The abuse of oxycodone in Northwestern Ontario, Canada, has escalated at alarming rates raising concerns that opiate use has reached epidemic proportions, particularly among the First Nations communities. The authors were involved in establishing Ontario's first rural inpatient medical withdrawal unit to serve patients seeking abstinence. Issues: The development of the medical withdrawal support services (MWSS) required creative and adaptive strategies to respond to the geographical, cultural and institutional circumstances. Lessons learned: Key factors to support program efficacy and successful outcomes for clients during the inaugural eight months of operation are interprofessional and collaborative approaches with a cultural awareness.

<p>Genuine cross-cultural competency in health requires the effective integration of traditional and contemporary knowledge and practices. This paper outlines an analytical framework that assists patients/clients, providers, administrators, and policy-makers with an enhanced ability to make appropriate choices, and to find pathways to true healing while ensuring that the required care is competently, safely and successfully provided. Examples presented are primarily based on experience of the Sioux Lookout Meno Ya Win Health Centre (SLMHC), which serves a diverse, primarily Anishinabe population living in 32 Northern Ontario communities spread over 385,000 sq. km. SLMHC has a specific mandate, among Ontario hospitals, to provide a broad set of services that address the health and cultural needs of a largely Aboriginal population. We will outline our journey to date towards the design and early stages of implementation of our comprehensive minoyawin1 model of care. This includes an evaluation of the initial outcomes. This model focuses on cross-cultural integration in five key aspects of all of our services:</p><ul><li>Odabidamageg (governance and leadership).</li><li>Wiichi’iwewin (patient and client supports).</li><li>Andaw’iwewin (traditional healing practices).</li><li>Mashkiki (traditional medicines).</li><li>Miichim (traditional foods).</li></ul>The paper outlines a continuum of program development and implementation that has allowed core elements of our programming to be effectively integrated into the fabric of all that we do. Outcomes to date are identified, and potentially transferable practices are identified.

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The study underlines the interdependence between personal choice and the health care system; "bad" experiences with the system cause clients to disengage from care, while client disengagement results in reduced care options.