Substance use disorder treatment transformations due to the COVID-19 pandemic: Impact on Indigenous patients and communities

The COVID-19 pandemic has had a serious impact on Indigenous Peoples across Canada. One area of concern pertains to the disruption of substance use treatment and recovery. Indigenous Nations have rapidly transformed services to expand access through telemedicine and greater access to medications. This study seeks to evaluate the impact of the pandemic on substance use treatment among Indigenous Peoples, including challenges and successes with these rapid service transformations. We also seek to understand the pandemic's impact on access to culturally-safe treatment, including access to Indigenous traditional healing practices. The study conception stems from the Indigenous Working Group (IWG) of the Quebec-Atlantic Node of the Canadian Research Initiative in Substance Misuse. The study will be a partnership with 6 Indigenous organizations affiliated with the IWG. Qualitative interviews and talking circles (via video-conferencing technology, as necessary) with key stakeholders, clinicians, patients, and community members will be conducted in order to understand experiences and necessary resources in the context of the pandemic and rapid service transformations. Questions will pertain to patients' response to the pandemic, barriers to treatment, complexities with the transition to telemedicine, challenges with accessing traditional healing, and strategies for expanding treatment access and promoting recovery. We anticipate documenting promising practices for expanding treatment access permanently, not only during the pandemic (given the limited treatment access many Indigenous communities have). The study will be guided by a Two-Eyed Seeing framework, and all research will be conducted in consultation with an Indigenous research advisory council. Data will be analyzed using principles of thematic content analysis. Knowledge from this study will be disseminated to Indigenous Nations and organizations across Canada, as well as to federal and provincial agencies.