Rear Adm. Michael Toedt, M.D., FAAFP
Assistant Surgeon General and Chief Medical Officer, Indian Health Service
To comprehend the challenge facing Native communities, it is first necessary to recognize that substance misuse is just one of many factors that contribute to health disparities faced by American Indians and Alaska Natives. Social determinants of health, such as food supply, housing, and education affect health. The impact of colonization, historical trauma, and forced relocation continue to resonate in tribal communities and contribute to substance use prevalence and worsened health outcomes.
Startling disparities
The Centers for Disease Control and Prevention reported in March of this year that American Indians and Alaska Natives had the second highest opioid-involved overdose death rates in 2018. The good news is that recent data also shows American Indians and Alaska Natives have the most significant decrease in opioid-involved overdose death rates over the previous year. The numbers are still concerning, but a sign of progress.
Tribal communities report that substance use patterns are shifting to methamphetamines, and that alcohol use disorders continue to rise. The challenges presented by COVID-19 related to recovery and prevention threaten to increase the troubling health disparities of American Indians and Alaska Natives.
The challenges ahead
Addressing these challenges requires partnering with Native communities to deliver trauma-informed, culturally competent services to American Indians and Alaska Natives. In the ongoing effort to meet behavioral health challenges in Indian Country, there is a trend toward tribal management and delivery of behavioral health services in American Indian and Alaska Native communities. Currently, more than half of mental health programs and 90 percent of substance use programs funded by the Indian Health Service are operated by tribes or tribal organizations.
The Indian Health Service has also embraced the use of telehealth and fostered innovation in care delivery, which is especially critical to improving access to care in rural, remote locations in Indian Country.
This evolution in healthcare delivery and management is changing the face of behavioral health services in Indian Country, providing a more diverse network and increased access to culturally competent care. More work needs to be done. Continued emphasis on indigenous values and partnership with Native communities, along with additional resources, will promote healing and support healthy communities.