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IntroductionCanada has one of the highest rates of prescription opioid consumption globally. Little is known about the prevalence and determinants of opioid use among citizens of the Metis nation – one of three Aboriginal groups recognized by the Canadian constitution.
Objectives and ApproachOur objectives were to (i) identify trends in prescription opioid use among Metis citizens from 2006 to 2018 and (ii) identify whether replacing OxyContin with OxyNeo in February 2012 differentially impacted prevalence of opioid use among Metis when compared with all other Manitobans. The Manitoba Metis Federation and the University of Manitoba partnered on this research. We identified prescription opioid use using dispensation records from the province's drug database, which includes records for all prescription drugs dispensed in community. We defined acute prescription opioid use as ≤28 days prescription and chronic use as ≥ 29 days' prescription. We tested for differences in annual trends in acute and chronic prescription opioid use between Metis and all other Manitobans. We used an interrupted time series design to test whether replacing OxyContin differentially impacted prevalence of acute and chronic opioid use among Metis when compared with all other Manitobans. We used generalized linear models to test for trends and the impact of replacing OxyContin.
ResultsAcross all years (2006-2018) acute prescription and chronic opioid use was higher among Metis than all other Manitobans. Acute and chronic use decreased in both groups, non-differentially. Replacing OxyContin with OxyNeo was associated with decreased acute opioid use in both Metis and all other Manitobans and had a greater impact on chronic opioid use among Metis than among all other Manitobans. Conclusion / Implications: Findings highlight the differential experiences arising from the historic and ongoing colonial project in Canada, which need to be considered when working to prevent and treat inappropriate Opioid use among Metis.

AbstractWe examined the perspectives of the Red River Métis citizens in Manitoba, Canada, during the H1N1 and COVID‐19 pandemics and how they interpreted the communication of government/health authorities' risk management decisions. For Indigenous populations, pandemic response strategies play out within the context of ongoing colonial relationships with government institutions characterized by significant distrust. A crucial difference between the two pandemics was that the Métis in Manitoba were prioritized for early vaccine access during H1N1 but not for COVID‐19. Data collection involved 17 focus groups with Métis citizens following the H1N1 outbreak and 17 focus groups during the COVID‐19 pandemic. Métis prioritization during H1N1 was met with some apprehension and fear that Indigenous Peoples were vaccine‐safety test subjects before population‐wide distribution occurred. By contrast, as one of Canada's three recognized Indigenous nations, the non‐prioritization of the Métis during COVID‐19 was viewed as an egregious sign of disrespect and indifference. Our research demonstrates that both reactions were situated within claims that the government does not care about the Métis, referencing past and ongoing colonial motivations. Government and health institutions must anticipate this overarching colonial context when making and communicating risk management decisions with Indigenous Peoples. In this vein, government authorities must work toward a praxis of decolonization in these relationships, including, for example, working in partnership with Indigenous nations to engage in collaborative risk mitigation and communication that meets the unique needs of Indigenous populations and limits the potential for less benign—though understandable—interpretations.