Opioids

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).

Goals

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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History

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.

Tribal Opioid Response National Strategic Agenda

The opioid epidemic has had profound effects on tribal communities. Since 1999, deaths due to drugs among American Indian and Alaska Native (AI/AN) people have quadrupled, and in 2017, Native people had the second-highest opioid death rate of any group in America. Across Indian Country, we have seen families torn apart, jobs lost, rising homelessness, the spread of disease, and impacts on community members’ ability to participate in aspects of their culture.

In response, the Northwest Portland Area Indian Health Board (NPAIHB), along with our partner, the National Indian Health Board (NIHB), developed this strategic agenda designed to comprehensively address the tribal opioid epidemic. The recommendations included are based on input from tribal policymakers, service providers, and community members; insights from national and regional experts; and feedback from people living with opioid use disorder (OUD). We want to specifically thank the attendees of the Indian Country roundtable at the 12th National Harm Reduction Conference, White Earth Nation 8th Annual Native Harm Reduction Summit, and the 10th Annual National Tribal Public Health Summit. This National Strategic Agenda would not be possible without input provided from attendees from these meetings.

Recommendations in this agenda span a wide breadth and include calls to action in several key actions areas through which we can all create measurable progress, help our relatives and relations walk the road to recovery, and prevent future opioid-related deaths.

These key action areas include:

  1. Preventing New Cases of OUD
  2. Offering Tribal, Evidence-based, and Practice-based Treatment and Recovery Services
  3. Protecting Mothers and Babies Affected by OUD
  4. Incorporating Harm Reduction into Tribal Treatment and Recovery Services
  5. Utilizing Data to Mount an Effective Community Response
  6. Growing the Evidence Base for Effective Tribal Opioid Interventions
  7. Cultivating Responsive Communities, Clinics, and Policies

It is our hope that, when appropriate, you are able to adapt the innovative approaches included in this agenda to meet your community’s needs through educating our community members about the potential harms of opioids, incorporating harm reduction policies, ensuring access to life saving treatments, and including the recommendations of those affected, we can all begin to walk the path toward healing.

To view the full Tribal Opioid Response National Strategic Agenda, click on the image to the right.

Tribal Opioid Response Consortium

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.

Indian Country ECHO

Indian Country ECHO offers a variety of online TeleECHO clinics, in-person training, and technical assistance.

Substance Use Disorder TeleECHO Clinics

We gather twice monthly to share important insights on clinical care related to substance use disorders. These 1-hour online sessions include case presentations, recommendations from an inter-professional team, and the opportunity to engage in didactic presentations.

To view upcoming TeleECHO clinics, please click here.

To view past TeleECHO clinics click here.

Join Us

To receive emails or texts from Indian Country ECHO click here.

Free Clinical Training

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.

To view upcoming events and trainings, click here.

Previous Trainings

Rocky Boy, MT July 30, 2019

Quinault, WA August 29, 2019

  • Training Agenda
  • MAT Waiver information
  • Download the Following Presentations
    • MAT Waiver Training
    • The Epidemiology of Substance Use Disorders in American Indians/Alaska Natives
    • Trauma and Addiction/Trauma Informed Care
      • Slides available soon
    • Introductions to Peer Recovery Mentors
      • Slides available soon
    • Effective Treatment Approaches for OUD in a tribal community
      • Slides available soon

Tahlequah, OK September 12-13, 2019

  • Training Agenda available soon
  • MAT Waiver information
  • Download the Following Presentations
    • MAT Waiver Training
    • Introductions to Peer Recovery Mentors
      • Slides available soon
    • Effective Treatment Approaches for OUD in a tribal community
      • Slides available soon

Oklahoma City, OK September 18, 2019

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

HCV/SUD Clinical Training

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.

To view upcoming events and trainings, visit Indian Country Echo.

Previous Trainings

Green Bay, WI May 1-2, 2019

Clinical Resources

In addition to offering TeleECHO clinics, in-person training, and technical assistance, Indian Country ECHO also provides up-to-date clinical and community resources. To view our clinical resources on substance use disorders, please click here.

Join Us

To view upcoming TeleECHO clinics, please click here.

To receive emails or texts from Indian Country ECHO click here.

Community Resources

In addition to offering TeleECHO clinics, in-person training, and technical assistance, Indian Country ECHO also provides up-to-date clinical and community resources. To view our community resources on substance use disorders, please click here.

Join Us

To view upcoming TeleECHO clinics, please click here.

To receive emails or texts from Indian Country ECHO click here.