Opiate Use Disorder in American Indian Populations

Opiate Use Disorder

The prevalence in Indian country is uncertain as data is sketchy at best and most citations use the data from the general population as surrogate marker. The data we have suggests that the number of recent non-medical use of prescription drugs by American Indians (AI) ages greater than 12 in the last 30 days and the number of American Indians seeking treatment at state supported facilities is greater than that of the general population by up to 65%.

Culture is prevention.-Use of culturally based treatment curriculums is emerging as a best practice with early studies consisting of observational studies that show a positive effect at 12 months. The spiritual transformation that is a major part of drug dependence recovery is well facilitated by a treatment curriculum that borrows from AI culturally-based beliefs and practices. Examples of such culturally based treatment initiatives include traditional sweat ceremonies, pipe ceremonies, prayer songs, social dance and adult- naming ceremonies.

Research is needed to properly measure the extent of the disorder in Indian country and to establish whether current treatment paradigms are applicable in Indian Country e.g., medication- assisted treatment, psycho-social treatment, abstinence- based treatment and incentive- based treatment. The Southern Plains Tribal Health Board and the Association of American Indian Physicians in conjunction with tribes possess the required expertise to conduct or oversee such research efforts. As new funding is appropriated by the US Congress targeting the “opiate epidemic”, those funds should be directed to such entities and not solely to state and federal agencies .

The deployment of nasal naltrexone in Indian country is lagging and technical assistance in the procurement and deployment of this life saving medication is needed. A strong recommendation from the U.S. Surgeon General to I/T/U facilities/organizations in promoting this one form of life saving treatment would likely increase the recognition that this is legitimate lifesaving treatment and not merely an expensive drug for a fringe group of patients.

Medication-Assisted Treatment

Buprenorphine (Suboxone) has emerged as a useful pharmacotherapy with the effect of stabilizing the chronic disorder of opiate dependence a, reducing sero-conversion rates of HIV and hepatitis C as well as reducing criminal activity in this population. The number of available prescribers in Indian country in I/T/U facilities is very small and there exist no substantial incentives for providers to obtain the education and expertise necessary to become DEA waivered to prescribe buprenorphine. As the leader of the Commissioned Corps, the establishment of such incentives available to Commissioned Corps physicians to generate interest in obtaining waivered status would help in increasing the number of physicians available to prescribe and treat the opiate addicted patient. Such incentives could be generalized to all health entities in Indian country.

Social Stigma

The concept that opiate addiction is a chronic disorder that is subject to relapse and is a legitimate medical disorder still needs emphasis as does the fact that its treatment with buprenorphine is beyond “replacing one drug with another”.

There continues to exist a therapeutic nihilism regarding the treatment of opiate addiction and the perception that such patients have a self-induced disorder that is too much trouble, too inconvenient or too expensive to treat is still prevalent among physicians. The short descriptive phrase that “Addiction is a Brain Disease” remains accurate and deserves no less of our attention than the treatment of type 2 diabetes mellitus.

Ronald Shaw,M.D.

Osage Nation Congress

President-Elect, Association of American Indian Physicians

Staff physician, Citizen Potawatomi Nation Health Services