They are called the "black planes."
They fly in the middle of the night, in total darkness, their running lights turned off.
They swoop over lakes nearby First Nations communities and invisibly drop their loads: boxes of OxyContin, much of which has been manufactured in illegal drug labs offshore.
Soon, there are snowmobiles roaring over the ice to pick up the cargo. Or in summertime, canoes, rowboats and small motorboats glide over the water with the same goal.
And so many of the men, women and children of a First Nation are able to get their fix.
If they don't, they will get very sick. So sick they may even die.
It's called "withdrawal."
Without their regular dose every eight hours or so, OxyContin addicts experience what has been called the "flu times 20" -- cold sweats, cramping, nausea, vomiting, stomach and leg cramps, diarrhea and overall sick, very, very sick. Withdrawal can last from 72 hours to a week and it is extremely difficult to cope without help from medical professionals.
First Nations leaders are saying that 70 per cent of the people in some of their communities are addicted to OxyContin. There are a multitude of reasons for this but the solutions are long term and a recent decision by the manufacturer of OxyContin (Purdue Pharma) seems to have created an immediate emergency, according to those same First Nations leaders.
Production of OxyContin ceased on March 1. In its place, the pharmaceutical manufacturers are offering OxyNEO, which is less susceptible to abuse because it is difficult to crush (and chew or snort or mix for intravenous injection) and it turns into a gel or tar when mixed with water, making it difficult to inject.
First Nations leaders are justifiably concerned about the potential of thousands of their citizens suddenly going into withdrawal, overloading their already overburdened health-care system. And face it, who wants to see friends and relatives and other loved ones go through so much sheer pain?
There are a multitude of reasons OxyContin addiction has become rampant in many remote, isolated First Nations. The experts testify it is both nature and nurture at work.
First of all, because these communities often are remote, there can be a genetic predisposition that is built up towards addictions. There are natural forces in the biology that are driving people towards seeking chemicals, which will release the endomorphs that cause addiction.
There is also the drive to escape reality -- multi-generational impacts of residential schools, abuse, dysfunctional environments -- which turns people into addicts.
The switch to OxyNEO doesn't seem to be the problem, because abuse of prescribed drugs has not been the major problem. Sure, there have been some unethical people who have obtained prescriptions they sell off for a profit, but an accounting of prescribed OxyContin in First Nations reveals it is not being handed out willy-nilly.
No, the major problem is the black market for addictive prescription drugs on Canada's remote First Nations.
"We are very worried about our brothers and sisters who are addicted to this drug. There is nothing to replace it," said Mike Metatawabin, the deputy chief of the 49-band Nishnawbe Aski Nation in the James Bay region.
"In our remote communities we are expecting a mass withdrawal of people who are addicted to this."
But the switch to OxyNEO seems to be causing nothing more than alarms about the highly addictive nature of the drug. As long as black market OxyContin continues to be manufactured and smuggled into First Nations, the problem of addiction continues and the worries about withdrawal can be withdrawn, for the immediate time being at least.
Still, Nishnawbe Aski Nation Chief Stan Beardy fears a "mass involuntary opiate withdrawal."
Patients who use OxyContin responsibly will get the same benefits from OxyNEO. Addicts who abuse this opiate by snorting or injecting will still get their supply from the black market.
We can all hope there isn't an "immediate problem" of mass withdrawal, but it appears the only real, long-term solution is to stop the supply of OxyContin from illegal offshore smugglers.