The national opioid epidemic is severely impacting Indian Country. According to the Centers for Disease Control and Prevention, American Indians and Alaska Natives had the highest drug overdose death rates in 2015 and the largest percentage increase in the number of deaths over time from 1999-2015 among all racial and ethnic groups. In some areas, the American Indian and Alaska Native mortality rate due to opioids runs six times that of non-Hispanic whites.

To stem the tide of the opioid crisis in Indian Country, the Northwest Portland Area Indian Health Board and many tribal governments have begun to institute promising solutions that could be expanded upon as well as serve as models for other Tribes that integrates evidence-based chemical dependency treatment with holistic, culturally competent care to successfully deal with the effects of opioid use disorder (OUD).


To deal with structural disaggregation of necessary OUD treatment components in the Indian Healthcare system, and provide tribes and clinicians with comprehensive information to do more for our patients and system, the Northwest Portland Area Indian Health Board aims to address the opioid crisis in tribal communities by increasing capacity to address the complex factors associated with a comprehensive opioid response, including:

  • access to culturally appropriate prevention, treatment and recovery activities with the intent of reducing unmet treatment need and opioid-related deaths
  • use of cultural and community strengths as prevention.

The NPAIHB opioid projects will carry out core public health functions, address tribal health priorities related to public health infrastructure, social determinants of health, and substance use prevention. We hope you will join us in this important endeavor.

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NPAIHB’s Northwest Tribal Epidemiology Center (TEC) has examined death certificate and hospital discharge data (corrected for AI/AN racial misclassification) to identify the burden and disparities in drug and opioid overdoses experienced by Northwest AI/AN. Since 1997, Northwest AI/AN people have had consistently higher drug and opioid overdose mortality rates compared to non-Hispanic Whites (NHW) in the region. From 2006-2012, AI/AN age-adjusted death rates for drug and prescription opioid overdoses were nearly twice the rate for NHW in the region. A higher proportion of AI/AN drug and opioid overdose deaths occurred in younger age groups (less than 50 years of age) compared to NHW overdose deaths. A more recent analysis of Washington death certificates found that although AI/AN and NHW had similar overdose mortality rates from 1999–2001, AI/AN overdose rates subsequently increased at a faster rate. From 2013–2015 mortality rates that were 2.7 times higher than those of NHW for total drug and opioid overdoses and 4.1 times higher for heroin overdoses. Further, Washington death certificates that were not corrected for misclassification of AI/AN race underestimated AI/AN drug overdose mortality by approximately 40%. An examination of Oregon and Washington hospital discharge data found that during 2012-2013, AI/AN had an opioid overuse hospitalization rate that was 2.4 times that of NHW in these states. AI/AN differed from NHW who were hospitalized for opioid overuse in that they were younger, and a higher proportion were hospitalized for opioid dependence as opposed to accidental opioid poisonings. Because of these data, as well as the lived experience and stories of Northwest Tribes, NPAIHB delegates have identified substance over-use–specifically increasing opioid dependence and overdoses–as a priority health issue in the NW Tribal communities.

NPAIHB has partnered with the National Indian Health Board (NIHB) to develop a tribal opioid response document as part of an enviromental scanning process with tribes across Indian Country. It is a compilation of best practices and ideas from tribal members and people who work in Indian Country. The document contains seven key focus areas that were recognized as having the greatest importance in addressing opioid response in tribal communities:

  1. Prevention
  2. Treatment and Recovery
  3. Neonatal Opioid Withdrawal Syndrome
  4. Harm Reduction
  5. Opioid and Overdose Data and Surveillance
  6. Research and Evaluation
  7. Organizational Development

To help guide our efforts in developing this document, we have posted our most recent draft here for your consideration. We invite you to review it and provide your feedback. Thank you.

The NPAIHB Tribal Opioid Response (TOR) Consortium will work to address the opioid crisis in tribal communities by increasing capacity to address the complex factors associated with a comprehensive opioid response, including: access to culturally appropriate prevention, treatment and recovery activities with the intent of reducing unmet treatment need and opioid-related deaths, as well as a focus on using cultural and community strengths as prevention.The aim of this work will be to significantly expand the capacity for Tribal Opioid Response to at least the 23 NW Tribes in the TOR Consortium. The overarching goal of the NPAIHB TOR Consortium is to develop a comprehensive and strategic approach to assist Tribes in developing capacity to address the complex factors associated with a comprehensive opioid response. This includes expanding access to culturally appropriate prevention, treatment, and recovery activities to reduce unmet treatment need and opioid-related deaths through development of a strategic opioid response plan. The strategic plan includes, but is not limited to:

  1. Developing a framework for a NW Opioid Response strategic plan,
  2. Increasing awareness of opioid use disorder,
  3. Preventing opioid use disorder,
  4. Increasing access to treatment and recovery services and overdose reversal capacity
  5. Reducing the health consequences of opioid use disorder in tribal communities.

The consortium will accomplish these objectives by focusing on cultural and community strengths as prevention and use of evidence-and-culture based interventions.



One of the projects the NW TOR Consortium undertook to aid in opioid prevention efforts was the development of the “How to Respond to an Opioid Overdose with Naloxone” video. Click on the image below to view the full video.

Each month, Project ECHO offers multiple teleECHO clinics with a multidisciplinary team of specialists focusing on the management and treatment of patients with Substance Use Disorder. The 1 hour long clinics include an opportunity to present cases, receive recommendations from specialists, engage in a didactic session and become part of a learning community. Together, we will manage patient cases so that every patient gets the care they deserve.

When: The 1st and 3rd Thursday of every month from 11am-12pm PST

How: Simply click here to join our email listserv. We’ll be sure to send you the connect information each month.

Present your case to our team of specialists for best practice treatment recommendations. If you would like to present a patient for treatment recommendations, please complete the case presentation form and send to David Stephens via email (dstephens@npaihb.org) or fax (503.228.4801) Download the case presentation form>> 


TeleECHO Didactic Presentation

Substance Use Disorders (SUD), including opioid use disorder, have a disproportionate impact on Indian Country, and can be treated at the primary care level. Free clinical trainings are being held at multiple locations and includes MAT Waiver training. The free trainings are being offered for Indian Health Service, Tribal and Urban Indian healthcare staff to effectively integrate SUD treatment at the primary care level – with a follow up ECHO collaborative to continue learning, knowledge sharing and support as you start treating. CE will be offered.

Upcoming Trainings

Rocky Boy, MT July 30, 2019

Quinault, WA August 29, 2019

Tahlequah, OK September 12-13, 2019

Oklahoma City, OK September 18, 2019


Previous Trainings

Colville, WA May 28-29, 2019

Green Bay, WI May 1-2, 2019

  • Training Agenda
  • Download the Following Presentations

Pendleton, OR March 5-6, 2019

  • Training Agenda 
  • Download the Following Presentations
    • Effective Treatment Approaches for OUD in a tribal community
    • Neurobiology and Diagnosis of SUDs
    • The Epidemiology of Substance Use Disorders in American Indians/Alaska Natives
    • The Role of Behavioral Interventions in Substance Use Disorder Treatment
    • MAT Waiver Training
    • Harm Reduction at Lummi Tribal Health Center
    • Starting to Provide MAT at Siletz Tribal Health Clinic
    • Methamphetamine Use Disorder: Common and Often Untreated
    • Alcohol Use Disorder: Treatment and Clinical Recommendations

Grand Ronde, OR February 28, 2019

Portland, OR December 12 – December 13, 2018



Clinical Resources

Staff serving American Indians & Alaska Native people are invited to participate in the Substance Use Disorders (SUD) & Hepatitis C (HCV) ECHO programs. The program provides comprehensive information to effectively address the evolving opioid & HCV epidemics. The program will offer a free 2-day in person training with MAT waiver & subsequent telehealth clinics. CE will be offered.

Upcoming Trainings

Green Bay, WI May 1-2, 2019


Clinical Resources

We recognize that every life is valuable and that substance use disorder is a chronic, neurobiological condition of the brain that has biological, genetic, and social determinants. We are building a community to support our healing journey  – to provide evidence based treatment for substance use disorder, and to offer a place to let people know that we want them to be safe, to be healthy.

For more information about substance use disorder, click on the resources below or contact Eric Vinson, evinson@npaihb.org

Resources from the First Nations Health Authority

Resources from the Indian Health Service

Templates for IHS, Tribal and Urban Indian Health Centers