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] 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 .
ALERT: Rainbow Fentanyl
In recent months, brightly colored fentanyl tablets, powder, and blocks that look like candy or sidewalk chalk have been trending nationally. Recently, the Drug Enforcement Administration advised the public about these products, known as rainbow fentanyl [PDF - 732 KB]. Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine. Due to potency, very small amounts of fentanyl can damage the brain and lead to overdoses or death. Rainbow fentanyl can be mistaken for candy and be attractive to children, so it is important to educate kids that something that looks like candy may be harmful.
Naloxone saves lives by reversing opioid overdose. It is quick and easy to administer, with trainings available across the country. Communities, parents, and teachers working with youth should consider educating on the dangers of rainbow fentanyl and seek naloxone training to prevent overdose deaths. To complete training online, visit our IHS Naloxone Toolkit.
Plans of Safe Care Toolkit
Clinicians can impact and improve outcomes for American Indian and Alaska Native pregnant and parenting people experiencing substance use disorders. To assist these efforts, the Northwest Portland Area Indian Health Board (NPAIHB), alongside clinicians and individuals in recovery, developed a Plans of Safe Care Toolkit.
The toolkit includes a comprehensive guide for clinicians [PDF - 8.9 MB], handouts for pregnant and parenting people and their supports, and posts to share on social media. It is designed to help clinicians care for pregnant and parenting people and their infants impacted by substance use disorders, support pregnant and parenting people transition into and remain in active recovery, and assist affected partners and families in growing stronger.
Watch the Plans of Safe Care video
Partnership to Advance Tribal Health (PATH) Learning Circle
Re-visiting Screening Strategies in a New Era of Evidence-based Treatment for Substance Use Disorder (SUD) on-demand video
This in-depth discussion on Screening, Brief Intervention, and Referral to Treatment (SBIRT) will illustrate best practices and practice improvement in SUD screening, examine practices for treatment referral or treatment initiation for patients screening positive for opioid use disorder (OUD), and discussion to support SBIRT implementation strategies.
Continuing Education (CE) Credit: To receive CE credit, you must watch the complete video and complete the evaluation
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 [PDF - 101 KB]
NOTICE
Appropriately prescribing opioid medications and managing chronic pain are critically important within the Indian Health Service. In February 2018, the IHS released the revised agency policy on Chronic Pain Management.
The information available on this site is intended for licensed health care professionals and adult patients. However, this site is not a substitute for clinical judgment and does not offer medical advice. Patients should consult their physicians or, in serious cases, contact emergency services. Health care professionals should confirm information available on this site with other sources.
Use of this site is at the user’s risk, and information is provided on an “as is” basis. There is no warranty or guarantee for the information provided on this site.
