Judith At the same time, though, my two sons around here, it became really big for kids to use OxyContin recreationally. And we had a young generation of a lot of people who got very addicted. And unfortunately, my son Roger, who was 18 at the time, and my son Corey, who was 15 at the time, both started a long life of addiction at that point. It’s still a battle for them, like they went from OxyContin. And then once you couldn’t find that anymore, it went to heroin. Now you can’t find heroin anymore, it’s fentanyl. And I said, like fentanyl makes heroin look like a cakewalk at this point. The amount of loss and deaths that we have due to fentanyl are just 100 times more than what they were with heroin. So on that personal note, I mean, I pretty much have lost my one son is living in the coast homeless, but my other son is living in the Bay Area and he’s living homeless. And I worry about him all the time. And I’m just work every day talking to him, trying to get him into treatment, you know. But the fentanyl is so hard for people to come off of that he doesn’t believe he can do it.
[00:01:29] Narrator This is Countermeasures brought to you by Emergent. Join us as we explore the shifting complex world of the opioid crisis. In each episode, we’ll hear from makers of positive change as they recount personal narratives of loss and perseverance and offer a way forward to a better future. Native American and tribal communities have been some of the hardest hit by the opioid crisis. Historical trauma continues to have lasting effects in these communities. In today’s episode, we will uncover how the opioid crisis has affected Native American communities, but also the programs that are helping people reconnect with their culture and community to help combat this crisis.
[00:02:23] Nathan Billy But when we look at the impact of the opioid epidemic in our tribal communities, especially one piece that is an important piece of that impact, but it’s only one piece, and that’s the available data that we have. So, for example, when you see reports or read reports specifically from the Centers for Disease Control and Prevention or the CDC, you will often see that American Indians and Alaska Natives report some of the highest rates, if not the highest rates of impact from opioids, including opioid overdose in general, opioid overdose related deaths. Recently, especially in our communitiesm that’s been the impact of fentanyl. And that may be a combination of either intentional fentanyl seeking, or it could also be substances and frequently is substances that contain fentanyl or that are compromised with fentanyl. And the person who is using that substance is just unaware that a lethal dose of fentanyl is within that substance. And so we can see through those reports, oftentimes those high rates that are reported that stretch back a decade, and that can be very daunting. But what I think is important to note is so much of that deficit based reporting is just not contextualized. So you might see all of the charts and the graphs, and they’re helpful in one sense, but it’s all too easy. I think at this point to get what I would think of a statistical fatigue. So we sort of have, you know, how many times can you be inundated with charts and graphs when the impact of what is actually happening in our tribal communities, we lose that personal focus, the sense that these are our relatives, you know, behind all of those data points, behind those numbers and behind those those charts and graphs. Why have we reported the highest rates? Why do we see the highest rates in our communities? There are very specific reasons for that. And sometimes those reasons there’s either for lack of time or lack of space on the report. It’s just not really fleshed out. And it’s important that we be able to do that.
[00:04:15] Narrator Nathan Billy is a member of the Choctaw Nation of Oklahoma and is the director of Behavioral Health programs at the National Indian Health Board, or NIHB based in Washington, D.C.. His family members went through the boarding school system that many Native Americans were forced to endure beginning in the early 19th century. The goal of these schools was to assimilate Native American children by forcing them to speak English and keeping them away from their families, culture and religion.
[00:04:44] Nathan Billy I think it’s really important. It’s impossible, really, to separate the opioid epidemic and its impact on tribal communities from the foundations in historical trauma and the historical trauma in our American Indian Alaska Native communities. It’s very specific. It’s very unique to us. And when we look back and see that that historical trauma that stems from colonialism, aggressive imperialism, takeover of land, where we see land dispossession, forced relocation, we have a history, for example, of federal Indian boarding school policies where the federal government, in collaboration with religious institutions, sought to create and did create entire systems of programmatic effort to assimilate us, to erase our identities, to really destroy us. And I think it’s interesting that when we look at something like the opioid epidemic or what is the way out, how do we heal from this? A lot of times we hear about we’ll be strong and be resilient and there’s self-care. And, you know, I think a good response to that is how in the world do you self-care your way out of a system that was designed to erase you? That’s a burden that no one should have to bear, but it is a burden that we are asked to bear repeatedly. Work on yourself. Show yourself. Help yourself, you know, pull yourself up by your bootstraps. And that mentality, that rugged American individualism, that Western mentality is easy to say when you haven’t been forcibly relocated, when you haven’t had your land taken, when you haven’t had your children stolen from you and placed into an educational system that will not allow them to be native. And as we have seen very tragically with some of the recent reporting and ongoing reporting, as we investigate boarding school experiences, many of our children were never returned. They did not survive. They died. And that’s harsh to say that, it’s harsh to say that word, but how do you soften that? You know, this is a part where I think euphemisms are not necessary. Euphemisms don’t work. We need to to be able to safely and carefully say that together, that these are experiences of trauma that are well-established. My own grandfather, Albert, was a boarding school survivor, and he was sent to boarding school in Oklahoma where he was not allowed to speak Choctaw. He was not allowed to dress traditionally. The entire goal was for him to assimilate, for him to learn Western ways, for him to learn, to be able to dress a specific way, speak English, and ignore everything about his identity that was native.
[00:07:21] Narrator Charlene Bingham is a social worker from the Oneida Nation just outside of London, Ontario, Canada. Canada has a similar system of boarding schools called residential schools, where children often experienced abuse at the hands of the school leaders. The last residential school in Canada closed in 1996.
[00:07:41] Charlene Bingham Where I came from, because my mother was in residential school, I was in day school and so was my brothers. So residential school impacted our family by, one of them was the drinking. My mom, in order to forget to drink because the pain she saw and felt the drinking helped her forget that moment. She told me one time that she saw a little boy about seven years old, jumped from a two storey building because he couldn’t take it. When she was in there, she had to scrub the floors. She had to clean. For their meals, they had to eat maggots. Sometimes not even eat sometimes if they if they were being disciplined. It was a real hard thing for my mom to overcome.
[00:08:41] Narrator Generational trauma and mistrust in the medical system are some of the effects that this history has on communities. Nickolaus Lewis is a council member from Lummi Nation in Washington State. He is also the vice chair of the NIHB, the vice chair on tribunal self-governance, the recording secretary of the National Congress of American Indians and the chairman of the Northwest Portland area. He, like many others, believes that this history and the present are inextricably intertwined.
[00:09:11] Nickolaus Lewis You look at the whole history of this country, everything that this country has was on the backs, our ancestors and our tribe tribes across the country have tribute, they have agreements with federal government. And those are often broken still today. And when you look at our health care system, which is a treaty right. And you see how it’s chronically underfunded, helps fuel that distrust. Can you say that this is important, but then you don’t honor your commitments. But what we’ve seen is a lot of that distrust in using our people for studies, guinea pigs and things like that. Go back to the trauma when the government gave up blankets and smallpox and things like those. A lot of those things still a trickle down. You look at the boarding schools that and where our people were ripped away from their communities and beaten for speaking their language. There’s always been a level of distrust and we have to work harder at that and make sure that when we’re delivering our our health care, it is by us first and foremost. And that’s why I think it’s worked really is that culture on trying to let people know that we’re not here to cause harm or we’re trying to do the right thing. I hope by doing that over time, it’ll change the data that we see.
[00:10:38] Narrator Judith, whose voice you heard at the top of the episode, has firsthand experience with the devastating effects that the opioid epidemic and subsequent introduction of fentanyl has had on Native communities and families.
[00:10:51] Judith My husband had been a really hard working logger his whole life. He was a Yurok tribal member from the next reservation, and he had been a very hard working logger on the ground, driving three hours a day to work and back in, and he got an accident on the job and so he hurt his back and torso muscles in his back. And I remember at the time the doctors coming in because he couldn’t hardly walk and go to work. And they said, we have this new drug and it’s going to really help you. It’s long lasting and it’s not going to be addictive. And honestly, that was the beginning of the end. My husband, like most native people here, had had a lot of trauma in his life. He had grown up with a lot of trauma. What they started is maybe 120 milligram OxyContin went to 40 to 60 to 80 to 240 a day. And it just was a fast upward spiral of addiction. He was very discreet and I didn’t even know that. And then all of a sudden, you know, there was this harsh stop on the medication and all of a sudden people started realizing that these are drugs are addicting and they’re bad and they’re hurting people. So people weren’t weaned down. They were just cut off like, nope, you can’t have it anymore. And so they’re a large group of people, including my husband, went on to find other things. They were never going to handle that come down and not the cold turkey, I guess. There wasn’t much information or knowledge about (MAT) medication assisted treatment. So he quickly then at that point went on to heroin. And I actually did not know that for years until he got to more the end of his life. He handled it well and just very functioning. And that’s what a lot of people don’t understand, that people can be addicted but be very functioning. He helped take care of our grandkids. He was just like, you would never notice anything different. And then a few years ago, my oldest granddaughter, who me and my husband had raised a lot in along co-parenting with her mother, she started having a fentanyl issue, and she overdosed several times. We started looking for treatment for her. And for native kids to get into treatment, I mean, I don’t know about other kids, but here getting a child into treatment that young was almost impossible. It took like five months to find somewhere that would take her and she had to go five states away. And it was very traumatic. And we were cut off of her all of a sudden for months. And I’m happy to say that she is home now. She is in recovery. She’s clean. She’s happy. She’s now a thriving 15 year old. And so I’m grateful that she made it out of this mess at this point. And that’s just the personal people. That doesn’t count the money, the possessions, the you know, pretty much when you have people who are this into addiction, you’d basically lose everything and you lose people because people turn away from you also. You know, Judith must like it. She stays. Judith must like it. She doesn’t keep her kids out. Judith must, you know, there’s no support for the families. And that’s what I’m trying to build into my program that I run is support for families who are struggling with family members and addiction.
[00:15:00] Narrator Judith works at the K’ima:w Tribal Health Clinic and is also a writer. She has published a book called Reservation High that is informed by her experiences.
[00:15:10] Judith I didn’t really know where I was going with it, but I knew I wanted it to be from the person’s perspective who was struggling with addiction. I had a lot of friends who basically kind of turned away from me and would say things like, Well, I wish I was an addict so I didn’t have to work or be responsible or I wish I could take that easy way out. And I just thought, if you think that’s the easy way out, then you don’t know what you’re talking about because it’s the hardest life, right know. So I wanted to give people, I wanted them to like this character so that they could feel empathy. I wanted empathy. I wanted people to realize that nobody wants this. Nobody chooses this. And so that was my goal, to make these characters that people really would like, but then have her struggling. And a lot of people have gotten on to me because in there I do have a relapse. And they were like, How could you do that? That relapse is real. Let’s face it, people relapse. And so it is part of, you know, recovery. It happens. And all we can do is get up and move on forward. And so I wanted to show that that could be done and that it does happen to people. And it’s not some big mark against you because it happened. So while I was writing the book, I got about halfway through and my son Roger, who was struggling, and his significant other, Ethel, I had gotten to a writer’s block and basically I got about halfway through and I just didn’t know where I was going with it. And I was really frustrated. It had been sitting for like a month. I didn’t know how I was going to get it moved on where I was going, so I had set it aside and on March 21st I got the worst phone call of my life and it was that my son had been shot in the head, in the chest, along with two other men. And so we ran up to the scene. It’s about five miles from my house, and I pull up and nobody’s there. I just see my car he had used in a little trailer, little tiny travel trailer. And so I’m thinking maybe it’s a mistake, you know. And I run in and my son had was laying there with another man shot and we had to wait hour and 40 minutes for any kind of help. There was no ambulance. Everybody was staging. They were waiting for help to come from Eureka. I’m calling 911 every second, freaking out. In the end, my son was flown out to Redding and so we got in the car and we drove three hours to Redding and I took everything with me that I thought I would need. But the one thing I grabbed was my computer. Like, I wasn’t in my right mind. I grabbed clothes that didn’t even make sense together and stuff that, summer stuff, you know, just stuff that didn’t make sense. But the one thing I grabbed was my computer. And while we were at the hospital for the next week, I just kept working on the book because I felt like if I relaxed or slept or anything, that something was going to happen to my son. So I just didn’t sleep. And I stayed up and I kept working on the book and it just kind of took a life of its own. And so finally, my son is fine now. He did not have any debilitating things. You know, it was a hard trauma, wise and healing wise. It was a long couple months, but I just sulked myself into the book. And one month after he was shot, I had taken my mom to a doctor appointment in San Francisco. And while I was there, I got the next worst call of my life, and that was that. My only daughter and my youngest, my baby of my family had been stabbed three times by a DV incident. And at that point, I truly lost it. Like I cried for 18 hours straight trying to drive home from San Francisco. And I’m happy to say she, too, is all right. She didn’t die in that sense. But at that point I thought, I am going to finish this book if it’s the last thing I do. That just became my mission. That was April 28th, and I finished the book on June 25th. So whether I ever did anything with the book, I feel like it saved my life at a time when I needed something to sink myself into. So that’s what the book means to me. And I have had a few people read it and say that they went to recovery after they read it. They felt like it was something they could do. And they did go and they did stay. And so, you know, whether it was only one person in the world, I feel like it did its job at that point.
[00:20:27] Narrator All of the interviewees emphasized the importance of culturally centered treatment to combat the opioid crisis and help those seeking recovery.
[00:20:36] Nickolaus Lewis One of the things that we really do strive to do the best that we can, is making sure that our services go up to them, go out to the community. I think when you look in Western lens, we say come to the providers. In our lens and it goes back to the cultural component. We will take our services to the people. One example, we have a crisis outreach team that consists of people in our behavioral health department, that consists of people in our MAT program, but they will go up into, for example, homeless encampments where people are struggling and bring them medication or feed and just talk to them, let them know that they matter. We’re trying to encourage them to come into services where we’re putting that extra step in there and trying to get people connected. And I think that’s something that we have to do a lot more of is meeting people where they are seeing the struggles. When you’re you’re trying to talk to people that are struggling with addiction, you have to earn a lot of trust because they’ve had their doors shut from everybody in their life. And it’s a feeling of hopelessness is what it really feels like at times. And remembering that the root cause of this is trauma. And so having somebody come there that’s genuine with the best intentions. It takes time, but it really makes the most of the difference.
[00:22:11] Charlene Bingham My grandmother taught me some things to remember. She told me I’m an Indian first. She taught me my foundation, where I come from, who I am. And don’t forget it. So they use the medicines a lot in treatment. They bring in elders. Elders talk to them from their experience because they went through all the residential school peers and drinking, drugging and whatnot. So they walk with that person to get to a good place.
[00:22:51] Judith I noticed that when we got funding and we could actually start putting cultural classes, cultural identity stuff into our program, our success and the interest went way up. And so right now we’re working to bring up Hupa Language, and they are going to start working at the first of the year. But we do things like have cultural classes of basket weaving and carving for the men, beading, jewelry making. We’re going to do a mink hair tie, so if we can bring in the classes. And then we also, like, have people who do sweats and they go to different ceremonial things, but it builds in a resiliency. I think it’s right now the best gauge we have to keeping people from relapsing or to coming right back to it. In Hoopa, we weren’t like discovered, as they say, until the later 1850s, 1860. So we were here and didn’t have contact with non-Indians for a long time and a lot later than other tribes. So we have a lot of culture. But when people start becoming struggling with addiction, a lot of times they turn away from their culture. So we know that if we can bring them back and connect them, their success rates of staying abstinent goes way up.
[00:24:31] Nathan Billy We know in tribal communities that our culture is our strength. Just for example, in May of 2023, when we had our National Tribal Health Conference in Anchorage, Alaska, at the National Indian Health Board, our theme was culture heals, culture knows, culture leads. And that wasn’t chosen just because that has a beautiful ring to it, that all of that is absolutely true. Our culture is our strength. It is the path of healing. It is the center of our knowledge. It is the way to lead forward through healing. And I think what’s really important, we talk so much about risk factors. You know, what are the risk factors that we have in terms of opioid use that deficit based understanding of ourselves. But there are protective factors in our culture. There are protective factors of strength. There is so much to celebrate in that attempt to what was attempted to be taken away from us in some of these policies. There’s so much there that when we are allowed to or when we are encouraged or equipped to reclaim that, to revitalize that, to focus on that, that becomes our protection and that becomes a positive experience in the work that we do, for example, in HIV with adverse childhood experiences. One of the things we want to make clear is while it is so important, yes, absolutely, to talk about adversity and what those adverse experiences are. What about the protective experiences? What about the positive experiences that we can really encourage and what is positive within our tribes that keep us safe and that keep us healthy? That is what we need. And that is that is the the root of that healing. I think it’s important, since we talked about some of those experiences earlier, the federal Indian boarding school. My own tribe now operates a boarding school. But far from the boarding school of the past, which was externally operated with attempts to erase identity. We’re talking about identity, encouragement, cultural encouragement, where the school is purposefully engaging in youth stickball leagues. So for culturally specific stickball as a prevention effort to create that connection with youth so they can be a part of something that is culturally relevant to them, that is specific to our background and gives us that sense of reconnection with our communities. So what happened to us should never be confused with who we are. That is not our identity. That is something external that happened to us. It is not who we are. And yes, what has happened to us has resulted in some very real deficits. It has resulted in very real health disparities. It has resulted in some very specific concerns and issues and problems that we are having within this opioid epidemic. But the way through is that reconnection and that protection. So we talk about intergenerational trauma. Yes, there is intergenerational trauma, but there’s also intergenerational strength and intergenerational knowledge and brilliance. There are native ways of knowing that are the foundation for the help and the foundation for the healing. And so that’s where we see that that cultural reconnection being that way through that is the path for us.
[00:27:39] Narrator The NIHB is the voice of tribal communities at the national level. Currently, a priority is advocating to have the fentanyl crisis declared a national emergency.
[00:27:50] Nickolaus Lewis Coming out of the national trouble yet some that we had this past year, we did finalize a lot of our reports, our recommendations. There is some legislation that’s coming out from that. It’s not all health care. But I think when we talk about this in a crisis, we have to understand that it’s not just health care. We can’t treat our way out of this. You have to look at housing and look at jurisdiction, community safety, health care. It really touches on everything. And one of the best things that the federal government can do, and this is something we’re here working on, is highlighting these recommendations. These are things that we need. These are improvements I’m going to be working on advocating to have a national no opioid crisis in the country. I’m going to be meeting with the White House to talk about things like that. And those things, I think when we do those kind of things, it doesn’t just benefit tribal members, it benefits everybody. And I think that’s the beauty of our leadership that we have in Indian country is that when we’re doing this work, this benefits everybody. That would be a short answer. Is having the federal government really take the time to read our recommendations but themselves in our place? One thing I often asked people is how many funerals have you gone to this past year? And I really ask him to think about that. Because in our communities, it’s not uncommon to go to the funeral a week. And when you are seeing somebody that you grew up with, somebody that was a family member or close friend died from something like an overdose at a young age, that causes trauma, that is unfortunately normalizing what our people are experiencing. And that’s not who we are. We shouldn’t be going to more funerals than we do birthday parties. That’s our reality today and we’re working hard to change that or being that voice knocking on every door we can to talk to them and make sure that they hear us. It feel like what we’re doing, we’re really uniting Indian country, was the common voice on saying this is an emergency. You know, when you look at the data, our people are dying three times the rate of anybody else especially in our area. We’re going to funerals far more often than birthday parties. But even uniting Indian country in uniting everybody that has a story of grief here, it’s not going to be enough to get this country to shift. What we’re talking about is working with our governors for the states and getting them to also call us. We’re trying to unite people. It doesn’t matter if you’re Republican or Democrat or religious belief, this doesn’t know the color of your skin. Once it gets a hold of you, it’s going to devastate all of us. And what we’ve seen is working with everybody to try to amplify this in a work was our county council. They’re getting ready to declare emergency, not crisis. And also call in President Biden to declare a working with our governor who’s funded to tribal state summits now in Washington state, working with them, trying to get President Biden. So I’m just encouraged to try to reach out to others as well. Is this, this is for all of us, this word. And we can’t do it alone.
[00:31:39] Narrator Native American peoples and tribes are not a monolith, and each have their own unique culture, history and priorities. However, culturally centered care grounded in community, traditional healing and understanding are vital parts of reconciling with the past and finding a way forward. If you’d like to read Judith’s book or a recent piece in The New York Times or learn more about the NIHB in their recent report, please visit the links in the show notes. Thank you to all of today’s guests for sharing their stories and insights. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to address public health threats like the opioid crisis, visit EmergentBiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.