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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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.

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.

Clinicians serving American Indians and Alaska Native people are invited to participate in the Opioid and Substance Use Disorders ECHO Clinic. The program provides comprehensive information for clinicians to integrate evidence-based substance use disorder treatment with holistic, culturally appropriate care to successfully deal with the effects of opioid use disorder. The program will offer a 2 day in person training with data waiver, and 12 subsequent telehealth sessions. Learn more>>

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