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Addressing the Opioid Epidemic in Indian Country through IHS Grants

by Cassandra Allen, Public Health Advisor, Community Opioid Intervention Pilot Project, Indian Health Service

The Community Opioid Intervention Pilot Project is a pilot grant project established by the Consolidated Appropriations Act of 2019. In Fiscal Year 2019, the IHS received a new appropriation of $10 million to combat the opioid epidemic in Indian Country. The IHS created a pilot project and issued grants to support the development, documentation, and sharing of locally designed and culturally appropriate prevention, treatment, recovery, and aftercare services for opioid misuse and opioid use disorders in American Indian and Alaska Native communities. Under this funding opportunity, grantees address the following objectives:

  • Increase public awareness and education about culturally appropriate and family-centered opioid prevention, treatment, and recovery practices and programs.
  • Create comprehensive support teams to strengthen and empower Native families in addressing the opioid crisis in tribal or urban Indian communities.
  • Reduce unmet treatment needs and opioid overdose-related deaths through the use of medication-assisted treatment.

In FY 2021, the IHS awarded 35 grantees representing tribal communities in rural and urban areas across the country. Since then, the COIPP grantees implemented various programs and services that include integrating cultural approaches, evidence-based, practice-based, promising practices, best practices, and experiential therapies into grant programming. The COIPP Year 1 Annual Progress Report, covering April 1, 2022, to March 31, 2023, reported the following key findings:

  • There were more than 23,000 individuals that participated in community education and awareness activities that included understanding the signs of an opioid overdose, how to administer naloxone, proper disposal of controlled prescription medications, safeguarding controlled prescription medications, and accessing local opioid-specific services.
  • The greatest number of participants were aged 25-54 years old.
  • 484 individuals self-reported as homeless.
  • 16 grantees established and partnered with local youth and elder advisory councils.
  • 12 grantees established crisis response teams.

The COIPP grantees hosted various community events and training sessions on drug concealment trends, awareness and de-stigmatization of substance use disorder, drug takeback, fentanyl education, historical trauma, and more. Because these grants were awarded during the COVID-19 pandemic, grantees had to be innovative in how to reach the public. The Choctaw Nation of Oklahoma initiated drive-thru naloxone distribution events at local clinics, housing authorities, community centers, and rural areas where commuting could be a struggle for those in need.

Cultural awareness and integration of tribal knowledge and practices is a protective factor. Grantees incorporated activities and programs such as drumming, beadwork, moccasin making, sweat lodge ceremonies, Wellbriety, spearing, plant gathering, and more. The Oneida Nation of Wisconsin included the “Longhouse Ceremony Etiquette,” which embraces cultural knowledge and encourages participation. Another cultural program provided by the Alaska Native Tribal Health Consortium, “the Alaska Blanket Exercise,” provides a participatory history lesson in collaboration with Alaska Native elders, knowledge keepers, and educators that fosters truth, understanding, respect, and reconciliation among Indigenous and non-Indigenous peoples. The objectives of the exercise are to learn the history of Alaska, the impact of historical trauma, and how to break the cycle of intergenerational trauma.

Through collaborative efforts in building local capacity to mitigate opioid-related risks, the COIPP grant project has positively impacted tribal communities by increasing knowledge about the dangers of opioids and harm reduction activities, creating crisis and support teams, and increasing access to treatment for opioid use disorder. Visit the COIPP website for more information.

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Cassandra Allen, Public Health Advisor, Community Opioid Intervention Pilot Project, Indian Health Service

Cassandra Allen, an enrolled member of the Navajo Nation, is a public health advisor for the Indian Health Service. Allen is responsible for providing programmatic and technical assistance in the administration of IHS opioid initiatives, specifically the Community Opioid Intervention Pilot Project, within the Office of Clinical and Preventive Services, Division of Behavioral Health. Prior to her current position, she served as the supervisory health promotion coordinator for the Chinle Service Unit in the IHS Navajo Area. Allen brings a wealth of knowledge and experience in health care administration, partnership development, and advocacy for American Indian and Alaska Native communities.