As the Opioid Crisis continues to devastate our country, Native Americans are one group in particular that are being hit the hardest. Native American populations are dying from drug overdose across the nation at disproportionate rates compared to whites. From the years 2013 to 2015, the fatality rate among American Indians(AI) and Alaskan Natives (AN) was 3x higher in comparison to the white population. This number continued to skyrocket and in 2016 it was estimated that “American Indians were almost six times more likely to die of a drug overdose than whites.” This alarming statistic continues to increase year by year and the reasons are somewhat unclear. American Indians make up a mere 1.5% of the population, so why is it that they are so heavily affected?
Throughout history, American Indians have endured an immense amount of trauma. This historical hardship and racial bias is still present today and has led to a lack of access to proper medical care. Researchers have found that there is a race rate disparity that disproportionately affects Native Americans and opioid use. Along with this, American Indian communities have a culture of sharing with loved ones. For most everyday things this can be helpful, but when prescription drugs are involved it becomes a toxic cycle of addiction. While individuals might believe they are helping their friends and family, they are actually putting them at risk to become dependent on drugs that are not even theirs. Ultimately, this cycle requires treatment to break and unfortunately there is limited access to treatment programs within Native American communities and even throughout the nation.
So why are overdoses and deaths increasing? The answer is simple: misuse. Prescription opioids are supplied through overprescribing, and subsequent overuse and abuse within Native American communities. Demand is increasingly high due to lack of access to medical care for pain management, relief for trauma, and subsequently the epidemic has been maintained due to high poverty levels and lack of funding for recovery programs. This problem of supply and demand where supply is exceedingly high, and demand is also quite high, leads to opioid abuse creating the epidemic we see in present day.
The most prevalent drugs at the backbone of this disaster are fentanyl and heroin. Heroin overdoses are extremely common due to the fact that users of this potent drug most likely misused another form of opioid first. In a study, Centers for Disease Control and Prevention (CDC) found that individuals using prescription painkillers are “40x more likely to be addicted to heroin.”
The most common ages for overdose deaths caused by opioids is between 25 to 44 years old. Non-medical use of opioids is not limited to these ages. It is also widespread among Native American youth. It has been found that the misuse of opioids is two to three more times likely to occur among Native American youth in comparison to other ethnic groups. The New Mexico Youth Risk and Resiliency Survey reported that “1 in 10 Native American high school students in New Mexico used a prescription pain medication without a doctor’s order in the past 30 days.” That is 11% of students misusing painkillers and another 2% reported currently using heroin. Not only are those numbers horrifyingly high, but they also might not be completely accurate due to misclassification.
While Native Americans are a minority, and make up a much smaller percentage of the population, they have a much higher death rates than whites or any other race according to the CDC.
As if the death rates are not disturbing enough, researchers have also found that death certificates were not corrected for misclassification of AI/AN race underestimating the mortality rates among AI/AN by about 40%. For example, the uncorrected data showed 28.7 drug-overdose deaths in Washington. The corrected number was 40.9. In contrast, the uncorrected number for whites was 15.7, vs 15.1.
As the epidemic continues to spread, individual tribes have even declared the opioid crisis a public health emergency. White Earth Nation says that 28% of Minnesota babies born addicted to opiates are Native American even though Native Americans account for just 2% of the state’s population.
While over 60 federally recognized tribes have filed lawsuits to join the multi-district litigation (MDL), there are many tribes that have not, and have either filed lawsuits in their own states or are supporting tribes from the sidelines. Over 448 federally recognized tribes signed an amici brief in support of the tribes that have chosen to join the MDL. The tribes have been given their own track, and have their own bellwether cases as well.
So how did this epidemic begin, and how did it become the large-scale crisis that has swept throughout Native American communities? Some tribes believe it began simply by listening to their doctors.
Dr. Michael Toedt, chief medical officer for the Indian Health Service has said that deaths increased more than 500 percent between 1999 and 2015, the largest increase when compared to other ethnic groups. “Each and every family I speak to has a personal story about a family member that has become addicted,” she said.
U.S. District Judge Dan Polster said, “the tribes are an important part of this litigation. They have been, I think, disproportionately affected by the opioid epidemic and I’ve made very clear if there is a resolution there won’t be one without them.”
Polster has created a separate litigation and settlement track for Native Americans named the Tribal Track. Bellwether cases include Muscogee (Creek) Nation and the Blackfeet Tribe of the Blackfeet Indian Reservation.