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Indian Country continues to fight opioid epidemic

By Lenzy Krehbiel-Burton

Naloxone is showing up in more corners of Indian Country as part of the continued growth of a two-year-old interagency agreement aimed at tackling the opioid epidemic.

In December 2015, the Bureau of Indian Affairs and Indian Health Service announced a memorandum of understanding to allow for the hands-on training of BIA officers on how to identify opioid and heroin overdoses and administer an atomized dosage of naloxone, a synthetic drug that blocks the nervous system’s opiate receptors. It can reverse an opioid overdose if administered in time, either by an injection into muscle tissue or by inhaling it.

In the two years since the memorandum was announced, 250 BIA police officers nationwide, including 35 in Oklahoma, are trained how to administer the drug.

The course includes an overview of opioids, common signs and symptoms of overdose and step-by-step instructions on overdose response and aftercare. Additionally, the officers receive training on all commonly available naloxone devices and must complete a competency assessment to assure they understand how to respond to overdoses properly.

As of Nov. 1, the officers educated under the agreement have only had to administer seven doses in the field nationwide.

With such a small sample size to date, concrete data has not yet been compiled to determine what impact the program has had on the opioid mortality rate in Indian Country, said Hillary Duvivier, a clinical pharmacist at Arizona’s Whiteriver Indian Health Service Hospital and member of the IHS Heroin Opioid Pain Efforts (HOPE) Committee.

However, she also said that IHS pharmacists receive more naloxone requests as word gets out that the medication is available.

“In 2016, IHS’ naloxone purchases doubled,” she said. “We’re seeing an overall increase across IHS as we’re making sure that patients and officers have it, even if they’re not necessarily using it right away.”

In 2010, opioid painkillers such as oxycodone, hydrocodone and hydromorphone were responsible for three-fourths of all prescription drug overdose deaths. American Indian or Alaska Native and non-Hispanic white women are at highest risk of dying from prescription opioid overdoses, CDC data shows.

Nationally, despite dropping from its peak levels in 2010, doctors prescribed 640 morphine milligram equivalents per person in 2015, or the equivalent of roughly 5 milligrams of hydrocodone every four hours for three weeks.

According to the U.S. Centers for Disease Control and Prevention, the rate of opioid abuse-related deaths among American Indians and Alaska Natives nationwide has increased almost fourfold since 2009.

Data collected by IHS indicates that the rate of drug-related deaths among American Indians and Alaska Natives is almost double that of the general population, with up to 130 overdose fatalities per day in 2014 alone.

“Every second counts,” Duvivier said. “They’ve (BIA police officers) been ready to take that on and ready to respond.”

With prescription drug overdoses accounting for 70 percent of Oklahoma’s accidental poisoning deaths, additional steps are underway closer to home to facilitate access to naloxone.

Thirty-three law enforcement agencies across Oklahoma have at least one officer trained to administer the drug, including the Oklahoma Highway Patrol and police departments with the Citizen Potawatomi Nation and cities of Shawnee and Tecumseh.

Thanks in part to grants from the Substance Abuse and Mental Health Services Administration and Indian Health Service’s Methamphetamine and Suicide Prevention Initiative, Citizen Potawatomi Nation’s Behavioral Health Services makes the nasal form of naloxone available at the formularies for both of the Tribe’s clinics. The drug is attainable without a prescription after a conversation with a primary care provider.

“Substance use addictions are brain disorders,” said Glenna Stumblingbear-Riddle, Citizen Potawatomi Nation Director of Behavioral Health. “They impact lots of people both in Oklahoma and beyond. It doesn’t matter your socioeconomic status, race, ethnicity or gender — it’s a big problem we’re facing, but it is a legitimate brain disorder. No one chooses to have this disease. It’s not a lack of willpower or a choice. Help is available and treatment works. Recovery is possible, as people overcome opioid addictions every day.

“When you have someone in your life who has an opioid addiction … it impacts everyone.”