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The Opioid Epidemic in Indian Country

Published online by Cambridge University Press:  01 January 2021

Robin T. Tipps ,
Gregory T. Buzzard  and
John A. McDougall
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Extract

The national opioid epidemic is severely impacting Indian Country. In this article, we draw upon data from the Centers for Disease Control and Prevention to describe the contours of this crisis among Native Americans. While these data are subject to significant limitations, we show that Native American opioid overdose mortality rates have grown substantially over the last seventeen years. We further find that this increase appears to at least parallel increases seen among non-Hispanic whites, who are often thought to be uniquely affected by this crisis. We then profile tribal medical and legal responses to the opioid epidemic, ranging from tribally-operated medication-assisted therapy to drug diversion courts rooted in traditional tribal cultures.

Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 46 , Issue 2: Law and the Opioid Crisis: An Inter-Disciplinary Examination , Summer 2018 , pp. 422 - 436
Copyright
Copyright © American Society of Law, Medicine and Ethics 2018

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References

We refer to the indigenous inhabitants of the lands that now comprise the United States in two different ways. In Part II, we use the term American Indian/Alaska Native (“AI/AN”) to comport with the use of this term in statistical data and the medical literature. Elsewhere, we use the term Native American. To indicate the nation-wide community of Native Americans, we use the widely-accepted term Indian Country in its generic, not statutory, sense. See 18 U.S.C. § 1151 (2012).Google Scholar
Complaint, St. Croix Chippewa Indians of Wis. v. McKesson Corp., No. 3:17-cv-00914 at ¶ 3 (W.D. Wis. Dec. 12, 2017) (discussing cost of opioid crisis to tribal government); Hoffman, J., “In Opioid Battle, Cherokee Want Their Day in Tribal Court,” New York Times, December 17, 2017, available at <https://www.nytimes.com/2017/12/17/health/cherokee-opioid-addiction-pharmacies.html?_r=0> (last visited May 8, 2018) (describing problem of tribal children neglected by parents suffering from opioid use disorder).+(last+visited+May+8,+2018)+(describing+problem+of+tribal+children+neglected+by+parents+suffering+from+opioid+use+disorder).>Google Scholar
National Center for Health Statistics, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, “Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016,” available through <https://wonder.cdc.gov/controller/datarequest/D77> (last visited January 17, 2018).+(last+visited+January+17,+2018).>Google Scholar
Rudd, R.A., Seth, P., David, F., and Scholl, L., “Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015,” Morbidity and Mortality Weekly Report 65, no. 50+51 (2016): 1445-1452.Google Scholar
Arias, E., Schauman, W.S., Eschbach, K., Sorlie, P.D., and Backlund, E., ‘The Validity of Race and Hispanic Origin Reporting on Death Certificates in the United States,” Vital and Health Statistics 2, no. 148 (2008): 1.Google Scholar
See Arias, supra note 5, at 7.Google Scholar
Jim, M.A., Arias, E., Seneca, D.S., Hoopes, M.J., Jim, C.C., Johnson, N.J., and Wiggins, C.L., “Racial Misclassification of American Indians and Alaska Natives by Indian Health Service Contract Health Service Delivery Area,” American Journal of Public Health 104, Supplement 3, no. 53 (2014): S295-S302, at S297.Google Scholar
Norris, T., Vines, P.L., and Hoeffel, E.M., “The American Indian and Alaska Native Population: 2010,” 2010 Census Briefs, C2010BR-10 (January 2010), at 2, available at <https://www.census.gov/prod/cen2010/briefs/c2010br-10.pdf> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Doyle, J. and Kao, G., “Are Racial Identities of Multiracials Stable? Changing Self-Identification Among Single and Multiple Race Individuals,” Social Psychology Quarterly 70, no. 4 (2007): 405-423, available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2759722/#S16title> (last visited May 8, 2018).Google Scholar
Jim, supra note 7.Google Scholar
Tupper, S., “Rounds: ‘Unimaginable horrors’ at Indian hospitals,” Rapid City Journal (Rapid City, SD), November 9, 2017, available at <http://rapidcityjournal.com/news/local/rounds-unimaginable-horrors-at-indian-hospitals/article_4dc23bbd-5df2-571b-a392-081b6be11820.html> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Drug Enforcement Administration, “Significant Fentanyl Seizures of More than 1 Kilogram, January 2016 – June 2017,” available at <https://www.dea.gov/druginfo/MAP-SignificantFentanylSeizures.pdf> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Drug Enforcement Administration, “National Heroin Threat Assessment Summary – Updated,” DEA-DCT-DIR-031-16 (June 2016): at 12, available at <https://www.dea.gov/divisions/hq/2016/hq062716_attach.pdf> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
National Congress of American Indians, Methamphetamine in Indian Country (Nov, 2006), available at <https://www.justice.gov/archive/tribal/docs/fv_tjs/session_1/session1_presentations/Meth_Overview.pdf> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Hilleary, C., “The Devil on Your Shoulder: Battling Meth Addiction in Indian Country,” Voice of America, April 8, 2016, available at <https://www.voanews.com/a/the-devil-on-your-shoulder-battling-meth-addiction-in-indian-country/3276782.html> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
U.S. Census Bureau, “Census 2010 American Indian and Alaska Native Summary,” available at <https://factfinder.census.gov/bkmk/table/1.0/en/DEC/10_AIAN/PCT2//popgroup~001|006|009?slice=POPGROUP~009> (last visited May 23, 2018).+(last+visited+May+23,+2018).>Google Scholar
See generally U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, “Improving Cultural Competency: A Treatment Improvement Protocol” (2014), available at <https://store.samhsa.gov/shin/content/SMA14-4849/SMA14-4849.pdf> (last visited May 8, 2018); see also J.D. Calabrese, “Clinical Paradigm Clashes: Ethnocentric and Political Barriers to Native American Efforts at Self-Healing, ETHOS 36, no. 3 (2008): 334-353; J.D. McDonald and J. Gonzales, Culturally Responsive Cognitive-Behavioral Therapy: Assessment, Practice, and Supervision (Washington, DC: American Psychological Association, 2006): at 23-45.+(last+visited+May+8,+2018);+see+also+J.D.+Calabrese,+“Clinical+Paradigm+Clashes:+Ethnocentric+and+Political+Barriers+to+Native+American+Efforts+at+Self-Healing,+ETHOS+36,+no.+3+(2008):+334-353;+J.D.+McDonald+and+J.+Gonzales,+Culturally+Responsive+Cognitive-Behavioral+Therapy:+Assessment,+Practice,+and+Supervision+(Washington,+DC:+American+Psychological+Association,+2006):+at+23-45.>Google Scholar
Indian Self-Determination and Education Assistance Act, Pub. L. No. 93-638 (1975); Tribal Self Governance Amendments, Pub. L. No. 106-2060; 25 U.S.C. § 458 (2000); 42 C.F.R. 137.Google Scholar
Indian Health Service, “Indian Health Manual Part 3, Chapter 30,” (June 21, 2014): at 3-30.7(A), available at <https://www.ihs.gov/IHM/index.cfm?module=dsp_ihm_pc_p3c30#3-30.1> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Indian Health Service, “Indian Health Manual Part 3, Chapter 32,” (June 30, 2016), available at <https://www.ihs.gov/IHM/index.cfm?module=dsp_ihm_pc_p3c32> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
U.S. Department of Health and Human Service, Indian Health Service, Alcohol and Substance Abuse Program (ASAP), <https://www.ihs.gov/asap/> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
See Indian Self-Determination and Education Assistance Act, supra note 18; see also Tribal Self Governance Amendments, supra note 18.Google Scholar
Seminole Nation v. United States, 316 U.S. 286, 296-297 (1942).Google Scholar
See U.S. Const. art. I, § 9; Johnson v. M’Intosh, 21 U.S. 543, 557 (1823); Cherokee Nation v. Georgia, 30 U.S. 1, 13 (1831); Seminole Nation, supra note 23.Google Scholar
U.S. Department of Health and Human Services, Indian Health Service, IHS 2016 Profile, available at <https://www.ihs.gov/newsroom/factsheets/ihsprofile/> (last visited May 8, 2018); Rudd, S., “The Opioid Epidemic: The Indian Health Service Response to a National Crisis” (presentation, SAMHSA Webinar on Strategies Addressing the Opioid Crisis in Tribal Communities, August 30, 2017), available at <https://www.samhsa.gov/sites/default/files/topics/tribal_affairs/tribal-opioid-webinar.pdf> (last visited May 8, 2018).+(last+visited+May+8,+2018);+Rudd,+S.,+“The+Opioid+Epidemic:+The+Indian+Health+Service+Response+to+a+National+Crisis”+(presentation,+SAMHSA+Webinar+on+Strategies+Addressing+the+Opioid+Crisis+in+Tribal+Communities,+August+30,+2017),+available+at++(last+visited+May+8,+2018).>Google Scholar
Indian Health Care Improvement Act, Pub. L. No. 94-437, 90 Stat. 1400 (1976).Google Scholar
Brown, H.J., “IHS National Prescription Drug Abuse Work-group” (presentation, A Report to the National Combined Councils, June 25, 2014), available at <ftp://ftp.ihs.gov/pubs/CSC/Workgroup%20NCC%202014%20Prescription%20Drug%20Abuse%20Report%20Out.ppt.508.pdf> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Memorandum on Addressing Prescription Drug Abuse and Heroin Use, 2015 Daily Comp. Pres. Doc. 201500743 (Oct. 21, 2015).Google Scholar
Indian Health Service, Press Release, New effort targets drug overdoses in Indian Country (Dec. 16, 2015), available at <https://www.ihs.gov/newsroom/pressreleases/2015pressreleases/new-effort-targets-drug-overdoses-in-indian-country> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Duvivier, H., Gustafson, S., Greutan, M., Jangchup, T., Harden, A.K., Reinhard, A., and Warshany, K., “Indian Health Service Pharmacists Engaged in Opioid Safety Initiatives and Expanding Access to Naloxone,” Journal of the American Pharmacists Association 57, no. 2 (2017): S135-S140 at S139.CrossRefGoogle Scholar
Id.Google Scholar
Smith, M., Indian Health Service Principal Deputy Director, Press Release, IHS Implements Groundbreaking New Policy Regarding Opioid Prescribing (July 6, 2016), available at <https://www.ihs.gov/newsroom/ihs-blog/july2016/ihs-implements-groundbreaking-new-policy-regarding-opioidprescribing> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
See Rudd, supra note 25.Google Scholar
Id.Google Scholar
Tupper, S., “New Problems Surface at Rosebud Indian Health Service Hospital,” Rapid City Journal (Rapid City, SD), February 13, 2016.Google Scholar
Rhoades, E.R. and Rhoades, D.A., “The Public Health Foundation of Health Services for American Indians & Alaska Natives,” American Journal of Public Health 104, no. 3 (2014): S278-S285; Tupper, supra note 35.Google Scholar
See Indian Self-Determination and Education Assistance Act, supra note 18; see also Tribal Self Governance Amendments, supra note 18.Google Scholar
25 U.S.C. § 458aaa-2; 42 C.F.R. § 137.15-26.Google Scholar
See IHS 2016 Profile, supra note 25; see also Rudd, supra note 25.Google Scholar
Personal communication from Christine Woods to author (RTT) (November 17, 2017).Google Scholar
Personal communication from Dan Cable to author (RTT) (November 27, 2017).Google Scholar
See Personal communication from Christine Woods, supra note 40.Google Scholar
Id.Google Scholar
Id.Google Scholar
Woods, C., “Quapaw Counseling Services Monthly Report,” speech to Quapaw Tribe Business Committee, Quapaw, Oklahoma, November 11, 2017; Y, Hser, A. J. Saxon, D. Huang, A. Hasson, C. Thomas, M. Hillhouse, P. Jacobs, C. Teruya, P. McLaughlin, K. Wiest, A. Cohen, and W. Ling, “Treatment Retention among Patients Randomized to Buprenorphine/Naloxone Compared to Methadone in A Multi-site Trial,” Addiction 111, no. 4 (April 2016): 695-705.Google Scholar
Id.Google Scholar
Cable, D., “State of the Art Opiate Treatment at Muckleshoot Behavioral Health,” annual report provided to the Muckle-shoot Tribal Council (November 2017).Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
Id.Google Scholar
E.g. Sullivan, M., Bisaga, A., Pavlicova, M., Choi, C. J., Mishlen, K., Carpenter, K. M., Levin, F. R., Dakwar, E., Mariani, J. J., and Nunes, E. V., “Long-Acting Injectable Naltrexone Induction: A Randomized Trial of Outpatient Opioid Detoxification with Naltrexone Versus Buprenorphine,” The American Journal of Psychiatry 174, no. 5 (2017): 459-467, at 461-463.Google Scholar
Id.Google Scholar
Cable, D., “Muckleshoot Adult Behavioral Health Program” (presentation, SAMHSA Webinar on Strategies Addressing the Opioid Crisis in Tribal Communities, August 30, 2017), available at <https://www.samhsa.gov/sites/default/files/topics/tribal_affairs/tribal-opioid-webinar.pdf> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
See Personal communication from Dan Cable, supra note 41.Google Scholar
See Cable, supra note 47.Google Scholar
See Woods, supra note 45.Google Scholar
See Cable, “Muckleshoot Adult Behavioral Health Program,” supra note 55.Google Scholar
Id.Google Scholar
Id.Google Scholar
See Cable, supra note 47.Google Scholar
Oliphant v. Suquamish Indian Tribe, 435 U.S. 191 (1978); 25 U.S.C. § 1304.Google Scholar
18 U.S.C § 1152.Google Scholar
Washburn, K.K., “American Indians, Crime, and the Law,” Michigan Law Review 104, no. 4 (2006): 709-777, at 710-714.Google Scholar
18 U.S.C. § 1162(a).Google Scholar
Flies-Away, J.T., Tribal Healing to Wellness Courts: The Judicial Bench Book (Tribal Law and Policy Institute, 2016): at 3.Google Scholar
Id. at 100-102.Google Scholar
Id. at 9-10.Google Scholar
Id. at 9.Google Scholar
Id. at 18.Google Scholar
Id.Google Scholar
Id. at 39.Google Scholar
Id.Google Scholar
Id.Google Scholar
Gottlieb, K., “Process and Outcome Evaluations in Four Tribal Wellness Courts,” 231167 (Dec. 30, 2006), available at <https://www.ncjrs.gov/pdffiles1/nij/grants/231167.pdf> (last visited May 8. 2018).+(last+visited+May+8.+2018).>Google Scholar
Id.Google Scholar
Rowan, M., Poole, N., Shea, B., Gone, J.P., Mykota, D., Farag, M., Hopkins, C., Hall, L., Mushquash, C., and Dell, C., “Cultural Interventions to Treat Additions in Indigenous Populations: Findings from a Scoping Study,” Substance Abuse Treatment, Prevention, and Policy 9 (2014): 34-60.Google Scholar
See Merrion v. Jicarilla Apache Tribe, 455 U.S. 130, 141 (1982) (noting that “a hallmark of Indian sovereignty is the power to exclude non-Indians from Indian lands”).Google Scholar
Yanick-Jonaitis, L., ‘Two Banished from Isabella Reservation Before their Day in Court,” Morning Sun, February 28, 2015, available at <http://www.themorningsun.com/general-news/20150228/two-banished-from-isabella-reservation-before-their-day-in-court> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Luger, C., “Banishment as Last Resort to Fight Meth Scourge in Indian Country,” Al-Jazeera America, November 9, 2015, available at <http://america.aljazeera.com/articles/2015/11/9/banishment-as-last-resort-to-fight-drug-trade-in-indian-country1.html> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Duro v. Reina, 495 U.S. 676, 697 (1990).Google Scholar
Kunesh, P., “Banishment as Cultural Justice in Contemporary Tribal Legal Systems,” New Mexico Law Review 37, no. 85 (2007): 85-145, at 117.Google Scholar
See Complaint, St. Croix Chippewa Indians of Wis. v. McKesson Corp., No. 3:17-cv-00914 (W.D. Wis. Dec. 12, 2017); Complaint, Flandreau Santee Sioux Tribe v. Purdue Pharma L.P., No. 4:18-cv-04003-KES (D.S.D. Jan. 8, 2018).Google Scholar
St. Croix at ¶¶ 207-16; Flandreau at ¶¶ 330-38.Google Scholar
Complaint, Coyote Valley Band of Pomo Indians v. McKesson Corp., No. CGC-18-563933 (Cal. Super. Ct. Jan 29, 2018).Google Scholar
Petition at ¶ 11, Cherokee Nation v. McKesson Corp., No. CV-17-203 (Cherokee Nat. Dist. Ct. Apr. 20, 2017), available at <https://goo.gl/QdP9qu> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Id. at ¶ 55.Google Scholar
Montana v. United States, 450 U.S. 544 (1981).Google Scholar
McKesson Corp. v. Hembree, No. 17-CV-323-TCK-FHM, 2018 WL 340042, at *15 (N.D. Okla. 2018).Google Scholar
Id. at *18-19 (quoting Plains Commerce Bank v. Long Family Land & Cattle Co., 554 U.S. 316, 341 (2008)).Google Scholar
Hoffman, J., “Cherokee Can’t Sue Opioid Distributors in Tribal Court, Judge Rules,” New York Times, January 11, 2018, available at <https://www.nytimes.com/2018/01/11/health/cherokee-opioids-lawsuit.html?_r=0> (last visited May 8, 2018).+(last+visited+May+8,+2018).>Google Scholar
Gluck, A.R., Hall, A., and Curfman, G., “Civil Litigation and the Opioid Epidemic: The Role of Courts in a National Health Crisis,” Journal of Law, Medicine, &Ethics 46, no. 2 (2018): 351-366.Google Scholar
Reid, C., “Cherokee Nation, grappling with opioid crisis, takes legal action,” CBS News, Oct. 17, 2017, available at <https://www.cbsnews.com/news/cherokee-nation-opioid-crisis-legal-action/> (last visited May 8, 2018) (“‘My goal is to change the behavior of these corporations and the way you do that is you hit them in the pocketbook,’ [the Cherokee Nation Attorney General] said”).+(last+visited+May+8,+2018)+(“‘My+goal+is+to+change+the+behavior+of+these+corporations+and+the+way+you+do+that+is+you+hit+them+in+the+pocketbook,’+[the+Cherokee+Nation+Attorney+General]+said”).>Google Scholar