Abstract
The number of opioid-related deaths in Ontario is rising, and remote First Nations communities face unique challenges in providing treatment for opioid use disorder. Geographic barriers and resource shortages limit access to opioid agonist therapy, such as buprenorphine or methadone. However, attempts to rapidly expand access have the potential to overlook community consultation. Our experience in Moose Factory, Ontario, offers insight into the ethical questions and challenges that can arise when implementing opioid agonist therapy in Northern Ontario and provides an example of how a community working group can strengthen relationships and create a culturally relevant program. We call on medical regulators and the provincial and federal governments to invest in community-based opioid dependence treatment programs that incorporate cultural and land-based healing strategies and draw on First Nations teachings.