Province took ‘colonialistic approach,’ to developing policy says Blackfoot doctor.
Five Indigenous treatment addiction centres are delaying using a program designed by Danielle Smith’s government. Photo: Todd Korol/The Canadian Press.
APTN News: Indigenous-led treatment centres in Alberta are not implementing the province’s addiction treatment policy according to records obtained by the Freedom of Information Act, or FOI.
According to the records, the treatment centres are upset the provincial policy was developed without Indigenous consultation.
“I have not seen an engagement approach with communities that suffer from high levels of addiction and mental health issues,” said Dr. Esther Tailfeathers, a family physician in Kainai Nation, also known as the Blood Tribe.
Tailfeathers has been outspoken against the Alberta government’s abstinence-focused treatment approach. She was a member of the Alberta Health Services program called Indigenous Wellness Core, a group of Indigenous medical professionals who advise the government on Indigenous health care but resigned due to hiring issues.
“It is a very unilateral and colonialistic approach,” said Tailfeathers.
One of the issues is an app that was commissioned by the province from a private company to collect information about substance users’ personal information. The information is not controlled by First Nation communities but is stored in a private database.
Organizations that sign on to use the program, called My Recovery Plan (MRP), are also required to sign non-disclosure agreements that prevent them from criticizing the company.
MRP is owned by a B.C. based organization called Last Door Recovery Society. The program was implemented through Alberta Health Services (AHS) from late 2022 to March 2024.
According to the FOI documents, clients are typically not informed that their private health information is readable by specified staff at the company who anonymize the data before providing it to the Alberta government.
“We have a government where there is no palpable move toward reconciliation,” said Dr. Janelle Syring, a family doctor and citizen of the Manitoba Métis Federation who works in Calgary and Yellowknife.
Syring pointed to the Canadian Medical Association, which apologized this September for racism and harm caused to Indigenous Peoples.
A part of the harm concerned the unethical collection and misuse of health data that has contributed to ongoing mistrust of the health system.
“The medical profession has said ‘I am so sorry’ and taken responsibility for what happened. Now the government seems to be ignoring the realities of Indigenous communities and the systemic racism that has occurred.” said Syring.
“It is kind of like another round of residential schools where they are forcing people to do things and taking away their will and agency.”
The province has worked to create the appearance of First Nations alignment with its recovery model. Despite many announcements with chiefs in headdresses, there has been pushback against its abstinence-oriented model, particularly among Treaty 6 Nations.
In July 2023, APTN News reported on the announcement made by Chief Leonard Standingontheroad, who asserted that “if harm reduction isn’t available, our people will die.”
The Confederacy of Treaty No. 6 said that 71 First Nations declared an opioid crisis but only an estimated 22 to 24 of them have received money to deal with it.
‘It’s basically selling out Indigenous communities’
MRP has been used to evaluate addiction recovery treatment since 2022. The app works by collecting information the province said will allow it to determine factors contributing to client recovery success across facilities.
It relies on a list of 120 questions answered by clients when they arrive for treatment and when their program is completed concerning “domains of well-being, commitment, barriers to care, and service needs.”
According to the province’s 2024-27 business plan, the “recovery capital scores” in MRP are the only criteria used to track the success of the government’s abstinence-focused drug treatment.
“I think that this approach breaks OCAP principles because there’s data being collected on Indigenous people that they don’t know about and it’s being owned by private companies,” said Tailfeathers.
OCAP, or Ownership, Control, Access and Possession of Information, was created by the First Nations Information Governance Centre.
It is a guideline for working with First Nations communities to ensure they have control over the data collected about them.
“It [MRP] is basically the selling out of Indigenous communities to private companies, for their benefit,” said Tailfeathers.
However, the documents obtained by APTN reveal pressure by the Alberta government on service providers to push recovery program participants to use the MRP.
A Feb. 28, 2024 email from Evan Romanow, the deputy minister of Mental Health and Addiction, to all publicly funded detox and residential recovery facilities, emphasized that providers are being “watched very closely by the Ministry” to ensure they are using the MRP “with every client,” according to the FOI documents.
The AHS implementation team for the app warned service providers that “while there will be no immediate impact on funding allocation based on outcome scores, outcomes-based funding decisions in the future will consider agency level results from MRP.”
Despite this pressure, AHS was warned through consultations with Indigenous service providers that the lack of accounting for the “current reality of Indigenous clients” would “create a sense of immediate failure for clients and service providers.” As a result, all five Indigenous service providers delayed implementing My Recovery Plan.
‘Not in a place to answer’
One issue raised by Indigenous service providers is the length of the MRP questionnaire that clients fill out multiple times during treatment.
The 120 questions presents barriers of time, particularly at intake, when people are not well enough to answer them.
According to the documents, one detox facility emphasized that “some clients are not in a place to answer” the questions.
Meanwhile, some questions asked by MRP were flagged as “disrespectful or offensive” to Indigenous people. One question asks, “Are you proud of your community?”
“It is such a silly question,” said Tailfeathers, “It is so vague and ignores what a patient is going through when they are seeking treatment.”
The questionnaire also fully omits intergenerational trauma, language, access to Elders, ceremony and foster care history – central elements of the drug toxicity crisis across Turtle Island or North America.
Feedback provided by an Indigenous treatment facility, interpreted through the AHS implementation team and disclosed in the FOI documents, emphasized that intergenerational trauma “has a large impact on several individuals… the absence of this recognition is likely to be seen as culturally insensitive or even inappropriate.”
This feedback from Indigenous service providers also noted that “while MRP captures if an individual uses a 12-Step model, which emphasizes a connection to a higher power, there are no direct questions to cultural/spiritual practice.”
Together within a system, these barriers and omissions could filter for a specific type of client: non-racialized, non-Indigenous Christians, free of serious withdrawal symptoms, stable enough to sit and focus through a long questionnaire.
APTN reached out to the province for comment on health providers’ concerns.
“Alberta’s government and Recovery Alberta are working with treatment providers who predominantly serve First Nation and Métis People in Alberta to ensure the system is implemented in way that is culturally appropriate. These engagements are ongoing, and as with any program will continue once fully implemented,” said Hunter Beril, press secretary for the Minister of Mental Health and Addiction.