Across the country, American Indian and Native Alaskan people die from unintentional drug poisoning at almost twice the rate of the overall population. In California, a new state program is hoping to solve that problem with a focus on addiction therapy.
The program is built around what substance-abuse experts call “medication assisted treatment.” This involves giving a patient a medication called buprenorphine to help suppress their desire for heroin and other dangerous drugs.
Here’s how it works: Buprenorphine provides a high, but it’s not as intense as morphine, methadone or heroin. Patients’ desires to abuse the drug become subdued.
But buprenorphine can also be addictive. So, drugmakers add in naloxone: an opiate antagonist that blocks the buprenorphine receptors and makes it less likely to be abused. Naloxone is also the drug used to stop overdoses in emergency situations. The two drugs combined are sold as Suboxone.
In 2017, California received $90 million in federal funding to reduce opiate addiction and overdose deaths. They’re using it on the California Medication Assisted Treatment Expansion Project, and the more targeted Tribal Medication Assisted Treatment Project. The latter aims to increase buprenorphine prescribing practices in tribal communities, while also expanding overdose prevention with naloxone. It also provides more therapy through telemedicine and training for more physicians to screen for and treat drug addiction.
Melissa Eidman with the California Consortium for Urban Indian Health said the high death rates have to do with both historic and modern traumas. “The experiences our parents, grandparents, and great grandparents have gone through are passed down,” she said.
She explained that modern traumas include the over-prescription of opioids in tribal communities and on reservations. Instead of addressing health issues.
“Many providers exacerbated the issues by prescribing large amounts of opioids. Our health care system has to take responsibility for that,” she said.
California is setting a good model for other states by investing funds in this issue, she said.
The state project also involves creating a youth and family services hub in Humboldt County, which will offer opioid treatment as well as suicide prevention services, intensive case management and other resources for American Indian youth and their families.
Dr. Laura Williams, a family physician and Juaneno/Acjachemen tribe member who practices in Southern California, says the interventions won’t be easy to phase in because many American Indians are wary of doctors.
“You have to understand the lack of trust in the system and the constant spinning around the merry-go-round of providers and the lack of time for the provider to talk,” she said.
Williams said doctors trying to wean patients off opioids should take the time to understand the pain that pushed them to substance abuse to begin with.
The new state project starts with a tribal-needs assessment, led by UCLA, to identify gaps in treatment and recovery services.