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Sharing Tribal Public Health Promising Practices to Address the Opioid Crisis in Indian Country

A snapshot of the opioid crisis in Indian Country reveals a stark and unsettling picture: American Indian and Alaska Native (AI/AN) communities are disproportionately affected by the opioid epidemic due to myriad social, economic, and historic factors. These groups experienced the largest increase in overdose deaths between 1995 and 2015. They are also currently experiencing the second-highest fatality rate from opioid overdose. Frequent racial misclassification and general underreporting suggests these statistics are likely much higher. To ensure and improve targeted opioid overdose prevention for AI/AN communities, NNPHI partnered with the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control and Seven Directions, the nation’s first indigenous public health institute, on a multi-year project that seeks to improve existing public health infrastructure, data and information systems, and programs and services to better address the needs of tribal communities.

In September 2019, Seven Directions released An Environmental Scan of Tribal Opioid Overdose Prevention Responses: Community-Based Strategies and Public Health Data Infrastructure to serve as a vehicle for sharing promising practices in AI/AN communities. The report highlighted existing practices that could be incorporated into opioid misuse prevention and treatment strategies. “Tribes have been the leaders [in opioid prevention and treatment], but their cultural practices, strategies, and approaches aren’t always available in the literature,” says Seven Directions Director Dr. Myra Parker. “This report showcases the work of the Tribes who have developed comprehensive, community-centered approaches to address opioid use disorder and prevent deaths from opioid overdose. At Seven Directions, we help gather and share this information with others to make it more widely known and help support other tribes who might be interested in reviewing and revising their practices in this area.”

Seven Directions’ latest report, Models of Tribal Promising Practices: Tribal Opioid Overdose Prevention Care Coordination and Data Systems, which will be released later this month, builds on this original work by taking a deeper look into four models of Tribal Promising Practices as well as the broader frameworks from which these models derive. These Tribal Promising Practices were developed using an Indigenous lens to meet the needs of AI/AN individuals, families, and tribal and urban Indian communities.

The new report also expands upon the traditional definition of care coordination to include AI/AN contexts. Care coordination is traditionally defined by the Substance Abuse and Mental Health Services Administration (SAMHSA) as “the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery.” The Tribal Promising Practices report offers a definition of care coordination that “includes designing a culturally-responsive continuum of care where Indigenous values incorporate cultural strengths, honor tribal sovereignty, and offer key support to community members seeking treatment for opioid use disorder (OUD) and opioid overdose.” Through a literature review and a series of key informant interviews, ten tribal practice themes were identified, which fall into three care coordination domains:

“We found that Tribes that we talked with [for the report] are pulling from several evidence-based interventions to address the opioid crisis in Indian Country,” says Dr. Parker. “This is a more complicated and nuanced story than what’s portrayed in the literature. Research is often restricted to testing and analyzing one approach. In practice, we can get a much richer picture.” The report features four Tribal Nations, all of which apply the care coordination framework in different ways, including a Harm Reduction Model, an Integrated Health Care Model, a Peer Support Model, and a Multi-Pronged Harm Reduction and Integrated Health Care Model. These different models highlight the importance of using tailored, culturally appropriate methods to address the most pressing health needs within a particular tribal community.

Through this report, Seven Directions intends to reach the entire public health workforce that has an interest in promising practices that address Indigenous OUD and opioid overdose prevention, treatment, recovery, healing, and wellbeing. The report emphasizes the importance of “addressing the opioid epidemic requires removing barriers to prevention in AI/AN communities through culturally-relevant, comprehensive, and holistic approaches led by tribes and supported by access to data, funding, and resources.”

Public health practitioners can use this resource to better inform the development and application of opioid overdose prevention, treatment, and recovery practices to save lives through the use of the tribal OUD and overdose prevention care coordination framework. “We need non-tribal partners to become knowledgeable about these tribal approaches, as more and more, we are seeing that coordination between tribal and non-tribal systems of care are necessary to save lives,” adds Dr. Parker. “Those community members struggling with substance use problems are moms, dads, and grandparents, who play many important roles in families and communities. They may be members of multiple communities, both tribal and non-tribal. We need to work together to make sure they have the support they need on their journey toward wellness and healing, and to reduce the negative effects for children and other family members who share this struggle.”

 

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