The United States is home to 574 ethnically, culturally and linguistically diverse federally recognized Tribal Nations.1 Due to a number of societal, economic and environmental factors, however, these communities have found themselves particularly hard-hit by the opioid crisis.1-13 In 2020 and 2021, for example, the CDC reported that the American Indian and Alaska Native (AI/AN) population had the highest drug overdose death rates—42.5 and 56.6 deaths per 100,000 persons—an increase of 33% from one year to the next.2

Opioids are not a new problem, however. According to a recent article in the American Journal of Preventive Medicine, opioid mortality rates among AI/AN have risen almost continuously for nearly 20 years.3 But why is the Native American community susceptible? And what can be done to address the opioid crisis in this population? Read on to find out more about the opioid crisis and Native Americans.

Why the Native American community is susceptible

For centuries, Native American communities in the US have faced barriers that challenge their ability to thrive. Generational trauma, economic factors and discrimination all have had devastating effects:4-6

Generational trauma—Generational trauma, including genocide and forced relocation, has adversely impacted Native Americans for decades.4-7 It has “wrought devastation on our traditional ways of life at key junctures in history,” said Joseph Gone, a member of the Aaniiih-Gros Ventre tribal nation and a public health researcher at Harvard University. “One thing we’ve seen around the world is when someone’s society collapses is a turn to substances of abuse.”5

Limited employment opportunities—According to the US Joint Economic Committee, Native Americans encounter obstacles to quality education and jobs, leading to disparities in employment opportunities. As a result, members of the AI/AN population are more likely to be unemployed than people in other minority groups.8

Income inequality—Income inequality is another significant issue for Native Americans.6 The poverty rate for white people in 2019 was 9% compared to 24.2% for the AI/AN population.6 Disparities in education may be partly to blame—only about 20% of Native Americans over the age of 25 hold a bachelor’s degree or higher.8

Discrimination—According to Dr. Nzinga Harrison, chief medical officer and co-founder of Eleanor Health, which operates outpatient addiction facilities in several states, “culture and identity are the basis for discrimination.” She goes on to say, “discrimination is the basis for illness and drives disparities in who develops addiction, who gets treatment for addiction and who does well in treatment.”9

How AI/AN groups are combating the opioid crisis

AI/AN groups are working to combat the opioid crisis at the tribal, state and national levels.7,10,11 A few examples include:

  • The Menominee Indian Tribe (Wisconsin), led by Tribal Chair Ronald Corn Sr., formed a task force designed to track opioid use and overdose data, increase communication about opioid addiction and expand behavioral health services and medication-assisted treatment programs.7
  • In early 2024, the Washington State Senate unanimously approved a bill that is expected to provide nearly $8 million total each year for the 29 federally recognized tribes in the state.10 These funds will likely be used to address the opioid crisis in these communities.10
  • The Substance Abuse and Mental Health Services Administration (SAMHSA) Office of Tribal Affairs and Policy (OTAP) and Office of Recovery (OR) hosted a Tribal Recovery Summit to share best practices and experiences related to expanding recovery-related programs and opportunities within AI/AN communities.11 The goal of the meeting was to provide attendees with valuable insights and information to help improve recovery-related outcomes.11
  • The Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control (NCIPC) is committed to addressing the opioid crisis in tribal and urban Indian communities.12 Visit the site to learn more about these efforts, including a list of partner tribes and tribal organizations receiving supplemental funding.12

Why culture-based care is promising

Native communities have been deeply affected by the opioid crisis.4 In spite of the challenges they face, their cultural and ancestral strengths and healing traditions may provide unique insights into the successful treatment of opioid use disorder.4

According to Kamilla Venner, PhD, assistant professor in the Department of Psychology at the University of New Mexico and member of the Ahtna Athabascan Tribe, “We need a more holistic view that goes beyond a person’s biology.4 We must integrate culture, societal factors, and even spirituality, when appropriate, into mainstream medical institutions and education.”4

Although Native communities face many challenges, they also embody strengths that can help people achieve recovery—strong family and community ties, Tribal sovereignty and hard-earned resilience, among others.4

Where to get help

Communities all across the nation are affected by the opioid crisis.13 If you or someone you know is at risk, it’s important to know that you are not alone. If you need help, call SAMHSA at 1-800-662-HELP (4357) or visit www.samhsa.gov. If you or someone you know is in crisis, call or text 988.

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References

  1. Tribal and Native American Issues. US Government Accountability Office website. Available at: https://www.gao.gov/tribal-and-native-american-issues. Accessed March 14, 2024.
  2. IHS Supports Tribal Communities in Addressing the Fentanyl Crisis. Indian Health Service website. Available at: https://www.ihs.gov/newsroom/ihs-blog/may-2023-blogs/ihs-supports-tribal-communities-in-addressing-the-fentanyl-crisis/. Accessed March 14, 2024.
  3. Bauer C, Hassan GH, Bayly R, et al. Trends in Fatal Opioid-Related Overdose in American Indian and Alaska Native Communities, 1999-2021. Am J Prev Med. DOI:https://doi.org/10.1016/j.amepre.2024.01.019.
  4. ‘To Walk in the Beauty Way’: Treating Opioid Use Disorder in Native Communities. National Institutes of Health/HEAL Initiative. Available at: https://heal.nih.gov/news/stories/native-cultures. Accessed March 12, 2024.
  5. Opioids are devastating Cherokee families. The tribe has a $100 million plan to heal. NPR website. Available at: https://www.npr.org/2023/03/19/1163694076/fentanyl-addiction-opioid-native-american-cherokee-nation. Accessed March 11, 2024.
  6. Whelshula M, Hill M, Galaitsi SE, et al. Native populations and the opioid crisis: forging a path to recovery. Environ Syst Decis. 2021;41(3):334-340.
  7. ‘It affects every single person on this reservation’: Menominee Indian Tribe works to curb record number of overdose deaths. Wisconsin Public Radio website. Available at: https://www.wpr.org/health/menominee-indian-tribe-overdose-opioid-deaths-drug-intervention-team. Accessed March 11, 2024.
  8. Native American Communities Continue to Face Barriers to Opportunity that Stifle Economic Mobility. Joint Economic Committee website. Available at: https://www.jec.senate.gov/public/_cache/files/f655e241-4db2-4ef9-bc50-f3987acac08f/nativeamericanscontinuetofacepervasiveeconomicdisparaties-final.pdf. Accessed March 14, 2024.
  9. Native Americans face a deadly drug crisis. How tapping into culture is helping them heal. Courier Journal website. Available at: https://www.courier-journal.com/in-depth/news/investigations/2021/09/22/culturally-competent-care-for-addiction-treatment-helps-native-americans-heal/7498590002/. Accessed March 13, 2024.
  10. Tribes in Washington are battling a devastating opioid crisis. Will a multimillion-dollar bill help? The Associated Press website. Available at: https://apnews.com/article/washington-tribes-opiod-crisis-legislature-funding-009de9d10143101112746999e952ed84. Accessed March 12, 2024.
  11. Recovery Resources for American Indian and Alaska Natives. Substance Abuse and Mental Health Services Administration website. Available at: https://www.samhsa.gov/tribal-affairs/recovery-resources-american-indian-alaska-natives. Accessed March 13, 2024.
  12. Opioid Overdose Prevention in Tribal Communities. Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/injury/budget/opioidoverdosepolicy/TribalCommunities.html. Accessed March 21, 2024.
  13. Provisional Drug Overdose Death Counts. Centers for Disease Control/National Center for Health Statistics website. Available at: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm#print. Accessed March 25, 2024.