Theme: Models of Care Year: 2019
Disclosure of Interest Statement:
Dr Marsan has received funding from Indivior in the past. No pharmaceutical grants were
received in the development of this project.
Background: In Québec, individuals from indigenous communities face barriers accessing
addiction medicine services, which are not generally coordinated between hospital-based
addiction medicine services and First Nations communities.
Description: To improve access to addiction medicine services, a novel, integrated model of care
was established between Onen’to:kon Healing Lodge, Indigenous Services Canada, and the
CHUM. Care processes were aligned with clear transitions defined between care settings. The
model was implemented in 2015, and clients were evaluated by the CHUM’s Service de
médecine des toxicomanies and admitted for rapid medical detoxification. Once stabilized,
patients were transferred to Onen’to:kon Healing Lodge to complete a 6-week, First Nations-run
treatment program. After completing the program, patients returned to their community with
an aftercare plan. In 2018, the model of care was extended to include access to mental health
evaluations and hepatitis C treatment.
Effectiveness: Between 2015 and 2016, 18 clients between 19 and 50 years old were referred to
the CHUM and 17 were evaluated. Time to initial treatment was 2.1 days on average. Four
patients who did not use opioids were treated the same day and were medically cleared to
return to Onento:kon. For the 13 opioid users, opiate agonist treatment was initiated an
average of 2.6 days after evaluation. Retention in the program was greater for the nine opioid
users referred to the CHUM by Onen’to:kon Healing Lodge (average duration 293 days)
compared to the four opioid users referred from other sources (average duration 52 days).
Analysis of cases from 2017-2019 is underway.
Conclusion and next steps: An integrated care model for addiction services facilitates access by
First Nations and Inuit clients residing in Quebec. Given its initial success, the integrated care
model and supporting MOU were extended to include hepatitis C prevention and treatment.