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20 July 2026
Kase Cragg
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Categories: Resource

United Southern and Eastern Tribes (USET): Naloxone Resource Guide

This is an online resource by United and Southern and Eastern Tribes that details how to use and where to locate naloxone (otherwise known as NARCAN®). This site lists National organizations that provide naloxone and select states that provide naloxone either through a nonprofit organization or through the county public health department. The states with listed naloxone information are: Alabama, Connecticut, Florida, Louisiana, Maine, Massachusetts, Mississippi, New York, North Carolina, Rhode Island, South Carolina, Tennessee, Texas.

Check Out the Guide Here

USET has also developed guidelines for creating one’s own supply kit to reduce the likelihood of accidental injury or death due to substance use. From their website: “In addition to providing resources on how to recreate the kit, USET has also created a training video that explains how to use the items in the kit. The training video can be shared with internal staff, community members, and anyone who has access to the Harm Reduction Kits. For collaboration opportunities, please contact Caro Caballero at [email protected] and Deviyani Bajpai at [email protected].“

2 July 2026
Emily Taylor
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Categories: Resource

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.

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30 June 2026
Kase Cragg
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Categories: Resource

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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Community members and students may request access to this article by completing the form here.

29 June 2026
Kase Cragg
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Categories: Resource

Tribal Opioid Response Resource Toolkit

From the National Indian Health Board, the Tribal Opioid Response Resource Toolkit “provides an array of materials, tools, resources and links to support Tribes as they are working to combat the epidemic within their communities.”

Click here to learn more

25 June 2026
Emily Taylor
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Categories: Resource

Widening Racial Disparities in the U.S. Overdose Epidemic

Introduction

More Americans died in 2021 from drug overdose than from vehicle accidents and firearms combined. Unlike earlier phases, the current epidemic is marked by its disproportionate impact on communities of color. This report investigates regional and substance-specific variations in racial disparities to generate possible insights into the various forces shaping these trends.

Methods

This report used data from 1999 to 2022 on opioid-related overdose deaths from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research database. Racial disparities at the national, state, and substance levels were compared to describe heterogeneities in disparities trends. Data were analyzed in 2024.

Results

Overall age-adjusted overdose mortality in the U.S. increased from 6.2 to 32.7 deaths per 100,000 between 1999 and 2022. In this same time period, mortality has increased most rapidly in Black, Native, and Hispanic/Latino Americans at 249.3%, 166.3%, and 171.8%, respectively. Disparities with White populations vary regionally. The upper Midwest (i.e., Minnesota, Wisconsin) and Washington state rank highest in excessive Native overdose death; the upper Midwest and Washington, DC rank highest as Black overdose deaths. In terms of substances, deaths from polyuse of methamphetamines and opioids have been highest among Native Americans over time, whereas deaths from cocaine and opioids disproportionately impact Black Americans.

Conclusions

The opioid epidemic continues to expand, with particularly rapid acceleration in racially minoritized communities. The growing role of stimulants in opioid overdose deaths is a racialized phenomenon disproportionately impacting Black and Native Americans. Wide variation in state-level disparities suggest that structural racism impacts health in regionally specific ways, highlighting the need for regional solutions.

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25 June 2026
Emily Taylor
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Categories: Resource

Risk and Protective Factors for Opioid Misuse in American Indian Adolescents

Abstract

Background:

American Indian (AI) youth have disproportionately high rates of both heroin and other opioid misuse and recently have seen a large increase in negative outcomes due to opioid misuse. To address the dearth of research on within-group risk factors for heroin and other opioid misuse in AI adolescents, the goal of the present study is to explore the influence of peer, family, and school factors on opioid use among AI youth.

Methods:

Participants (n=3,498, 49.5% female, Mage=14.8) were drawn from a large school-based sample of AI youth living on or near reservations, across six geographic regions, between 2009 and 2013. Participants completed a self-report questionnaire regarding substance use and related factors. Multilevel logistic regression was utilized to examine the role of peer, family, and school-related factors on past-month and lifetime heroin and other opioid misuse.

Results:

Greater peer substance use (OR = 1.14, p<0.001), lower family disapproval of use (OR = .98, p = 0.01), and lower school performance (OR = .90, p = 0.01) were associated with greater likelihood of lifetime opioid misuse. Greater peer substance use (OR = 1.05, p<0.001) and lower family disapproval of use (OR = .99, p = 0.04) were associated with greater likelihood of past month opioid misuse. Greater peer substance use was the only variable significantly related to greater likelihood of lifetime (OR=1.15, p<.001) or past month heroin use (OR=1.02, p=.047).

Conclusions:

Findings highlight the need for interventions and offer potential factors to consider in developing interventions for heroin and/or other opioid misuse among AI adolescents.

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24 June 2026
Kase Cragg
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Categories: Resource

Opioid Misuse Among American Indian Adolescents

Objectives. To present data for opioid misuse among US reservation-based American Indian (AI) adolescents and to compare these data with national rates from Monitoring the Future (MTF). Methods. Data were from a national sample of 33 schools participating in a substance use epidemiological survey of reservation-based AI adolescents during 2018 and 2019. Participants were 8th-, 10th-, and 12th-grade AI students (n = 1592). Measures included 12-month and 30-day use of OxyContin, Vicodin, heroin, and narcotics. We computed prevalence and compared it with MTF national prevalence. Results. Across grades, AI youths demonstrated significantly greater past 12-month and 30-day opioid use relative to a national sample. Significant absolute differences in 12-month and 30-day prevalence levels ranged from 1.6% (8th-grade heroin) to 4.7% (12th-grade narcotics) and from 1.6% (12th-grade narcotics) to 1.8% (12th-grade heroin), respectively. Conclusions. Opioid misuse prevalence levels were significantly greater for reservation-based AI adolescents relative to national prevalence levels. Public Health Implications. Findings suggest that implementation of evidence-based efforts, adapted or developed to be culturally appropriate, should be significantly increased in tribal communities, along with policies to address the unique social, economic, and health issues they face.

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Community members and students may request access to this article by completing the form here.

24 June 2026
Kase Cragg
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Categories: Resource

Narrative Review of Opioid Use Disorder Treatment Changes During the COVID-19 Pandemic and Their Impact on American Indian/Alaska Native Communities

ABSTRACT

Background: The United States (US) declared drug overdose a public health emergency in 2017. Despite this, two million people reported having an opioid use disorder (OUD) in 2018. However, following the beginning of COVID-19 there was a 53% increase in overdose deaths, with American Indian/Alaska Native (AI/AN) individuals experiencing the highest rates of all racial groups. In response to the COVID-19 pandemic and OUD treatment access challenges, OUD treatment policies were changed to improving access to care. Purpose: This review examines how the state- and federal-level policies impacted access to medications for opioid use disorder (MOUD) during the COVID-19 pandemic. Due to the devastating impact of overdose and COVID-19 on AI/AN communities, as a secondary aim, we examined the inclusion of these populations in the samples of the included studies. Methods: We completed a narrative review using a data-based convergent synthesis design. Results: Forty-four studies met the inclusion criteria. Most of the studies were quantitative descriptive studies (n =25). Only two studies offer AI/AN as a category for ethnicity and both had less that 4% of the sample that identified as an AI/AN individual. Conclusion and Implications: Telehealth OUD treatment increased initiation and retention for patients taking buprenorphine. No increase in overdose rates was associated with allowing for additional take-home doses of methadone. However, access to treatment, even telehealth, remains difficult for individuals due to a lack of OUD treatment providers and access to the internet. More needs to be done to address the opioid overdose crisis, especially among AI/AN communities. Research focused on cultural strategies to address this health disparity is desperately needed. We included nursing implications in response to this health disparity among AI/AN individuals.

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18 June 2026
Emily Taylor
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Categories: Resource

Complementary Alternative Medicine: A Culturally Centered Approach to Managing Chronic Pain from One American Indian Community

Abstract: This evaluation explored the benefits of Complementary Alternative Medicine (CAM) within a reservation-based, State-certified outpatient treatment provider. The three CAM strategies provided were massage, acupuncture, and chiropractic therapies. The evaluation team worked with a peer recovery support specialist and tribal evaluation intern to co-create a one-page, eight-question, fixed-response instrument based on previous work in the community. Surveys were collected by the peer support specialist post-session with individuals receiving CAM therapies. Surveys assessed self-reported impacts, reasons for attending CAM sessions, and mental, physical, spiritual, and emotional health before and after CAM sessions. Paired t-tests were used to examine significant differences in mean scores before and after CAM sessions. A total of 40 participants completed the survey between March 2021 and March 2022. The evaluation found a significant increase in the mean scores for all measured self-reported health ratings: physical, spiritual, emotional, and mental. The greatest increase observed was for physical health (M = 5.32, SD = 2.53) and physical health after (M = 8.38, SD = 1.60) based on self-report data; t(78) = 6.46, p = .0001. CAM sessions positively influenced participants; 83% (n = 33) reported being more hopeful about their overall health and wellness. The holistic approach demonstrated promising results and potential benefits of CAM on overall wellness and belonging. Further research is needed to explore how CAM may be implemented as a culturally centered approach to managing chronic pain often associated with opioid use disorder.

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16 June 2026
Kase Cragg
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Categories: Resource

Racial, Ethnic, and Language-Based Inequities in Inpatient Opioid Prescribing by Diagnosis from Internal Medicine Services, a Retrospective Cohort Study

Introduction. Opioid administration is extremely common in the inpatient setting, yet we do not know how the administration of opioids varies across different medical conditions and patient characteristics on internal medicine services. Our goal was to assess racial, ethnic, and language-based inequities in opioid prescribing practices for patients admitted to internal medicine services. 
Methods. We conducted a retrospective cohort study of all adult patients admitted to internal medicine services from 2013 to 2021 and identified subcohorts of patients treated for the six most frequent primary hospital conditions (pneumonia, sepsis, cellulitis, gastrointestinal bleed, pyelonephritis/urinary tract infection, and respiratory disease) and three select conditions typically associated with pain (abdominal pain, acute back pain, and pancreatitis). We conducted a negative binomial regression analysis to determine how average administered daily opioids, measured as morphine milligram equivalents (MMEs), were associated with race, ethnicity, and language, while adjusting for additional patient demographics, hospitalization characteristics, medical comorbidities, prior opioid therapy, and substance use disorders.
 Results. The study cohort included 61,831 patient hospitalizations. In adjusted models, we found that patients with limited English proficiency received significantly fewer opioids (66 MMEs, 95% CI: 52, 80) compared to English-speaking patients (101 MMEs, 95% CI: 91, 111). Asian (59 MMEs, 95% CI: 51, 66), Latinx (89 MMEs, 95% CI: 79, 100), and multi-race/ethnicity patients (81 MMEs, 95% CI: 65, 97) received significantly fewer opioids compared to white patients (103 MMEs, 95% CI: 94, 112). American Indian/Alaska Native (227 MMEs, 95% CI: 110, 344) patients received significantly more opioids. Significant inequities were also identified across race, ethnicity, and language groups when analyses were conducted within the subcohorts. Most notably, Asian and Latinx patients received significantly fewer MMEs and American Indian/Alaska Native patients received significantly more MMEs compared to white patients for the top six most frequent conditions. Most patients from minority groups also received fewer MMEs compared to white patients for three select pain conditions. 
Discussion. There are notable inequities in opioid prescribing based on patient race, ethnicity, and language status for those admitted to inpatient internal medicine services across all conditions and in the subcohorts of the six most frequent hospital conditions and three pain-associated conditions. This represents an institutional and societal opportunity for quality improvement initiatives to promote equitable pain management.

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Community members and students may request access to this article by completing the form here.

Overdose Prevention Hub for Tribes and Native Communities

created by staff at Seven Directions: A Center for Indigenous Public Health

© All Rights Reserved Seven Directions
Website by TDG Agency

Who We Are

The initiative for establishing an online one-stop native overdose prevention resource hub came about as one component of the U.S. Centers for Disease Control’s Opioid Overdose Prevention in Tribes. Learn More

Acknowledging Urban and Rural Native Communities

The Native Overdose Resource Hub aims to provide culturally inclusive and tailored resources regarding Opioid Prevention for Indigenous communities, both urban and rural. Seven Directions recognizes the strengths and unique needs of Indigenous communities on both traditional lands and in urban areas. Learn More

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As Indigenous scholars and allies, one of our main priorities is privacy and data sovereignty for those who visit our website. All the information on the Overdose Hub can be viewed without revealing or sharing personal information. Learn More