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How The Opioid Crisis Is Affecting Native Americans


We're going to return to another subject of great national concern, the opioid crisis. On Thursday, the Drug Enforcement Administration announced a new crackdown on all variations of fentanyl. That's the drug considered responsible for tens of thousands of drug overdoses in the United States, that according to the Centers for Disease Control. We want to continue our conversation about how this crisis is being experienced in different communities.

Last week on this program, we had a conversation about how the opioid crisis is affecting African-Americans and Latinos. We thought that was necessary because so much of the news coverage has focused on the white rural experience, which while important, is not the only one.

Today, we wanted to look at how the crisis is affecting Native Americans. For some insight, we called Dr. Ron Shaw. He's the president of the Association of American Indian Physicians, and he's with us on the line now. Dr. Shaw, thank you so much for speaking with us.

RON SHAW: Thank you, Michel.

MARTIN: So, Dr. Shaw, it is a fact that white rural communities have been hit especially hard by this opioid crisis. But we were looking at a report from the Centers for Disease Control that said that, actually, the death rate of Native Americans from opioid overdoses was the highest of any racial demographic. Some 8.4 per 100,000 Native Americans died of opioid overdoses in 2014. Can you tell me more about that?

SHAW: Well, I believe that in any population where there are a depressed or a low socioeconomic status, any time you have those issues, people are more vulnerable to opiate overdose. Now for Native Americans, many Native American populations suffer from what is known as historical and intergenerational trauma, which has to do with historical events that have afflicted Native American tribes, everything from Wounded Knee to other issues that have affected us culturally that have caused kind of a historical shame that has transmitted across generations, even to succeeding generations, that it has been shown to be associated with increased rates of depression, drug use and drug addiction. So that's the additional issue faced by Native Americans and perhaps more sensitive in those populations that live in reservation areas.

MARTIN: From the work that you've seen and the work that you've done yourself, what do you think are the best ways to treat this problem with a particular focus on Indian country and Native American communities?

SHAW: I think the two most important pieces are, first of all, this is a biological disease at its core, whatever the reason is. And we're still finding out why experimental and recreational use in youth progresses more rapidly to opiate addiction in native populations. We're still trying to find out the best practices for preventing or slowing that down. But the biological basis is a disorder in the reward pathway in the brain known as the mezal limbic system. An important part of that therapy has to be medication-assisted treatment.

Now, the psychosocial treatment of the disease, which has to do with social living skills and having to address historical generational intergenerational trauma, that will be specific for native populations. We've always known that culture is prevention when it comes to drug use or drug abuse at an early age, but culture also is treatment. And so implementing treatment specific and culturally relevant treatment items in the treatment curriculum are very important.

MARTIN: Dr. Shaw, I just have to ask you. You know, you've been - you've spent your entire adult life as a caregiver. And you've also been, you know, a community leader serving, as I said, in the Osage Congress and so forth. I mean, how are you coping with this as a - I mean, I'm assuming that people look to you for answers and for help. I mean, how are you coping with this?

SHAW: I don't have the treatment or the cure for opiate dependents in my back pocket, I wish I did. I'm humbled every time I get someone that I've tried everything I know and they relapse, but I have to acknowledge that this is a chronic relapsing disease. And if I can get a patient into remission, then I've - and even if they're in remission only for a year and I have to retreat them, then they've had a year of improvement in their life. That doesn't mean that the treatment was futile.

But I think trying to use influence and education, both for native leaders so they can get a better perspective of this illness - in particular, the biological nature of it - to be able to testify before Congress, including the Senate Committee on Indian Affairs, and try to put the native-specific issues before our legislators, that's my been role and my target.

MARTIN: Is there anything giving you hope right now? I mean, what is giving you hope right now? What's getting you up in the morning to keep working at this?

SHAW: As bad as it is that people are dying, it's finally got people's attention that this is an illness. And it'll translate into proper illness funding for other substance use disorders. Because in Oklahoma, it's still methamphetamine and alcohol. Who knows? Maybe before this battle has had some results, opioid use disorder and overdose deaths may increase in Oklahoma. But it's affecting Indian country, so I've used my expertise for any community, even if it's not particularly as high in the Osage nation right now.

MARTIN: That's Dr. Ron Shaw. He is the president of the Association of American Indian physicians. We reached him on the line in Shawnee, Okla. Dr. Shaw, thanks so much for speaking with us.

SHAW: Thank you, Michel. Transcript provided by NPR, Copyright NPR.