On an Indian reservation in Montana, the opioid crisis has hit harder

But things started to go downhill over the next year and a half. Friends and relatives saw Littledog’s six-year-old stepson wandering around town alone. One day, Ollinger received a call from his youngest son while one of Littledog’s children was crying in the background. He was briefly unable to wake Littledog’s girlfriend.

Fentanyl overdoses

Ollinger asked Littledog if he and his girlfriend used drugs. Littledog denied. He explained to his mother that people were using a drug she had never heard of: fentanyl, a synthetic opioid that is up to 100 times more potent than morphine. He said he would never use something so dangerous.

Then, in early March, Ollinger woke up screaming. She let her grandchildren sleep in her bed and went to the next room. “My son was lying on the floor,” she said. He wasn’t breathing.

She followed the ambulance to Browning, hoping that Littledog had just forgotten to take his heart medication and would recover. He was pronounced dead shortly after the ambulance arrived at the local hospital.

Littledog was among four people who died of a fentanyl overdose on the reserve that week in March, according to Blackfeet health officials. Thirteen more people who live on the reservation have survived overdoses, a startling total for an Indigenous population of about 10,000.

Native Americans most affected

Fentanyl has taken hold in Montana and Mountain West communities during the pandemic, after spreading primarily east of the Mississippi River, said Keith Humphreys of the Stanford-Lancet Commission on the North American Opioid Crisis. .

Law enforcement officials in Montana have intercepted a record number of pale blue pills designed to look like prescription opioids such as OxyContin. In the first three months of 2022, the Montana Highway Patrol seized more than 12,000 fentanyl tablets, more than three times the number in all of 2021.

Nationwide, at least 103,000 people died from drug overdoses in 2021, a 45% increase from 2019, according to data from the Centers for Disease Control and Prevention. About 7 in 10 deaths were due to synthetic opioids, primarily fentanyl.

Many treatment centers are at capacity.

Overdose deaths disproportionately affect Native Americans. The overdose death rate among Indigenous people was the highest of any racial group in the first year of the pandemic and was about 30% higher than the rate among white people, according to a study co-authored by the UCLA graduate student and researcher Joe Friedman.

In Montana, the opioid overdose death rate among Indigenous people was double that of whites from 2019 to 2021, according to the state Department of Public Health and Human Services.

The reason, in part, is that Native Americans have relatively less access to health care resources, Friedman said. “With the drug supply becoming so dangerous and so toxic, it takes resources, knowledge, skills and funds to stay safe,” he said. “It requires access to harm reduction. This requires access to health care, access to medicines.

The Indian Health Service, which is responsible for providing health care to many indigenous peoples, is chronically underfunded. According to a 2018 report by the US Civil Rights Commission, IHS spending per patient is significantly lower than other federal health programs.

“I think what we’re seeing now are deep disparities and the social determinants of health are being confirmed,” Friedman said, referring to disproportionate overdose deaths among Native Americans.

Stacey Keller, a member of the Blackfeet Tribal Business Council, said she had first-hand experience of the lack of resources while trying to get a family member into treatment. She said it was difficult to find a rehab center, let alone find one for treatment.

“Our treatment center here, they’re not equipped to deal with opioid addiction, so they’re usually referred,” she said. “Some of the struggles we’ve seen across the state and even in the western part of the United States are that many treatment centers are at capacity.”

Scarce healthcare resources in the face of the opioid crisis

The local treatment center does not have the medical expertise to supervise a person in opioid withdrawal. Only two detox beds are available at the local IHS hospital, Keller said, and are often occupied by other patients. The reservation’s health system also does not offer drug treatment. The closest places to get buprenorphine or methadone – drugs used to treat opioid addictions – are 30 to 100 miles away. This can be a burden for patients who are required by federal rules to report to licensed dispensaries daily to receive methadone or must hike weekly for buprenorphine.

Keller said tribal leaders have asked IHS for help in setting up treatment and other substance use resources in the community, to no avail.

IHS alcohol and drug addiction program consultant JB Kinlacheeny said the agency has largely shifted to allocating funds directly to tribes to run their own programs.

The Rocky Mountain Tribal Leaders Council, a consortium of tribes in Montana and Wyoming, is working with the Montana Healthcare Foundation on a feasibility study for a tribal-run treatment center to build capacity specifically for tribal members. Tribes in both states, including the Blackfoot, passed resolutions supporting the effort.

Blackfoot political leaders declared a state of emergency in March after fentanyl overdoses. Shortly after, some of the Tribal Council Chairman’s children were arrested on suspicion of selling fentanyl from his home. The council removed President Timothy Davis as tribal leader in early April.

The tribe created a task force to identify short-term and long-term needs to respond to the opioid crisis. Misty LaPlant, a Blackfeet Tribal Police investigator, helps lead this effort.

It’s heartbreaking to see your children die unnecessarily.

Driving around Browning, LaPlant said she plans to train more people on the reservation to administer naloxone, a drug that reverses opioid overdoses. She also wants the tribe to organize needle exchanges to reduce infections and the spread of diseases like HIV. There is also hope, she said, that a revamp of the Tribal Health Department will result in a one-stop-shop for Blackfeet Nation residents to find addiction resources on and off of Reserve.

However, she said addressing some of the underlying issues — such as poverty, housing and food insecurity — that make communities like the Blackfeet Nation vulnerable to the current fentanyl crisis is a massive undertaking that won’t. will not be completed any time soon.

“You can connect historical trauma, unresolved trauma in general, and grief to what makes our community vulnerable,” she said. “If you look at the impact of colonialism and Indigenous communities and peoples, there’s a correlation there.”

Marla Ollinger is happy to see the momentum building to fight opioid and fentanyl addiction following the death of her son and others. As a mother who struggled to find the resources to save her son, she hopes no one else has to go through this experience.

“It’s heartbreaking to watch your children die unnecessarily,” she said.

*Aaron Bolton is a reporter in Flathead Valley for Montana Public Radio.

This story is part of a partnership that includes Montana Public Radio, NPR and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.

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