The White Earth Reservation has been hard hit by the opioid epidemic, but the Ojibwe band north of Detroit Lakes has not taken the problem lying down, and in some ways has taken a leading role in fighting addiction.
"From rescue to long-term sobriety support, White Earth offers some of the best, most evidence-based, most effective, cutting-edge, and compassionate care in the multi-state region," said Carson Gardner, a doctor with the White Earth Tribal Health Department. "Many of our programs are considered model pilot programs by state agency leaders. White Earth was recently invited to the National Senate Indian Affairs Committee to talk about what we've done around opioid treatment. One of the most important things that can happen is to stop being paternalistic and thinking tribes don't have the capacity or ability to do it best."
White Earth Tribal Police officers began carrying naloxone (Narcan) over two years ago to save people who overdose on narcotics.
And while the White Earth Reservation Ambulance Service and Shooting Star Casino First Responder unit have responded to many opioid overdose calls requiring a naloxone rescue attempt, the tribe has also trained hundreds of non-professional people to use the life-saving injection.
"We realize that there are more overdoses than just the ones to which the ambulance or first responder unit are called," said Dr. Gardner, "and estimate there are three to four times more Naloxone rescues by family members - we've become proactive and trained over 1,000 people locally to use Naloxone."
A drug emergency
The opioid problem is nothing new in White Earth, Dr. Gardner said. "Since our White Earth Tribal Council's drug abuse emergency declaration in about 2011, all our tribal recovery services have increased in availability and effectiveness."
White Earth has been working with the state health department in opioid abuse healing efforts, and the reservation has continually added tools to its kit to help addicts and those affected by them.
There is a tribal civil commitment process for those who are killing themselves with drugs but won't seek help on their own.
There will soon be an "Adult Healing to Wellness" Drug Court available through Mahnomen County District Court and White Earth Tribal Court.
Local hospital administrators have been approached about a pilot program to offer emergency-room-based Suboxone-bridging, which basically means starting treatment for addiction right away in the emergency room.
In one study, that approach (using opioid withdrawal medication, a 10-minute counseling session, and a referral) doubled - to 75 percent - the number of patients in treatment 30 days later.
Most of the 329 people in that Yale Medical School study were interested in treatment but couldn't find the help they needed.
White Earth is attacking that problem of timely treatment on many fronts: It continues to expand its intensive outpatient drug treatment programs. The Behavioral Health Division is developing an on-reservation residential detoxification unit that will be linked to an on-site recovery program, as well as sobriety support services. The recovery program will take a multidisciplinary approach, because drug or alcohol addiction often coexists with mental health and other medical needs.
The point is to get people the help they need, when they are most receptive to it.
"Our Tribal Behavioral Health, Public Health, and Harm Reduction Coalition teams have approached local hospital administration about implementing a point-of-crisis recovery coach response - 24/7/365 - to immediately connect with overdose survivors ... and assist with timely connection to treatment," Dr. Gardner said.
Like Narcotics Anonymous, the tribe doesn't believe in shooting its wounded. For those who are still using drugs, White Earth's Harm Reduction Coalition team provides one-on-one help, such as sexually-transmitted-disease testing, and prevention education.
The tribe's "harm reduction" efforts aim to reduce the damage done by psychoactive drugs to people unable or unwilling to stop. The focus is on preventing harm, rather than on the prevention of drug use itself. The White Earth program, for instance, has reduced blood-borne infectious diseases such as Hepatitis C, Dr. Gardner said.
White Earth will also reach out to people leaving prisons and jails, aiming to provide support before they are released and after they come home.
On the law enforcement front, the White Earth Police Department, White Earth Harm Reduction Coalition team, and White Earth Boys and Girls Clubs now provide safe and fun activities for young people on evenings and weekends.
The Tribal Council has enacted laws to make the community safer, make tribal housing safer, protect elders, require responsible restitution, and offer better access to sobriety-support services.
"Our tribal citizens, on their own," Dr. Gardner said, "have formed a community anti-drug-dealing group that has conducted protest marches against drug dealing." The anti-drug group teaches people how to use naloxone to save lives, and pushes for community solutions to drug abuse issues.
White Earth has applied for a four-year federal grant to hire a new community service officer in the tribal police department.
And, thanks to the White Earth Cultural Division, spiritual and cultural support interventions are now part of the tribe's substance abuse and mental health treatment programs for all ages.
The cultural division offers healing traditional Anishinaabe ceremonies for all tribal employees and others who wish to participate. Many ceremonies are held during work hours, so tribal employees can attend on paid time to address their own secondary trauma, Dr. Gardner said.
A spiritual approach
So how are the needs of tribal communities in Minnesota different from non-native communities? "Native Americans in Minnesota have overdose rates five times that of whites," Dr. Gardner said. "Our people have been in and out of external (non-native) treatment programs unsuccessfully. By operating our own treatment programs we can base curriculum, activities, and way of life on our culture."
Culture is everything, he added. When treatment programs for Native American people are based on their culture, "you are then getting to the heart of healing. Substance abuse and mental health counseling is treating symptoms, but providing culturally-based ceremonies and activities is healing - and that is where we see the old 'using' spirit leaving people, and the good healthy spirit returning in people..."
Tribes face unique challenges, he added: They are dealing with multi-generational historical trauma, including loss of land and independence. They are struggling to preserve historical language, culture, and spirituality. They have to cope with too many untimely deaths, health disparities, and child welfare system disparities, as well as court system sentencing and incarceration disparities, Dr. Gardner said.
The treatment success rate for natives goes up when non-native staff become culturally competent, he added.
That means recognizing that the Anishinaabe way of life is a good way of life and learning about what that means, he said.
"Learn the stories, learn about ceremonies. Recognize that the addiction spirit in people is not the Anishinaabe way," he said. "Respecting that, honoring it, promoting it."