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Opioid Stewardship in the Indian Health Service


The Indian Health Service (IHS) supports safe and effective therapies to help patients and providers best manage pain and opioid use disorder. The IHS Opioid Strategy aims to improve perceptions and beliefs associated with substance use by promoting an appropriate, sensitive, and sympathetic message among health systems and the communities we serve. We are working to eliminate stigma and encourage positive patient outcomes through appropriate and effective pain management, reducing overdose deaths from heroin and prescription opioid misuse, and improving access to culturally appropriate treatment. The IHS actively coordinates, collaborates, and participates in listening sessions, formal consultations, and community roundtables to ensure HOPE Committee work is aligned with the President's National Drug Control Policy Priorities [PDF - 334 KB] Exit Disclaimer: You Are Leaving  and relevant to tribal communities.

Treatment and recovery support services help people with substance use disorders manage their conditions successfully. Download and customize the recovery card for IHS, tribal, and urban health facilities to use to connect people to resources in your community.

Watch a video to learn more about how IHS is Preventing and Treating Opioid Addiction in Tribal Communities Exit Disclaimer: You Are Leaving .

What Is Chronic Pain?

Chronic pain is defined as persistent pain, which can be either continuous or recurrent and of sufficient duration and intensity to adversely affect a patient's well-being, level of function, and quality of life. Chronic pain is persistent, typically 3 months or more, and exists beyond an expected time for healing. The cause of pain may not be removable or otherwise treated. It may occur despite generally accepted medical treatment. The IHS Indian Health Manual Chapter 30 Update: Chronic Non-Cancer Pain Management is available for additional guidance.

What Are Opioids?

Opioids are illicit drugs, such as heroin, as well as some prescription medications used to treat pain. Examples of prescription opioids include: morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, hydromorphone, and buprenorphine. Opioids work by binding to specific receptors in the brain, spinal cord, and gastrointestinal tract. In doing so, they minimize the body’s "reward centers" in the brain which can also trigger other systems of the body, such as those responsible for regulating mood, breathing, and blood pressure.

A variety of effects can occur after a person takes opioids, ranging from pleasure to nausea, vomiting, severe allergic reactions (anaphylaxis), and overdose, in which breathing and heartbeat slow or even stop.

Throughout the site, we refer to opioids, which are natural or synthetic derivatives of opium that act on the central nervous system to relieve pain. The term "opioid" is used to distinguish pain medications from illegal narcotics used to induce euphoria.

What is Dependence?

Dependence refers to the normal adaptive state that results in withdrawal symptoms if a medication is abruptly stopped or decreased.

What is Opioid Use Disorder?

The DSM-5 defines opioid use disorder as a problematic pattern of opioid use leading to clinically significant impairment or distress, as manifested by at least two out of 11 criteria within a 12-month period.

Opioid Use Disorder DSM V Diagnostic Criteria Exit Disclaimer: You Are Leaving [PDF - 101 KB]