The FH Healing Model and Community Defined Evidence Practice (CDEP) Study 2022 – 2025 utilizes a non-experimental study design, measuring variables as they naturally occur through Friendship House programs and services and studied through the lens of tribal and intertribal healing practices. The traditional healing methods for FH CDEP examination during the 3-year study period (October 1, 2022, through September 30, 2025) include Traditional Counsel (Group and Individual) Counseling, Sweat Lodge Ceremony, Talking Circle, Drum Circle, Walking the Red Road, and Cultural Gatherings. In general, the evaluation focus of the FH CDEP is to examine the effectiveness of traditional healing methods on the substance abuse treatment population of AI/AN adults who are residential clients at FH: Does the integration of AI/AN healing practices into service delivery efforts have a positive impact on program recipients’ wellness (mental, spiritual, physical and emotional), social and economic engagement, home stability, and cultural connectedness? The FH CDEP examination includes 2 process questions, 8 outcome questions, and 1 formative evaluation question.
Resource
Culturally tailored substance use interventions for Indigenous people of North America: a systematic review
Purpose– The purpose of the current study is to conduct a systematic review of peer-reviewed work on culturally tailored interventions for alcohol and drug use in Indigenous adults in North America. Substance use has been reported as a health concern for many Indigenous communities. Indigenous groups experienced the highest drug overdose death rates in 2015, the largest percentage increase in the number of deaths over time from 1999 to 2015 compared to any other racial group. However, few Indigenous individuals report participating in treatment for alcohol or drug use, which may reflect the limited engagement that Indigenous groups have with treatment options that are accessible, effective and culturally integrative. Design/methodology/approach– Electronic searches were conducted from 2000 to April 21, 2021, using PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PubMed. Two reviewers classified abstracts for study inclusion, resulting in 18 studies. Findings– Most studies were conducted in the USA (89%). Interventions were largely implemented in Tribal/rural settings (61%), with a minority implemented in both Tribal and urban contexts (11%). Study samples ranged from 4 to 742 clients. Interventions were most often conducted in residential treatment settings (39%). Only one (6%) intervention focused on opioid use among Indigenous people. Most interventions addressed the use of both drugs and alcohol (72%), with only three (17%) interventions specifically intended to reduce alcohol use. Originality/value– The results of this research lend insight into the characteristics of culturally integrative treatment options for Indigenous groups and highlight the need for increased investment in research related to culturally tailored treatment across the diverse landscape of Indigenous populations.
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Implementing public health vending machines on the reservation lands of the Bois Forte Band of Chippewa (United States)
Abstract
Background: Public health vending machines (PHVMs) have been shown to improve access to numerous health promoting supplies. However, they are understudied in the United States and no study of which we are aware has
examined their implementation on American Indian reservation lands.
Objective: This study describes how PHVMs were implemented on the Bois Forte Band of Chippewa Reservation
lands in Minnesota (United States) and associated costs during the first 24 weeks of operations.
Methods: We summarize the steps undertaken to implement PHVMs on reservation lands. We describe formative
research in which we assessed willingness to use a PHVM among a sample of people who use drugs. Then, we
describe how we worked with community members to ensure the appropriateness of a PHVM initiative. Finally, we
present utilization data from the first 24 weeks of PHVM operations and describe associated implementation costs.
Results: In May 2022, the academic research team presented to the Bois Forte Reservation Tribal Council about
PHVMs and requested a Resolution that authorized their implementation on Reservation lands. The Resolution was
unanimously approved, and the team began working with a local Community Research Council to determine the
most appropriate way to implement the PHVMs. Prior to implementation, we conducted a survey among people
who used drugs (N=227) on Reservation lands and found that most (56%) reported willingness to use PHVMs if they
were available. In October 2023, two PHVMs were installed. During the first 24 weeks of operations, there were 2,534
successful dispensations at the PHVMs. Items dispensed through the PHVMs included COVID-19 test kits, naloxone,
drug test strip kits, menstrual supply kits, wound care kits, sterile injection equipment kits, pregnancy tests, safer sex
kits, and HIV self-test kits. In total, the PHVM initiative cost approximately $30,406.75 (USD) during its initial 24-week
implementation period.
Conclusions: The Bois Forte Band of Chippewa took swift action upon learning about the potential public health
benefits of PHVMs and immediately authorized their implementation, catalyzing a collaborative effort between local
community members and academic partners. Thousands of life-sustaining supplies were dispensed at the PHVMs,
supporting the prevention and treatment needs of the community
Racial/ethnic representation in opioid use disorder-related clinical trials
Highlights
- American Indians and Alaska Natives were under-represented in clinical trials dealing with Opioid Use Disorder.
- Black Americans were enrolled in clinical trials for opioid use disorder at levels that exceeded those expected.
- White people were enrolled in clinical trials for opioid use disorder at levels that were lower than those that were expected.
Impact of opioid overdoses on US life expectancy and years of life lost, by demographic group and stimulant co-involvement: a mortality data analysis from 2019 to 2022
Summary
Background
The United States’ opioid crisis is worsening, with the number of deaths reaching 81,806 in 2022 after more than tripling over the past decade. This study aimed to comprehensively characterize changes in burden of opioid overdose mortality in terms of life expectancy reduction and years of life lost between 2019 and 2022, including differential burden across demographic groups and the contribution of polysubstance use.
Methods
Using life tables and counts for all-cause and opioid overdose deaths from the National Center for Health Statistics, we constructed cause-eliminated life tables to estimate mortality by age in the absence of opioid-related deaths. We calculated the loss in life expectancy at birth (LLE) and total years of life lost (YLL) due to opioid overdose deaths by state of residency, sex, racial/ethnic group, and co-involvement of cocaine and psychostimulants.
Findings
Opioid-related deaths in the US led to an estimated 3.1 million years of life lost in 2022 (38 years per death), compared to 2.0 million years lost in 2019. Relative to a scenario with no opioid mortality, we estimate that opioid-related deaths reduced life expectancy nationally by 0.67 years in 2022 vs 0.52 years in 2019. This LLE worsened in all racial/ethnic groups during the study period: 0.76 y–0.96 y for white men, 0.36 y–0.55 y for white women, 0.59 y–1.1 y for Black men, 0.27 y–0.53 y for Black women, 0.31 y–0.82 y for Hispanic men, 0.19 y–0.31 y for Hispanic women, 0.62 y–1.5 y for American Indian/Alaska Native (AI/AN) men, 0.43 y–1 y for AI/AN women, 0.09 y–0.2 y for Asian men, and 0.08 y–0.13 y for Asian women. Nearly all states experienced an increase in years of life lost (YLL) per capita from 2019 to 2022, with YLL more than doubling in 16 states. Cocaine or psychostimulants with abuse potential (incl. methamphetamines) were involved in half of all deaths and years of life lost in 2022, with substantial variation in the predominant drug class by state and racial/ethnic group.
Interpretation
The burden of opioid-related mortality increased dramatically in the US between 2019 and 2022, coinciding with the period of the COVID-19 pandemic and the associated disruptions to social, economic, and health systems. Opioid overdose deaths are an important contributor to decreasing US life expectancy, and Black, Hispanic, and Native Americans now experience mortality burdens approaching or exceeding white Americans.
A cross-sectional study of differences in medication for opioid use disorder receipt among pregnant people enrolled in Medicaid in Oregon, United States
Abstract
Background and Aims
Medication is the gold standard to support a healthy pregnancy for pregnant people with opioid use disorder (OUD). This study measured inequities and differences in OUD medication treatment among pregnant people in Oregon, USA.
Design, Setting, Participants and Measurements
Our study population consisted of Medicaid enrollees across the US state of Oregon who had at least one live hospital birth between 2012 and 2020 and one diagnosis of OUD prenatally (n = 4363). We measured differences in demographic characteristics (age, race, ethnicity, location) among those with and without medication for OUD in the prenatal through 3-months postpartum period (any medication use, and by type), and compared exclusive methadone versus buprenorphine receipt. We report unadjusted and adjusted odds ratios.
Findings
Adjusted odds ratios for medication for OUD were lower among American Indian/Alaska Native pregnant people compared with White pregnant people [adjusted odds ratio (aOR) 0.59 (95% confidence interval [CI] = 0.42, 0.83)], younger pregnant people compared with those aged 30–34 years [aOR, ages 15–19: 0.1 (95 CI = 0.06, 0.18); aOR, ages 20–24: 0.58 (95 CI = 0.49, 0.69)] and rural pregnant people compared with those in urban communities [aOR 0.58 (95 CI = 0.5–0.67)]. Rural pregnant people with OUD also had lower odds of methadone receipt [aOR 0.23 (95 CI = 0.17, 0.3)] and higher odds of buprenorphine receipt [aOR 3.99 (95 CI = 2.97, 5.35)] than other people in this study. Among those who received medication, Black pregnant people had increased odds of receiving methadone compared with buprenorphine [aOR 2.09 (95 CI = 1.1–3.97)].
Conclusions
In Oregon, USA, inequities in receipt of any medication for opioid use disorder were observed among pregnant people who identified as American Indian or Alaska Native, younger than 25, and living in rural communities. Black pregnant people in Oregon, USA, were more likely to receive methadone than buprenorphine.
Native Hawaiian Culturally Appropriate Substance Use Disorders Formative Program Evaluation
Abstract Substance use disorders (SUDs) disproportionately affects Native Hawaiians, yet conventional treatments often overlook the cultural, spiritual, and relational foundations of well-being for Native Hawaiians. This gap represents a human services problem, as it perpetuates health disparities, limits recovery, and slows social change within Native Hawaiian communities. The purpose of this qualitative single case study was to identify culturally relevant components for an SUD treatment program tailored to Native Hawaiians. The research question guiding this study was, what are culturally appropriate components for a SUD program for Native Hawaiians. The Nā Pou Kihi framework grounded the exploration of Indigenous approaches to healing that may be integrated into treatment models. Case data were gathered through an interview with a cultural practitioner and secondary sources, then analyzed using thematic analysis. Findings revealed that effective treatment affirms cultural identity, restores reciprocal relationships with ʻāina, promotes accountability and reconciliation through practices such as Hoʻoponopono, and embeds spirituality as a foundation for recovery. Results suggest that culturally grounded programs foster intergenerational healing, cultural resurgence, and community-level social change. Recommendations include increasing funding for culturally based services, training providers in Native Hawaiian health frameworks, and strengthening partnerships between licensed professionals and cultural practitioners to advance equity and contribute to long-term social change
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Tribally-affiliated syringe services programs in the United States: a brief report
Background Few studies have examined the implementation of syringe services programs (SSPs) that serve Indigenous people who inject drugs in the United States (US). There are 574 Federally-recognized tribes in the US, each characterized by unique traditions, values, and customs. Given the diversity of tribes, better understanding SSP implementation in Native contexts first requires examining the degree to which tribes in the US implemented these programs. Objective This research describes the number of SSPs that are affiliated with Federally-recognized tribes in the US. Methods From July to September 2022, we conducted an online search of all 574 Federally-recognized tribes to determine how many had affiliated SSPs. We downloaded a list of Federally-recognized tribes from the Bureau of Indian Affairs (BIA) and conducted Boolean searches on Google for the name of each tribe and SSPs. Our searches included several synonyms for SSPs, including “needle exchange,” “syringe exchange,” and “harm reduction.” In instances where “harm reduction programs” were identified, we reviewed website contents to determine if the program was inclusive of a SSP. We considered SSPs to be affiliated with Federally-recognized tribe(s) if they were housed in a tribal health clinic or tribal organization, or via an explicit partnership with a Federally-recognized tribe. Results We identified 21 SSPs that were affiliated with Federally-recognized tribes. The majority (85.7%) of SSPs were affiliated with a single tribe. Eight of the SSPs also offered medications for opioid use disorder (MOUD) on-site (e.g., the SSPs operated out of health clinics that offered MOUD). Conclusions The results of this study demonstrate that there are at least 21 SSPs that are affiliated with Federally recognized tribes in the US, with some serving multiple tribes. This research makes a noteworthy contribution to the public health literature given that no systematic exploration of the number of SSPs affiliated with tribes has been conducted. The scale of substance use inequities among Indigenous people underscores the critical importance of communities implementing and managing their own comprehensive harm reduction programs.
Provider perspectives on the impact of COVID-19 on treatment of substance use and opioid use disorders among American Indian and Alaska Native adults
Abstract
Introduction:
American Indian/Alaska Native (AI/AN) communities are more likely to suffer negative consequences related to substance misuse. The COVID-19 pandemic exacerbated the opioid poisoning crisis, in combination with ongoing treatment barriers resulting from settler-colonialism, systemic oppression and racial discrimination. AI/AN adults are at greatest risk of COVID-19 related serious illness and death. In collaboration with an Indigenous community advisory board and Tribal leadership, this study explored AI/AN treatment provider perceptions of client-relatives’ (i.e., SUD treatment recipients) experiences during the pandemic from 2020 to 2022.
Methods:
Providers who underwent screening and were eligible to participate (N = 25) represented 6 programs and organizations serving rural and urban areas in Washington, Utah, and Minnesota. Participants engaged in audio-recorded 60–90 min semi-structured individual interviews conducted virtually via Zoom. The interview guide included 15 questions covering regulatory changes, guidance for telemedicine, policy and procedures, staff communication, and client-relatives’ reactions to implemented changes, service utilization, changes in treatment modality, and perceptions of impact on their roles and practice. Interview recordings were transcribed and de-identified. Members of the research team independently reviewed transcripts before reaching consensus. Coding was completed in Dedoose, followed by analyses informed by a qualitative descriptive approach.
Results:
Five main domains were identified related to client-relative experiences during the COVID-19 pandemic, as observed by providers: (1) accessibility, (2) co-occurring mental health, (3) social determinants of health, (4) substance use, coping, and harm reduction strategies, and (5) community strengths. Providers reported the distinctive experiences of AI/AN communities, highlighting the impact on client-relatives, who faced challenges such as reduced income, heightened grief and loss, and elevated rates of substance use and opioid-related poisonings. Community and culturally informed programming promoting resilience and healing are outlined.
Conclusion:
Findings underscore the impact on SUD among AI/AN communities during the COVID-19 pandemic. Identifying treatment barriers and mental health impacts on client-relatives during a global pandemic can inform ongoing and future culturally responsive SUD prevention and treatment strategies. Elevating collective voice to strengthen Indigenous informed systems of care to address the gap in culturally-and community-based services, can bolster holistic approaches and long-term service needs to promote SUD prevention efforts beyond emergency response efforts.
Scope and historical origins of substance use disorders among Native American communities
Abstract: American Indian and Alaska Natives (AIAN) are a rapidly growing and diverse population: There are 9.7 million AIANs in the United States (including 5.9 million people who identify as AIAN and one or more racial groups), constituting 2.9%of the total population. In 2018, 10.8% of AIANs were classified as having a substance use disorder (SUD) in the past year. As SUD rates continue to increase along with premature mortality, AIAN communities are deeply and actively committed to the health of future generations and to developing solutions that incorporate culturally meaningful strategies that push toward integrated, multilevel recovery and healing. This chapter provides an overview of substance use and SUDs in AIAN communities, including historical background and prevalence. It explores factors that may contribute to SUDs and highlights factors related to resiliency and recovery. Finally, the chapter provides an overview of some promising interventions and implications for policy and practice.
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