fort William — was the highest in Ontario, at five times higher than the provincial average.

To support those seeking treatment, the community purchased an off-reserve facility where individuals, including those who have completed detox, can stay while they wait up to eight weeks to enter an intensive residential treatment program. Without that respite, many risk relapsing during that waiting period.

The facility, however, is not yet up and running, because of a funding shortage.

It is intended to provide cultural resources, for example access to an elder, to support people emotionally in the early stages of recovery, says Chief Michele Solomon.

“By itself, I don’t believe (OAT) made a significant impact” in helping people break their addiction, says Solomon, who had a 14-year background in the mental health and addictions field before becoming a leader in the community.

She believes creative solutions such as this facility, that take into account the community’s specific needs, may help the odds of success for those on OAT.

“Not to say that it’s going to fix everything. I’m saying it would afford more people an opportunity to get well.”

***

Another challenge is that OAT treatment often requires frequent in-person visits, which can tie people to the area in which they receive care and make life difficult for those who need to travel regularly. Medications such as methadone are usually dispensed daily under the supervision of a health professional.

Pahpeguish, a former nurse, was living in Brantford where she worked and received methadone treatment, while regularly travelling more than 500 kilometres to visit her home community of Wikwemkong First Nation on Manitoulin Island.

“When people are seeking healing they need to come home (to their First Nation community). This is what my heart wanted,” she said. “I said, ‘This is really shackling me.’ ”

Methadone prescribing has declined in recent years, partly due to changes in prescribing guidelines and the increasing complexity of the illicit drug supply, especially fentanyl. It also carries a higher risk of toxicity and side effects, as Pahpeguish experienced.

Suboxone is a less toxic pill taken daily and requires less oversight from medical professionals. And a monthly injectable called Sublocade offers logistical advantages for those who travel.

Leonora Regenstreif, a physician specializing in substance-use disorders in remote First Nation communities in the Northwest Territories, said she has significantly reduced prescribing methadone in favour of the newer alternatives.

“(Suboxone) is a game changer,” says Regenstreif. It acts quickly and is easier on the body, she says.

“Sublocade even more so, because people don’t have to think about taking a pill every day.”

While it’s not uncommon to be on OAT treatment long-term, tapering off is possible, she says.

“I don’t agree with telling people they’re gonna be on it the rest of their life. That’s kind of like saying, there’s no hope for you.”

***

Pahpeguish, 50, has been clean since 2012 after about 12 years of addiction.

Her recovery began not with an immediate change of heart, but with the cold reality of a police arrest in 2009. That moment started her on the long path through OAT.

“Ever since I made up my mind … that was it,” Pahpeguish says of her decision to seek help. “It’s a holistic decision, mind, body and spirit.”

Pahpeguish, who is part of the Lived Experience Circle that helped inform the new report, now works in prevention where she helps people in her community struggling with addiction. She serves as a resource, even after work hours, connecting people with traditional cultural supports and a caring community.

“I provide that human connection,” she says. “I say: you know, you’re loved. I love you.”

The struggle continues within her own family. While one daughter faces a severe addiction on the streets, her 29-year-old son, Cody, recently began his own recovery journey at a land-based treatment program, which draws on the connection First Nations People feel towards their land and heritage to improve mental wellness.He has been sober since February.

“I got clean pretty much because my mom picked me up,” he says.

For Pahpeguish, sharing her story has been a cathartic part of her recovery. She says the journey has not only been about quitting drugs, but about reclaiming what was lost.

“I’ve slowly regained things,” she says. “Myself, especially, and my voice.”

Wendy-Ann Clarke is an award-winning multimedia journalist with the Investigative Journalism Bureau, based in Toronto. The IJB, at the University of Toronto’s Dalla Lana School of Public Health, is a collaborative investigative newsroom supported by Postmedia that partners with academics, researchers and journalists while training the next generation of investigative reporters.

BY THE NUMBERS: OPIOID HARM AMONG ONTARIO FIRST NATIONS

• The rate of opioid-related deaths is nine times higher among First Nations people than among non-First Nations people in Ontario;
• The annual rate of opioid-related deaths among First Nations People between 2019 and 2022 nearly tripled, climbing from 4.3 to 12.8 per 10,000 people;
• People aged 25 to 44 had the highest rate of opioid-related death, with rates of 20.6 per 10,000 among First Nations people and 2.4 per 10,000 among non-First Nations.
• People aged 25 to 44 had the highest use of Opioid Agonist Therapy (OAT) across the province and First Nations were roughly 16 times more likely to access treatment than were non-First Nations.
• The annual rate of hospital visits for opioid-related toxicity among First Nations was roughly 10 times higher than for non-First Nations People.

— Source: Report, Opioid Use, Related Harms, and Access to Treatment Among First Nations in Ontario, 2025

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