Embracing Change: Using Native Ways of Knowing to Combat the Opioid Crisis

By Meg Schneider, TOR Program Coordinator, National American Indian & Alaska Native ATTC 

Provisional data from the Centers for Disease Control and Prevention in 2022 showed a 39 percent increase in drug overdose deaths for Native people from 2019 to 2020. Only Black people had a higher increase (44 percent). Drug overdose deaths hit a record in 2021, with almost 108,000 deaths recorded. In late 2021, the CDC also reported that, although the overall suicide rate in the U.S. declined during the height of the COVID-19 pandemic, suicide deaths for young adult males and people of color increased – possibly (at least in part) because people of color were more likely to lose their jobs and have poorer access to both primary and mental health services.

Overdose Deaths Involving Opioids Among American Indians and Alaska Natives, U.S. 2010-2020

Source: https://www.cdc.gov.injury/budget/opioidoverdosepolicy/TribalCommunities.html

In late 2018, the National American Indian and Alaska Native Addiction Technology Transfer Center (AI/AN ATTC) received additional funding from the Substance Abuse Mental Health Services Administration (SAMHSA) to provide technical assistance for its Tribal Opioid Response (TOR) program. TOR grantees are tribal entities serving their own communities; consortia serving several tribal populations in their geographic area; and Urban Indian Organizations (UIOs) serving Native people who live away from their tribal homelands. The TOR program recognizes that AI/AN communities are disproportionately affected by Opioid Use Disorders (OUDs), drug overdose deaths, and barriers to treatment and recovery services. d It strives to assist grantees in developing and implementing culturally appropriate strategies for addressing these issues.

One of our primary goals with our TOR involvement was to leverage the knowledge, experiences, and expertise of Native communities so we could facilitate workforce development and innovations among the grantees. In 2019, we began hosting regional meetings so grantees could gather in person to share with and learn from each other.

In early 2020, the COVID-19 pandemic closed virtually all traditionally Native avenues for sharing, learning, and supporting each other. In-person gatherings for ceremonies and socializing suddenly posed unprecedented dangers for AI/AN communities, which – as with OUDs and overdose deaths – suffered disproportionate infection and mortality rates from COVID-19.

Like everyone else, we were taken off guard by the suddenness and severity of the pandemic and had to pivot quickly to continue supporting TOR grantees. 

From early 2020, all our TOR events were virtual, and we added a monthly Care & Share session to help grantees connect, share ideas, and support each other as they face their own challenges with the pandemic — which, in many cases, worsened the opioid crisis and sparked higher incidences of suicide and mental health issues.

From the beginning, we felt that virtual events were a poor (but necessary) substitute for in-person gatherings. But we learned that online trainings and meetings also had unintended benefits. Grantees did not have to budget time or money for travel; they were able to connect with other grantees outside their own geographic areas; links to additional resources were immediately available via the chat box.

Just as important, we witnessed the incredible strength, resilience, and creativity of Native communities in addressing OUDs. We highlighted some examples in our award-winning publication, TOR Grantee Success Stories: Prevention, Treatment, and Recovery Innovations in Native American Communities. We are compiling a second volume to be published in the coming weeks to celebrate more of the successes grantees have seen in their programs by incorporating their culture and traditions. We also developed the TOR Resource Guide as a token of our appreciation for the critical services these grantees provide for their communities.

Our role as a technical assistance center for TOR grantees ended in September with the expiration of our supplemental funding. However, we are continuing and expanding the Care & Share monthly sessions under the National AI/AN ATTC. These 90-minute sessions take place on the third Wednesday of the month and are guided discussions for participants to offer peer-to-peer support and share their expertise and unique tribal and community practices. Care & Share is now open to all professionals working in addiction prevention, treatment, and recovery in Native communities.

It has been an honor and a privilege to be a part of the TOR grantees’ journey, and we look forward to continuing and strengthening the relationships forged in our common purpose.

About the author:

Meg Schneider is the communications manager for the Native Center for Behavioral Health at the University of Iowa and served as coordinator for the TOR Technical Assistance program during 2022. She has 25 years’ experience in a variety of communications and training functions, including more than a decade working with American Indian communities in the Eastern U.S.

Embracing Change: Providing Program Specific Harm Reduction Technical Assistance

By Lisa Carter and Jill Eriksen, Mid-America ATTC and Katie Burk, Facente Consulting

SAMHSA defines Harm Reduction as “a comprehensive approach to addressing substance use disorders through prevention, treatment, and recovery where individuals who use substances set their own goals. Harm reduction organizations incorporate a spectrum of strategies that meet people “where they are” on their own terms and may serve as a pathway to additional prevention, treatment, and recovery services.” 

SAMHSA is increasingly encouraging the integration of harm reduction philosophy and programming in drug treatment and prevention programs. In response, the Mid-America ATTC partnered with Katie Burk, MPH, a managing consultant from Facente Consulting, to launch a harm reduction consultation pilot program in early 2022.  

“It was really gratifying to support the agencies around their processes of reflection and inventory around their own policies,” Burk said. “It is not easy to take a critical look at your practice, but the agencies really leaned into thinking about where they could adjust and evolve to more meaningfully incorporate a harm reduction framework in their engagement with clients.”

The goal of this program was to act as a harm reduction resource to empower individuals and organizations that wish to educate, implement, or improve evidence-based practices within their systems to reduce stigma and promote the safety and well-being of people who use drugs. Mid-America ATTC distributed applications to organizations in Iowa, Kansas, Missouri, and Nebraska.  Applicants answered a brief questionnaire assessing their organization’s understanding of harm-reduction principles, current practices, and what level of technical assistance they wished to receive. 

The Harm Reduction Team was able to support four agencies, three of which were drug treatment and mental health organizations, and one local Health Department. The agencies were located in Iowa, Missouri, and Nebraska. The team developed a harm reduction assessment tool that they used in their initial meeting with each applicant. The Harm Reduction team worked cooperatively with each agency to develop a technical assistance plan and identify appropriate technical support.  The team provided harm reduction support utilizing a variety of formats, including: 

  • Conducted Harm Reduction: 101 basic training for staff and key partners
  • Facilitated conversations with management and discussed harm reduction value alignment within the organization
  • Reviewed current organizational policies and procedures and proposed areas of improvement to reflect evidence-based harm reduction principles. 
  • Provided technical assistance around integrating peer support services into more comprehensive recovery programming
  • Developed train-the-trainer materials for harm-reduction activities
  • Created tailored flyers, resources, and tip sheets per organization.   
  • Provided national resources that provide harm-reduction training to peer support workers, community awareness campaigns, and naloxone distribution 

Jill Eriksen, a senior project manager from the Mid-America ATTC worked closely on the project. 

“Harm Reduction takes a compassionate approach to people that have substance use disorders.  Agencies understand the importance of shifting the paradigm to engage their clients in meaningful change that empowers the individual to take an active role in seeking and committing to long-term recovery,” she said. “This pilot program was a great opportunity to listen to agencies and tailor their training needs to help them advance their treatment services. Overall, the pilot program was successful, and we received positive feedback from all four agencies.” 

The Mid- America ATTC also simultaneously launched a smaller initiative to offer stigma training and naloxone kits to agencies.  Two hundred safety kits were assembled that contained naloxone nasal spray, a Deterra disposal pack, fentanyl testing strips, and instructional materials in both Spanish and English. The kits were distributed to local agencies, along with naloxone and stigma reduction training.  

Harm reduction kit compiled by Mid-America ATTC.

“A major misconception with harm reduction is that we are enabling people with substance use disorders to continue to use,” Eriksen said. “The truth is that harm reduction is a tool to create a relationship with the client that provides trust and an opportunity to encourage recovery.  Recovery often is a process, and harm reduction practices can serve as a valuable bridge to assist a client in safely moving from actively using to making a personal decision to choose sobriety.” 

About the contributors:

Lisa Carter, MS, LPC, LCAC, is the co-director of the Mid-America ATTC and has over 25 years of experience as a licensed clinical addiction counselor.  Before coming to Mid-America ATTC, she directed numerous substance use disorder treatment programs across the continuum of care. Lisa has provided training and consultation to professionals and related organizations in the field in the Midwest. She serves on the Addiction Counselor Advisory Committee of the Kansas Behavioral Sciences Regulatory Board. 

Jill Eriksen, MBA, is a Senior Project Manager, in the Collaborative to Advance Health Services at the University of Missouri-Kansas City. She has over 15 years of public health experience as a Director of Community Health, working on a variety of topics such as communicable disease surveillance and reporting, harm reduction, emergency management and public health strategic planning grant writing.

Katie Burk, MPH, has over 20 years of experience in program development and capacity building with an emphasis on the health and wellness of people who use drugs. Katie is currently a managing consultant at Facente Consulting, where she leads various projects assessing and evaluating harm reduction programs. Previously she served as the Viral Hepatitis Coordinator at the San Francisco Department of Public Health, where she developed a portfolio of Hepatitis C services for people who use drugs and co-founded End Hep C SF, the first citywide Hepatitis C elimination initiative in the United States.