Indian Country's Continued Struggle with the Opioid Crisis: Focused Problem Areas, the Federal Government's Response, and What More Can Be Done

Details: By AshLynn M. Wilkerson; Parent Category: Basic Needs; Category: Targeting Alcohol, Drugs, Tobacco; 18 October 2023; Hits: 1025

Abstract

Excerpted From: AshLynn M. Wilkerson, Indian Country's Continued Struggle with the Opioid Crisis: Focused Problem Areas, the Federal Government's Response, and What More Can Be Done, 47 American Indian Law Review 301 (2022-2023) (291 Footnotes) (Full Document)

AshLynnMWilkerson Tribes are “running out of homes” for children whose parents are battling opioid use, and increased rates of babies are born with neonatal abstinence syndrome--a postnatal withdrawal syndrome from in utero opioid exposure. Tribes feel “preyed upon” by pharmaceutical companies who have fueled the “worst drug epidemic in American history” and, as of 2020, 169 civil suits were brought on behalf of the federally recognized tribes. Indian Country experiences the impact of the opioid crisis more than nonnatives. However, when tribal communities take steps to establish facilities and programs to help the crisis as a whole, they are blocked by individuals who not only experience the effects at a decreased rate, but who have significantly greater access to resources. The federal government has invested billions of dollars into roughly fifty-seven different treatment and recovery efforts in response to the opioid crisis since its designation as a public health emergency in 2017. Yet, five years later, the crisis was still a pervasive problem. The opioid crisis presents a myriad of complexities that require a multifaceted approach to properly confront and overcome. In 2020, “nearly 75% of overdose deaths ... involved an opioid”--a figure further exacerbated by the COVID-19 epidemic; thus, an expansion of currently effective programs and reallocation of funds to newly effective solutions is essential now, more than ever.

Part I of this Comment will discuss the extensive history of the opioid crisis and, thereby, highlight the necessity of taking new, unique steps to ameliorate its impact. Part I will also establish the direct impact of the opioid crisis in Indian Country and the specific concerns raised in relation to these communities.

Part II will lay out two focused problem areas: tribal jurisdiction and mental health, to which proposed solutions will be particularly crafted. The first section will establish key areas of tribal jurisdictional precedent that can potentially provide tribes with powerful tools to assert control over matters that directly affect their communities. The second section will explain the mental health issues that influence and are influenced by the opioid crisis, particularly illuminating substance use and opioid use disorders. Mental health concerns specific to the American Indian/Alaskan Natives (AI/AN) communities will be discussed at length to accurately depict the harrowing situation these communities are enduring.

Part III will discuss the federal government's response to the crisis by analyzing two regulatory agencies, the Substance Abuse and Mental Health Services Administration (SAMHSA) and Indian Health Service (IHS). A review of each agencies' grant programs that provide funding specifically for treatment, prevention, and recovery services for opioid use disorder is conducted. A consideration of the benefits of grants and reasons for why they may not be the best solution for AI/AN communities is also discussed. Finally, Part III will overview two relevant pieces of legislation, (1) the Comprehensive Addiction and Recovery Act of 2016 and (2) the 21st Century Cures Act, which also acts as sources of federal funding.

Part IV will consist of additional potential solutions to the opioid crisis outside of the primarily relied upon grant process. This part will argue that drug consumption rooms, mobile narcotic treatment program units, telehealth services, and jurisdictional control are all solutions apt to address not just the opioid crisis in general but to specifically and immediately mitigate notable concerns facing AI/AN communities as well.

[. . .]

Indian Country has seen the greatest impact of the opioid crisis in the United States. The multifaceted complexities that contribute to the devastation experienced in these communities center around mental health concerns that have been prevalent within them long before the incidence of the opioid crisis. It is clear that solutions geared towards addressing these overwhelming mental health concerns are long overdue and will be imperative to any meaningful resolution of the damage caused by the opioid crisis.

While the federal government has allocated notable avenues for assistance in response to this crisis, a reconsideration of priorities and desired outcomes is something paramount to be considered at every level--individual to systematic. A long-oppressed community is once again signaling for help. This Comment seeks to present a few of the accessible, effective approaches that could greatly increase access to essential resources and restore faith and balance to the deep-rooted federal government tribal trust relationship. While no solution is perfect on its own, and each contain drawbacks in their own regard, implementation of these proposed solutions show promise to mitigating the effects of the opioid crisis in tribal communities.

2023 Graduate, University of Oklahoma College of Law

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