Opioid Crisis: Native Nations strike back against opioid use, misuse
SEATTLE, Washington – To Angela Ridley, Nooksack, opioid addiction sneaked into her household like a thief in the night.
Her then-husband had been prescribed Vicodin and oxycodone after he sustained a back injury at his job in heavy construction. The doctor told him he could go back to work –- “Just take it easy” –- but in doing so her husband continued to do more damage to the injury, prolonging his reliance on the powerful pain-killing medication.
When she complained one day of her own back ache, her husband told her, “Try one of these.” She says they were on a dangerous downward spiral before they knew it.
“I was hooked immediately,” Ridley said. “Soon, I was using 10 OxyContin pills a day.” When access to OxyContin ran out, she fed her cravings with alcohol and methamphetamine. Her odyssey led to disintegration of her marriage, separation from her children, life on the streets, and prostitution to support her habit.
Angela Ridley before and after: From left, Angela Ridley during opioid dependence and, nine years later, restored to health. “I saw the end of my life, and I had a new desire to live,” she said of her terrible nine-month odyssey. (Courtesy Angela Ridley)
Nine or 10 months later –- alone, shivering in a bathtub and throwing up — she found herself at rock bottom. “I saw the end of my life, and I had a new desire to live,” she said.
She checked into rehab and began the hard road to recovery. Breaking free from nine months of drug use took four and a half years. It took her a year and a half to detox, during which she suffered seizures. She relapsed. She underwent Methadone treatment; it took her three years to get weaned off the synthetic opioid maintenance drug.
Nine years later, Ridley is sober and healthy and says she is grateful to God for her new life. She is an advocate for alternatives to opioids in pain management, and also advocates for alternative forms of addiction treatment. She wants to start a non-profit organization dedicated to that work.
In her ex-husband’s case, she said, opioids were prescribed, although the real problem –- a back injury –- was not treated. Regarding addiction treatment, she said, “Methadone and Suboxone are not the answer, because they replace one opioid with another. It worked for me, but it took a lot of will to get off of it.”
Ridley’s story is not rare: 2.1 million Americans had an opioid use disorder in 2016 and 2017, according to the U.S. Health and Human Services Department; 42,249 Americans died from opioid overdose.
America’s opioid crisis has hit Indian Country hard, partly, according to the National Indian Health Board, because “access to critical opioid prevention and treatment dollars are not reaching many of the Tribal communities that are in serious need of these funds.”
In addition, as sovereign entities, Indigenous Nations “are not systematically included within statewide public health initiatives such as the recent prevention and intervention efforts created through the new opioid crisis grants,” the NIHB reported.
According to the NIHB:
- Opioid-related fatalities among American Indians and Alaska Natives occur at three times the rate for African Americans and whites.
- American Indians and Alaska Natives experienced the highest prescription opioid death rate of any people from 1999-2009.
- Non-medical use of opioids in American Indian and Alaska Native youth older than 12 was reported to be twice the rate of whites and three times the rate for African Americans.
Native Nations are striking back
Native Nations are suing pharmaceutical companies, alleging — as former ICT contributor Ruth Hopkins wrote in Teen Vogue — that the companies violated federal Racketeer Influenced and Corrupt Organizations (RICO) laws, engaged in deceptive trade practices, practiced fraudulent and negligent conduct, and failed to comply with federal prescription-drug laws intended to help prevent opioid misuse.” The plaintiffs also accuse the companies of being deceptive with Tribes, “allegedly making light of the risk of opioid dependency,” Hopkins wrote.
In a similar action, several cities, counties and towns across the U.S. are suing pharmaceutical companies, seeking to recover some of the costs they have incurred in responding to opioid-related crimes and medical emergencies in their communities.
Additionally, several Native Nations have started programs to prevent and treat opioid addiction.
Among them are the following:
The White Earth Ojibwe Tribal Council
White Earth was one of the first Indigenous legislative bodies in the U.S. to issue an emergency declaration regarding opioids. Since that 2011 declaration, Tribal Police officers have carried naloxone, an injection that can save the life of someone who has overdosed; or Narcan, naloxone’s nasal spray form. The Tribe has trained more than 1,000 White Earth Reservation residents to administer Narcan or naloxone.
The Tribe established a civil commitment process for those who won't seek help on their own. Those arrested for opioid-related offenses may find themselves in the Adult Healing to Wellness Drug Court.
White Earth Nation has worked with local hospitals to ensure treatment for addiction begins in the emergency room. “In one study, that approach (using opioid withdrawal medication, a 10-minute counseling session, and a referral) doubled — to 75 percent — the number of patients in treatment 30 days later,” a Detroit Lakes online news site reported. “Most of the 329 people in that Yale Medical School study were interested in treatment but couldn't find the help they needed.”
White Earth Nation’s Behavioral Health Division developed an on-reservation residential detoxification unit and on-site recovery program. The recovery program provides sobriety support services and assistance addressing mental and physical health needs that can lead to substance use and abuse.
The Lummi Nation
The Lummi Nation’s Healing Spirit Opioid Treatment Program offers medication-assisted treatment, individual and group counseling, relapse prevention support, and accountability through drug testing. Participants may be connected with culturally-based programs such the Canoe Journey.
Many people who have struggled with substance abuse have testified to the healing power of the Journey, an annual gathering of Northwest Native Nations that includes traveling the way of the ancestors; sharing traditional songs, dances and food; and reconnecting with an often-extensive kinship network.
Dr. Carson Gardner of the White Earth Nation Health Department told DL-Online.com that such programs (such as the Lummi Nation’s Canoe Journey) are part of a critical road to Native recovery. “Culture is key to recovery among Indigenous Peoples...Substance abuse and mental health counseling is treating symptoms, but providing culturally-based ceremonies and activities is healing — and that is where we see the old 'using' spirit leaving people, and the good healthy spirit returning in people."
The Port Gamble S’Klallam Tribe
For Port Gamble S’Klallam, recidivism is down 70 percent since the launch of the THOR (Tribal Healing Opioid Response) program. “Alcohol was bad enough. We never thought [opioids] would be a problem here,” said Jeromy Sullivan, Port Gamble S’Klallam’s chairman.
Port Gamble S’Klallam launched THOR “to rally around those needing help,” Sullivan said.
“An individual’s addiction usually comes to the surface when he or she is arrested for an opioid-related crime, such as theft or DUI,” Sullivan said.
The individual is immediately connected with THOR, which follows the individual through the system and connects that person to services he or she needs to rebuild their life such as substance abuse treatment, job skills assessment, and counseling. Once the individual is released, he or she continues treatment and participates in job training on the reservation. THOR then works to find the individual employment.
An attractive incentive for employers is that the Port Gamble S’Klallam Tribe, not the employer, pays the individual’s wages.
“They have to maintain their treatment program and check in with Mental Health and attend classes,” Sullivan said. Staff members running the program are THOR graduates.THOR was wholly grant-funded for the first three years, and is now funded partly by the Port Gamble S’Klallam Tribe.
Of the lawsuit against pharmaceutical companies, of which Port Gamble S’Klallam is a plaintiff, Sullivan said, “We want the pharmaceutical companies to stop pushing these drugs. They had said they would not affect us like this.”
In the late 1990s, the HHS reports, “pharmaceutical companies reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates. Increased prescription of opioid medications led to widespread misuse of both prescription and non-prescription opioids before it became clear that these medications could indeed be highly addictive.”
Sullivan said there are alternatives to opioids in pain management. “For those turning to opioids, the pain is real,” Sullivan said. “But there are other proven pain-management systems.”
The Pauma Band of Mission Indians
The Pauma Band of Mission Indians in Southern California is taking a proactive approach to preventing addictions and the problems that result, including domestic violence.
“For our Tribal youth, we met and worked together to design their personal message to our Tribal people,” said Juana Majel Dixon, a member of the Pauma Band legislative council and the National Congress of American Indians executive board.
Young participants celebrated good health and the Creator’s blessings “by creating posters displaying Indigenous Power, to affirm their humility to be respectful of the life that Creator’s love has given us, [to] do no more harm to mind, body and Spirit,” Majel Dixon reported. The messages were put on a CD and gifted to all Pauma Band members.
Pauma Band photos: Young ones from the Pauma Band call out drugs for what they are: A path to destruction. The young ones celebrated good health and the Creator’s blessings “by creating posters displaying Indigenous Power, to affirm their humility to be respectful of the life that Creator’s love has given us, [to] do no more harm to mind, body and Spirit,” Juana Majel Dixon reported. The messages were put on a CD and gifted to all Pauma Band members. “It’s making a difference,” she said. (Photos courtesy Juana Majel Dixon)
“It’s making a difference,” Majel Dixon said. “No more secrets.”
Facts and statistics about opiates and opioids
What are they?
“Opiate” refers to natural substances that come from opium. Opium extracted from the poppy contains chemical compounds, including codeine and morphine. “Opioids” are made by chemical synthesis to imitate opiates. Synthetic opioids include Fentanyl and Methadone; semi-synthetic opioids include Hydrocodone and Oxycodone.
How do they work?
Opioids attach to receptors in the brain. Once attached, they send signals to the brain of the "opioid effect" which blocks pain, slows breathing, and has a general calming and anti-depressing effect.
“Opioids target the brain's reward system by flooding the circuit with dopamine,” the National Institute on Drug Abuse reports. “Dopamine is a neurotransmitter present in regions of the brain that regulate movement, emotion, cognition, motivation, and feelings of pleasure. The overstimulation of this system, which rewards our natural behaviors, produces the euphoric effects sought by people who misuse drugs and teaches them to repeat the behavior.”
What are the alternatives?
“There are many non-opioid pain medications that are available over-the-counter or by prescription, such as ibuprofen (Motrin), acetaminophen (Tylenol), aspirin (Bayer) and steroids, and some patients find that these are all they need,” the American Society of Anesthesiologists reports.
Other people find relief with non-drug therapies that can be used alone or in combination with medications, the ASA reports. These include acupuncture, massages, physical therapy, surgery to correct the medical condition causing pain, and relaxation techniques.
Opioid Overdose Death Rate per 100,000 in Washington State, 2011-2015
- 34.4: American Indian/Alaska Native
- 15.1 Pacific
- 12.4: White
- 12.3: Black
- 1.2: Asian
- 1.1: Hispanic
- 1.0: Other
Opioid Stats in Washington State
2015 Survey of Opioid Users (1,036 valid responses)
- 22 percent overdosed in past 12 months.
- 52 percent witnessed overdose in past 12 months.
- 47 percent said they or someone else had called 911.
- 46 percent carry Naloxone.
- 50 percent were hooked on prescription opiates prior to heroin.
- 51 percent were interested in getting help to cut down or quit.
Richard Walker is an ICT correspondent reporting from Western Washington.