Opioid Misuse in Indian Country: A Guide for 

SAMHSA Grantees

Tribal communities are drawing on their cultural strengths to fight a growing public health crisis in the United States 

and across Indian Country—opioid misuse. From 2002 to 2014, over half of the substance misuse-related deaths 

among American Indians and Alaska Natives (AI/ANs) were linked to opioids.1 Misuse of opioids can also contribute 

to increased crime, family violence, child neglect, sexual abuse, and sex trafficking.2 Misuse also contributes to 

challenges, and sometimes failure, in school or work. Many tribal families have suffered from the loss and trauma of a 

family member’s fatal overdose.

AI/AN communities are tackling the challenging issues that result from opioid misuse in their communities. This fact 

sheet was developed for AI/AN communities and organizations. It provides a definition of opioids, an overview of how 

opioid dependency affects physical health, and AI/AN efforts to prevent opioid misuse in communities and villages. 

Draft, March 2018

What Are Opioids? 

Opioids are a class of drugs commonly prescribed to 

treat pain. Opioids are narcotics that dull the sense 

of pain and cause drowsiness by depressing the central 

nervous system. They should never be taken with 

other drugs that do the same (such as alcohol). Opioids 

include heroin, morphine, and prescription painkillers, 

such as Methadone, OxyContin, Vicodin, and Percocet. 

Opioids also refer to synthetic opioids, like Fentanyl, 

which is roughly 50 times more potent than morphine 

and about 10 times more potent than heroin.3 

What We Know Today

Opioids attach to parts of the brain, central nervous 

system, and digestive tract. They cause drowsiness 

and slow a person’s breathing, which may heighten the 

risk of overdose.

AI/ANs experience opioid addiction at a higher rate 

than other populations.4

 The overuse of opioids 

creates new brain pathways, which causes a desire 

for more and creates withdrawal symptoms if the user 

suddenly stops using the narcotic drug.

AI/AN women have one of the highest rates of death 

from prescription opioid overdose compared to all 

women in the United States.5 Deaths from prescription 

painkiller overdoses among women have increased more 

than 400% since 1999, compared to 265% among men.6 

More than 1 in 10 American Indian women have a 

diagnosis of opiate dependency or misuse during 

pregnancy.7 Babies born to mothers who misuse opioids 

during pregnancy are at risk of neonatal abstinence 

syndrome and often need special medical care. 

This fact sheet was prepared for SAMHSA under contract number HHSS280201300001C 

with SAMHSA, U.S. Department of Health and Human Services (HHS). The views, 

opinions, and content of this publication are those of the author and do not 

necessarily reflect the views, opinions, or policies of SAMHSA or HHS.

AI/AN Leadership Response

Leadership from tribes, Alaska Native corporations, 

AI/AN organizations, and urban Indian centers have 

stepped up to address the opioid epidemic. Using 

partnerships and mandates, below are some of the 

innovative approaches taken to help American Indian 

communities and Alaska Native villages regain health 

and wellness.

• Alaska Native health organizations partnered

with the state of Alaska to form the Alaska

Opioid Policy Task Force. The task force released

recommendations to the governor and legislature

that range from opioid prevention to recovery.

• Tribal leaders from New Mexico pueblos met

with the U.S. Department of Justice to create an

educational blitz about opioid misuse for American

Indian children.

• United South and Eastern Tribes partnered with

tribal epidemiology centers to host an Opioid and

Substance Abuse Summit. The summit included

discussions on historical trauma, the neuroscience

of addiction, and strategies to address the opioid

epidemic.

• Tribal leaders in Minnesota sponsored a TribalState Opioid Summit, where tribal and state leaders

worked together to develop opioid prevention and

treatment recommendations.

www.samhsa.gov

1-877-SAMHSA-7 (1-877-726-4727)
• Blackfeet Nation and the Rocky Mountain Tribal

Epidemiology Center received funding from the

Montana Healthcare Foundation to use cultural

strengths and other approaches to address drug

misuse among pregnant women on the Blackfeet

Reservation.

• Indian Health Service (IHS) became the first

federal agency to require training in opioid use

disorders for all prescribing clinicians. More than

1,300 tribal health care providers have attended

the courses.

Approaches to Prevent Opioid Misuse

American Indian communities and Alaska Native villages 

use a range of approaches to prevent opioid misuse. 

These efforts educate and engage the broadest range 

of the community, including youth, family members, 

health care providers, police, schools, and other 

community services. Below is a list of efforts that can 

be effective for AI/AN communities.

• Prevention activities: Develop prevention activities

that promote anti-drug messages grounded in

cultural strengths and use traditional narratives and

healing practices.

• Education opportunities: Educate community

members, health care providers, community

leaders, and youth on the opioid addiction process,

how to avoid addiction, and how to reverse it.

• Family and youth voices: Guide American Indian

community or Alaska Native village outreach

and prevention efforts with family and youth

perspectives.

• Painkiller prescription monitoring: Support

local health clinics in their efforts to strengthen

prescription drug monitoring programs.

• Prescription drug disposal programs: Spread the

word about tribal police “take-back” programs for

safe and anonymous ways to dispose of unwanted or

expired opioid medications.

Where to Begin

Communities that are ready to address their opioid 

misuse concerns can obtain information about opioid 

addiction and prevention efforts from pre-recorded 

trainings and other resources that are available at no 

cost through the internet, such as those listed in the 

Resources section of this document. 

Resources*

SAMHSA’s Center for the Application of Prevention 

Technologies resources to support the prevention of 

opioid misuse and overdose: 

http://www.castri.org/CAPT-Resources-Opioids.pdf

The IHS Response to a National Crisis:

https://www.ihs.gov/newsroom/includes/themes/

newihstheme/display_objects/documents/2017_

Speeches/OpiateEpidemic-AllTribesCall-2017-05.pdf

Alaska Opioid Policy Task Force recommendations:

http://www.dhss.alaska.gov/AKOpioidTaskForce/

Documents/AOPTF-Recommendations-1-19-17.pdf

The National Tribal Behavioral Health Agenda: 

http://store.samhsa.gov/product/PEP16-NTBH-AGENDA

National Institute on Drug Abuse – Drug Facts: Lessons 

from Prevention Research: https://www.drugabuse.

gov/publications/drugfacts/lessons-prevention-research

The 2016 Surgeon General’s Report on Alcohol, Drugs, 

and Health: https://addiction.surgeongeneral.gov

How to Seek Help

Q&A from the National Institute on Drug Abuse offers 

help for young adults who think they have a problem 

with drugs and want to learn how to get help. https://

www.drugabuse.gov/related-topics/treatment/whatto-do-if-you-have-problem-drugs-teens-young-adults

Seeking help is a sign of strength. AI/AN tribes and 

urban organizations in your region offer opioid addiction 

treatment services for adults and youth. Contact your 

local health care office to learn more about how they 

can help. 

About the Tribal TTA Center 

The Tribal TTA Center is funded by the Substance Abuse 

and Mental Health Services Administration (SAMHSA). 

The Tribal TTA Center uses a culturally relevant, holistic 

approach to deliver TTA on mental and substance 

use disorders, suicide prevention, and mental health 

promotion. TTA is offered to a broad audience of all 

tribal communities, a focused audience of SAMHSA 

tribal grantees, and an intensive audience of selected 

AI/AN tribes per year.

For More Information 

To request more information about the Tribal TTA 

Center or submit a technical assistance request, 

call (301) 257-2967 or visit http://www.samhsa.gov/

tribal-ttac.

1 2016 USET Opioid and Substance Abuse Summit: https://www.rmtlc.org/event/

opioid-substance-abuse-summit/

2 National Indian Health Board. (2016). The Opioid Crisis in Indian Country. 

Retrieved from https://www.nihb.org/docs/06162016/Opioid%20Crisis%20Part%

20in%20Indian%20Country.pdf

3 Vergano, D. (2017, October 12). Fentanyl is now the leading cause of U.S. 

overdose deaths. Buzzfeed News. https://www.buzzfeed.com/danvergano/

fentanyl-leading-overdoses?utm_term=.guGO0A6gD#.upylO3804

4 The White House Administration Office of National Drug Control Policy. (n.d.).

Collaborating with Native Americans and Alaskan Natives. Retrieved from 

https://obamawhitehouse.archives.gov/ondcp/native-americans-and-alaskanindians

5 Centers for Disease Control and Prevention. (2013, July). Prescription painkiller 

overdoses: a growing epidemic, especially among women. CDC Vital Signs. 

Retrieved from https://www.cdc.gov/vitalsigns/prescriptionpainkilleroverdoses/

index.html

6 See footnote 4 

7 See footnote 2

* This publication lists non-federal resources to provide additional information to 

consumers. The views and content in those resources have not been formally

approved by HHS. Listing of the resources is not an endorsement by HHS or its

components.