Responding to the Opioid Crisis
in Indian Country

Tribal communities are grappling with one of the worst-ever drug crises. Unprecedented numbers of people are dying from opioid-related overdoses, and some experts say the death toll may not peak for years. Meanwhile, users, their families, and the community at large are suffering from the consequences of opioid addiction. In this important class, we’ll look at how tribal communities can respond to the opioid crisis, and highlight best or emerging practices and community experiences. We’ll examine the epidemic from the perspectives of public health and policy, and look at integrated, community-based solutions.

T O P I C S   I N C L U D E
Background of the Crisis
  • Pre-Test: How Much Do You Know about the Opioid Epidemic?
  • Basic terms and concepts
  • Science of opioid addiction
  • History of opioid addiction in the U.S.
  • Addiction as a public health issue
  • History and outsize consequences of opioid addiction in Indian Country
  • Characteristics of opioid use disorder
  • Types of opioid medications and availability
  • Prevention and treatment options
  • Opioid response case studies:
    • Mashpee Wampanoag
    • Chickasaw Nation
    • Muckleshoot Tribe
Government-to-Government Relations
  • What is sovereignty?
  • Addressing public health issues while protecting your tribe's sovereignty
  • The Indian Self-Determination and Education Assistance Act, P.L. 93-638
  • Working with Indian Health Services:
    • Options for operating treatment centers or medical facilities
  • Funding opportunities and sources
Working with State and Local Governments
  • Guiding principles in tribal-state/local relations
  • Overcoming common barriers
  • Working together on shared interests
  • Sovereignty considerations
Resources for Addressing Addiction
  • Interventions and treatments
  • Prescription monitoring practices
  • Addressing prenatal exposure
  • Tribal law enforcement and public safety
  • Tribal action plans:
    • What is a tribal action plan?
    • Codification at 25 USC 2412
    • Steps in creating a plan
    • Case studies
  • SAHMSA's Strategic Prevention Framework (SPF):
    • Using the SPF to plan, implement and evaluate prevention practices and programs
    • Steps in the framework
    • Example: Comprehensive Opioid Abuse Site-Based Program
  • Sequential Intercept Model:
    • Overview
    • Using the model to identify service gaps
    • Exercise: Preparing a Funding Request
Legal Response to the Opioid Epidemic
  • Policy and litigation tools
  • Increased federal enforcement:
    • Measures and resources from the Department of Justice
    • Department of Interior Opioid Reduction Task Force
  • Compliance concerns:
    • Safeguards over controlled substances at IHS facilities
    • Case Study: OIG Audit of Passamaquoddy Tribe's Pleasant Point Health Center
  • Civil litigation:
    • Legal recourse from drug manufacturers, distributors and pharmacies
    • In Re: National Prescription Opiate Litigation, Case No. 17-md-02804 (N.D. Ohio)
    • Cherokee Nation v. McKesson, Case No. 18-cv-00056 (E.D. Oklahoma)
  • Criminal response:
    • Jurisdictional issues
Tribal Healing to Wellness Courts
  • As an innovative expression of sovereignty
  • Similarities and differences to drug courts
  • Culturally relevant treatment services
  • Group exercise: The Key Components of Tribal Healing to Wellness Courts

*Topics subject to change.

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