How Canada's Blood Tribe brought opiate overdose deaths down to zero

It was a child’s scream that first introduced Dr. Esther Tailfeathers to fentanyl.

The family physician had just pulled in to a Walmart, shopping ahead of a July 2014 sun dance, when she saw a man passed out in a parked van. The child told her the man had taken a pill just minutes before collapsing.

“He was jammed between the car door and the pavement. And he was out cold; he wasn't breathing at all,” she recalls. “I started CPR, I got a heartbeat back and some really shallow breaths, and then the ambulance arrived.”

Within months, Dr. Tailfeathers’ indigenous reserve just north of the Montana border had become the epicenter of a public-health crisis that continues to spread across Canada. But the 7,500 residents of the Blood Tribe – who lost 35 members to painkiller overdoses last year – have turned the tide, showing how a community can rally against drug abuse in the face of immense hurdles and historical trauma.

The Blood Tribe indigenous reserve in Alberta is Canada’s largest – a spectacular landscape of long-grass plains and shining rivers abutting the towering Rockies. Oilfields make the reserve one of the country’s richest, too – and that makes it a target for drug peddlers.

For years, dealers sold painkillers like oxycodone at steep markups across this sprawling territory.

But three years ago, oxycodone manufacturers introduced tablets that couldn’t be snorted or injected. Drug dealers switched to fentanyl, a painkiller 50 times more potent than heroin that reportedly killed the musician Prince in April. Too much of it shuts down one’s breathing and heartbeat.

Two small grains can kill someone, so traffickers cut the drug with sugar or baby powder into pills. That makes it impossible for addicts to know how strong a dose they’re buying. In Alberta, fentanyl-related deaths have multiplied tenfold in the past four years, and the victims are disproportionately indigenous.

Do something, now

The drug took root on the Blood Tribe reserve in mid-2014. Officials say deaths would spike every two weeks when welfare and pension checks arrived.

“We were seeing overdoses in the emergency room daily,” Tailfeathers says. “Parents were spending everything they had on fentanyl; children were going hungry.” Social service took in 35 children as a result of fentanyl deaths or overdoses.

So Tailfeathers took action. With funding from the reserve’s semi-autonomous government, she put together 200 emergency overdose kits including a pre-filled syringe of naloxone, an opioid antidote, a CPR mask, and instructions on how to use them. The authorities distributed the kits to places where they suspected fentanyl was being used – whether private homes or public spots such as bars.

The reserve also launched two confidential hotlines: one to help addicts quit, the other to report traffickers. Every public building in town is plastered with instructions on how to deal with an overdose.

At the pharmacy outside Tailfeathers’ office, a line forms every morning as recovering addicts get their daily dose of suboxone, an opioid used to wean people off more dangerous drugs. About 150 members of the Blood Tribe have suboxone prescriptions; reserve employees drive most addicts to the pharmacy daily for their fix – often from miles away – to stop them from trafficking in the drug.

“The leadership in the community has done a good job of addressing the issue right off the hop, and not waiting for other people to come help them,” says Sgt. Jason Colon, a local police officer.

The police are playing their part, too. They still conduct weekly drug busts, but officers are also embracing harm reduction. Parents suspected of harboring traffickers in exchange for drugs are given multiple warnings before their homes are raided, in the hope of keeping families together. And during traffic stops, officers confiscate only used syringes; they turn a blind eye to new ones since they are safer.

Serving the soul

Authorities on the reserve are administering not only to the body, but to the soul. At the reserve’s social-services office, beside a cabinet full of naloxone kits, a bookshelf holds a stack of wooden trays. They are traditional Blackfoot “smudge boxes,” used traditionally to purify the mind with smoke from burning sweetgrass, dirt, and charcoal.

Reserve counselor Gayle Chase has recovering addicts cut, stain, and decorate these boxes at weekly meetings. “It’s healing and recovery,” she says. “While they're talking and sharing, they're working on smudge boxes. They can have that at home and do their daily prayers, and reconnect with their spirituality.”

For Tailfeathers, the scourge of drug abuse is a direct consequence of Canada’s past attempts at cultural assimilation. From the 1870s until 1996, the government took 150,000 children from their indigenous families to live in church-run dormitories known as “residential schools.” Children were beaten for speaking their native languages, and many were sexually and physically abused. Now adults, they struggle to raise their own children.

“Hundreds of years of colonization of our people have resulted in disease,” says Tailfeathers. “Most of us grew up around alcoholism, and in the last 20 years we’ve seen prescription drug abuse.”

I was lost

Pamela Little Bear sits in the bleachers at a baseball diamond, watching one daughter pitching while another tugs at her sweatpants. Little Bear’s shock of red hair makes her a popular school-bus driver, as does her contagious smile.

In her purse, she carries a decade-old photo of herself. Her sunken face peers out of an emaciated frame, with patches of clear scalp. “I didn’t realize I was picking out my hair. My teeth were falling out. I had no fat; you could pull the skin on my arms,” she says.

For more than five years, Little Bear was hooked on painkillers, at one point taking 54 pills every day to repress memories of childhood abuse and domestic violence.

In 2009, Little Bear’s family and friends stepped in. “My husband told me that he didn't want me to die,” she recalls. She admitted she was addicted and spent weeks in detox, shaking with anxiety and pain.

Little Bear’s family and friends stood by her, even when she yelled and punched them. After three months, she woke up one day feeling no pain, and slowly pieced her life back together.

When fentanyl hit Standoff in 2014, Little Bear’s nephew was an early victim, dying of an overdose. She started giving speeches about her own experience and organizing noisy protest marches, hoping that addicts and traffickers hiding in their homes would know their community was not scared.

“If I can help one person get out of the same thing I’ve been through, then I can make a difference,” says Little Bear. For her, counselors, drivers, and cultural programs can only help a community heal when it’s ready to admit it has a problem.

“Now everyone's aware, and they're not afraid to talk.”

Little Bear has supported 15 addicts in their attempts to quit fentanyl. She tells them what to expect, and coaches their families. She does not always succeed, but her efforts are part of a broader community-wide approach that has undoubtedly saved lives.

The reserve’s last fentanyl-related death occurred eight months ago. Overdoses have dropped since the winter, from once a day to once every few weeks. While these numbers encourage Little Bear, her hope comes from seeing her community slowly take the same journey she took, from fear to strength.

“Before, we were in dark times because a lot of our loved ones were dying,” she says. “But there's going to be better days.”