Use wastewater monitoring as a weapon to stop opioid deaths

In 2022, Yukon declared a substance-use health emergency in the territory. Earlier that year, three Carcross/Tagish First Nation members died of toxic drug overdoses in the span of six days. Despite efforts to address the issue, the death rates remain shockingly high, with 23 deaths recorded in 2023 and three so far this year.

But the opioid crisis in Yukon is not just a statistic, it's a devastating reality that continues to claim lives at an alarming rate. Yukon faces Canada’s highest per capita death rate from illicit drugs. First Nations in the territory are disproportionately affected by the crisis — taking an irreversible toll on individuals, families and entire communities.

To date, the solutions to address the crisis have been reactive, focused on providing resources like naloxone to reverse overdoses, drug testing kits and food and mental health support. When opioid use is monitored, we can implement targeted interventions. The sad part about the opioid epidemic, like infectious diseases, is that it often leads to deaths that were preventable. There is a need to tackle the issue head-on — and the answer might be in your toilets.

Wastewater sampling is a process that involves the collection, testing and analysis of multiple samples every few days. Wastewater samples for testing are taken from a source where it is all mixed together so water monitoring for opioids is always anonymous. Because we don’t know whose poop we’re testing, we can respect people’s privacy and collect data about opioid use in the community at the same time.

During the pandemic, One Yukon Coalition, an emerging First Nation-led community health-centred organization, successfully used wastewater monitoring as an early warning system. In February 2022, we developed and piloted a wastewater monitoring program with the Public Health Agency of Canada, the National Microbiology Laboratory, Champagne and Aishihik First Nations and the Village of Haines Junction. The data we collected showed communities if there was an uptick in COVID-19 cases before it showed up in home-test kits. This allowed communities to assess the risk and act fast — whether that be allocating resources or encouraging the use of masks.

The results of wastewater monitoring are quick and accurate. Currently, communities can see if there is an uptick in respiratory illnesses in the area and share the information with community members — empowering Yukoners with the information they need to make decisions about their health. Wastewater monitoring has the potential to be an invaluable tool for tracking the prevalence of substances of potential abuse, including opioids, in communities. This knowledge can save lives by providing citizens with the appropriate resources in advance.

First Nations in the Yukon have the right to self-determination. Proactively collecting anonymous data that is owned by the community also helps build resilience to emerging health concerns and empowers us with the knowledge to take care of each other.

Now more than ever, we need innovative, Indigenous-centred solutions to tackle this pressing issue head-on. Wastewater monitoring can provide a path forward from the opioid crisis, but it cannot work in isolation. Tackling the root causes of substance use disorders requires a holistic approach that addresses social, economic and historical harms caused by colonialism. This includes shifting the focus from a binary view of health to one that focuses on physical, mental, emotional and spiritual wellness.

It requires us to find innovative, flexible solutions that are responsive to the unique needs of communities and are not tied down by bureaucracy. By harnessing the power of Indigenous knowledge and perspectives, we can develop comprehensive strategies that promote healing and resilience within our communities.

A shining example

Southcentral Foundation's Nuka System of Care is a successful, award-winning example of an Indigenous-led, person-focused health-care system.

For 50 years, Indigenous Peoples in southcentral Alaska received their health care as “beneficiaries” of the Indian Health Service's Native hospital. Disappointed by the long wait times, lack of primary preventative care and a disconnect between mental and physical health, patients started to advocate for a voice in program planning and service delivery.

By 1999, Alaska Native people were no longer “beneficiaries” of a government-run system but, instead, chose to become self-determined “customers” and also “owners” of their tribally managed health care. They could now make informed choices about their health-care system and work to sustain it for future generations.

Policymakers, health-care professionals and community leaders across Canada need to prioritize Indigenous-centred solutions in our efforts to combat the opioid crisis. Yukon is at a pivotal point with its timely creation of a health authority — Shäw Kwä’ą — that will integrate First Nations’ ways of knowing and being into a person-centred approach to well-being.

Through taking the best of both worlds, we can create a brighter, healthier future for the Yukon — one that is built on a foundation of empowerment, resilience and hope.

Math’ieya Alatini is the CEO and president of One Yukon Coalition and chief strategist of GSD Strategies.