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September 21 is National Opioid Awareness Day

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

National Opioid Awareness Day on September 21 aims to increase awareness about the opioid crisis and bring focus to overdose prevention strategies. It is also a time of reflection and remembrance for the lives lost due to an opioid overdose.

Opioids are a class of drugs used to manage and reduce pain. Whether occurring from nature or synthetic, opioids can become highly addictive and lead to misuse which can then progress to a chronic disease, also known as an opioid use disorder.

Opioids can be highly addictive because of the how they impact the brain. Not only do they reduce or eliminate pain, but they also create feelings of euphoria or an overall sense of well-being. The stronger the desire to experience this, the likelihood of misuse increases. Opioid misuse can include taking more than your prescribed medication dosage and/or taking it more often to achieve an altered state of consciousness, also referred to as a high. Misuse can produce adverse physical reactions, such as confusion, constipation, dilated pupils, drowsiness, nausea, and restlessness. Furthermore, opioid misuse can increase feelings of agitation, anxiety, depression, and paranoia. Behavioral implications of misuse can include requesting refills of medication before they are available, reporting medication as lost or stolen with the goal of obtaining more, losing interest in activities normally enjoyed previously, and isolation from friends and family. When someone stops using opioids, they may experience unmanageable withdrawal symptoms, making it harder to refrain from taking opioids. It is highly recommended for anyone experiencing these conditions to seek medical help and further treatment.

How the Indian Health Service is Combating the Opioid Crisis:

The Indian Health Service Opioid Strategy supports holistic, patient-centered care that incorporates the physical, emotional and spiritual needs of each individual patient. A strong patient-provider relationship that respects American Indian and Alaska Native cultures and traditions through shared-decision making is an important component in developing a treatment plan. The IHS aims to reduce stigma while promoting culturally-sensitive, appropriate, and effective best practices related to opioid stewardship and substance use disorders, including evidence-based treatment, recovery support, primary prevention, and other harm reduction strategies.

Innovative Approaches to Address the Opioid Crisis in Tribal Communities

In 2021, the IHS funded a pilot project called the Community Opioid Intervention Pilot Program that provided funding to 35 rural and urban tribes across the United States to address the opioid crisis in their local tribal and urban Indian communities, aiming to reduce opioid overdose-related deaths through the use of Medication Assisted Treatment (MAT) and Medications for Opioid Use Disorder. More information about the COIPP grant and the many accomplishments highlighted in the year one report can be found here.

The agency is also committed to increasing and assuring access to MAT for patients with opioid use disorder. The IHS strategy focuses on creating community and clinical resources and technical assistance to share best and promising practices.

The IHS has created and released a comprehensive Opioid Stewardship workbook to assist sites with creating best practices surrounding safe opioid prescribing and increasing access to integrative pain treatments. The workbook emphasizes utilizing opioid surveillance strategies to evaluate population health outcomes, target opioid interventions, enhance clinical decision support, and create professional practice evaluation strategies.

To facilitate IHS, tribal, and urban clinician access to free substance use disorder tele-consultation services, the IHS has partnered with the Northwest Portland Area Indian Health Board and the Clinician Consultation Center. These services are intended to assist clinicians with patient treatment planning, facilitate didactic learning, and provide support for health systems that desire to create local protocols.

The IHS has also expanded access to harm reduction interventions that include increased access to the opioid overdose reversal medication, naloxone. In 2015, the IHS signed a memorandum of agreement with the Bureau of Indian Affairs, allowing the IHS to provide BIA law enforcement officers with training and naloxone rescue kits for responding to incidents of opioid overdose.

Harm Reduction Approach for Opioid Use

Harm reduction is an evidence-based approach engaging with individuals who use drugs, equipping them with life-saving tools and information to create positive change and potentially save their lives. Harm reduction strategies, other than naloxone for opioid overdose prevention, include:

  • Fentanyl test strips are used to test illicit drugs for fentanyl and alert people who use drugs that the presences of fentanyl is detected and precautions should be taken.
  • Xylazine test strips are test strips used to test illicit drugs for xylazine contamination and alert people who use drugs that the presences of xylazine is detected and precautions should be taken.
  • Medication lock boxes are secured containers to limit accessibility for only the prescription holder and are meant to reduce or prevent misuse or overdose from others.
  • Drug deactivation and disposal bags are used to permanently destroy and dispose unused or left-over prescription medication to reduce potential harm.

Harm reduction is an important strategy to save lives. Individuals who use drugs may be afraid to contact 911 or seek medical attention due to fear of criminalization. The Good Samaritan Law protects those that render aid – and each state may have slight variations to the law – therefore, it is important to educate yourself as well as the community at large about this law.

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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 headquarters in Rockville, Maryland. 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.