Opioids are devastating Cherokee families. The tribe has a $100 million plan to heal
The fentanyl crisis is hitting young people hard, and the highest death rates are in Native American communities. The Cherokee Nation is working to help young families recover.
Late one afternoon, Mazzy Walker gives a tour of her family's farm near Tahlequah, Okla., capital of the Cherokee Nation.
"Cows are walking, turkeys, a dog," she said, giggling at her role as tour-guide. "I don't know what!"
Mazzy is 9 years old. Walking through the grass, she wears a flowing red dress, huge eyeglasses and big boots. She's curious about everything.
"So I heard you live in New York?" she said to a reporter who had come to visit.
"Tell him why you want to go there, Mazzy," said Gary Walker, her dad. She grins and answers, "Because there's an American Girl doll store." Turns out Mazzy loves American Girl dolls.
Mazzy and her 6-year-old brother, Ransom, are both Cherokee, as is Gary. The kids are also both adopted. Their biological parents got caught up in the opioid crisis that has hit the reservation with devastating force.
"All of the children we've adopted or fostered have been because of that," said Cassie Walker, Gary's wife. So far, they've taken in nine Cherokee kids.
Asked about her first family, her biological mom and dad, Mazzy shrugs and laughs nervously, some of her boldness slipping away.
"I don't know, I never got to meet them," she said.
An epidemic of overdoses and broken families
This is a part of the opioid-fentanyl crisis that doesn't get talked about much. Fentanyl is now a leading cause of death for Americans under the age of 40.
Even when people survive, addiction is breaking up families, as far more parents lose custody of their kids.
The Cherokee nation's Principal Chief Chuck Hoskin says the drug crisis here is so intense, it threatens efforts to strengthen his people's way of life.
"That's such an important mission for the Cherokee nation, [restoring] our language and culture, and yet this drug problem is really hampering it."
According to Hoskin, so many Cherokee families are being disrupted that children wind up being fostered or adopted outside the tribal culture.
"Families not only being broken up, but children being removed from tribal lands, this is an additional pressure," he said. "Anything we can do to keep families whole means we can keep our children."
Gary Walker experienced this wave of addiction and despair up close, as he and Cassie worked with the foster care system.
"Going to court, I would sometimes sit there for four or five or six hours," he recalls. "I would watch 30 or 40 cases at the same time. It really hit me then just how big the problem was."
All the kids the Walkers have taken in, including Mazzy and Ransom, were exposed to drugs in the womb.
"Some of them were definitely opioid," Gary said. "One of them, it was 14 different drugs. I didn't even know 14 different drugs existed at the time. It's really heartbreaking."
That's meant health and developmental challenges for Mazzy and Ransom. As we talk, Mazzy listens closely and chimes in with a question for her parents.
"How old was I when I like learned to like talk and stuff?" she asked.
"You were closer to 3," said Cassie, who notes she has struggled at times to explain to the children how this drug crisis reshaped their lives.
"We always remind them that God gave them to us very special. Their parents were sick so we were able to raise them. There are mothers out there that did lose their child, and I was able to become their mother. So there is just a lot of emotions."
Vulnerable Native American communities fight back
Public health experts say it's not surprising Native American families have been so vulnerable to opioid addiction and other forms of addiction.
Across the U.S., many tribes like the Cherokee faced generational trauma, including genocide and forced relocation. Later, government boarding schools tore apart families and economic discrimination drove tribes into grinding poverty.
"This has wrought devastation on our traditional ways of life at key junctures in history," said Joseph Gone, a member of the Aaniiih-Gros Ventre tribal nation and a public health researcher at Harvard University. "One thing we've seen around the world is when someone's society collapses is a turn to substances of abuse."
Beginning in the late 1990s, drug companies began flooding many Native American towns with prescription pain pills.
Much of the public awareness during America's opioid crisis has focused on rural white towns. But Gone says Native communities suffered even higher rates of opioid addiction, overdose death and suicide.
"Deaths of despair were actually worse among American Indians and Alaska Natives for a longer period of time," he said.
A study Gone co-authored in The Lancet, a leading medical journal, found deaths among middle-age Native Americans rose at three times the rate of white Americans from 1999-2013, the period when prescription opioid sales boomed in the U.S.
New studies and drug distribution data released as part of opioid lawsuits show Native American towns like Tahlequah were swamped with prescription opioids.
"I'm completely convinced that the [drug] industry bears responsibility because of the number of pills that were dumped on the reservation," said Principal Chief Hoskin.
"That's not an accident. That's because there was profit to be gained."
One prescription, 10 years lost
Many of the families around Tahlequah tell stories of how prescription pills wrecked their lives and damaged their children.
Brenda Barnett, a Cherokee citizen, was pregnant with her son, Ryan, in the 1990s when the reservation was first flooded with opioids.
She says her family had already been scarred by her brother's addiction to pain pills and heroin.
"At that time, I was thinking, 'I can't go through what my Mama went through. I can't do it.' I was terrified," she recalled "That was one of the biggest fears I had in raising a child, and it happened."
Ryan was 15 when he hurt his hand in a car door. A doctor prescribed Oxycontin.
According to Ryan, that first opioid prescription, that first high, derailed his life. "I was like, this is great. I'll do whatever I got to do to feel this way forever," he said.
Ryan, who's 31 years old now, says he hates thinking about what followed. He lost 10 years to pills, heroin and fentanyl — and also lost many of his Cherokee friends to drugs.
"You know, I did take a big chunk of my life and throw it in the trash," he said. "You lose your best friends in this whole thing. If they're alive, they're in prison for the most part."
The Cherokee sued Big Pharma, winning $100 million
Over the past decade, thousands of governments around the U.S., including tribal governments, sued the drug industry for its alleged role fueling the opioid crisis.
In the end, most companies involved in the opioid trade, including name brand companies such as Johnson & Johnson and Walmart, agreed to national settlements, cash payouts worth more than $50 billion.
Principal Chief Hoskin says his tribe's share of that money, roughly $100 million dollars, has revolutionized addiction care for the Cherokee.
"The suffering would have continued, our inability to directly provide care would have been very limited. And now that's completely changed," he said.
At a ceremony last month, Cherokee leaders unveiled the first major project, an in-patient addiction recovery center planned for Tahlequah.
The ceremony was packed with tribal leaders and Cherokee, including Jennifer Janelle Pena Lassiter, who lost loved ones to overdoses and struggled with addiction.
"The opioid industry harmed millions of people. Thousands of Cherokees have been devastated by it all," Pena Lassiter said.
She lost custody of her children and spent time in prison during an 11-year struggle with opioid addiction that begin with a pain pill prescription.
"The road I went through was hell, and I wouldn't wish it on my worst enemy," she said. "All of my twenties were gone. I missed things like starting a happy family. I missed college life. I missed milestones with my children which I will never ever get back. It rips families apart completely."
According to Pena Lassiter, the tribe offered healthcare and financial support to help her rebuild her life. She has her kids back and owns her own home.
She believes these new, much more ambitious addiction treatment facilities and programs will help people heal faster.
"I believe the Cherokee nation is doing right by this money they got from the settlement," she said.
Hope for healing but also anger — and new dangers
Some of the money is already at work. There's a new harm reduction clinic in Tahlequah where Cherokee can get clean needles, counseling and other support.
The tribal hospital now offers buprenorphine, a medication that helps people with opioid addiction avoid relapses. Roughly 400 Cherokee are getting treatment.
Over the next five years, the tribe plans to roll out a total of $75 million in new treatment facilities. The remainder will go toward the costs of running these sites as well as a scholarship fund. It's a huge change for a reservation with a population of roughly 150,000 Cherokee.
But while this is a hopeful time for the Cherokee, it's also a perilous one.
Over the last five years, fentanyl has largely replaced pain pills and heroin on the streets. Pena Lassiter says overdoses in her community have surged.
"It's terrible, it's everywhere. There are people dying here all the time," she said. "If I go into a gas station at any time, somebody could be dead in a bathroom."
As fentanyl deaths surged across the U.S. during the COVID pandemic, research funded by the the Centers for Drug Control and Prevention found the biggest spike in fatal overdoses was among Native Americans.
"American Indian youths started to have really dramatically increased rates of death and overdose," said Gone, the researcher at Harvard.
Given the scale of death and loss around Tahlequah, one thing that angers many Cherokee is the lack of an apology. While America's drug companies agreed to pay billions of dollars, none apologized or admitted wrongdoing.
Principal Chief Hoskin notes only a handful of drug company executives have been prosecuted for pushing opioid sales long after addiction rates soared.
"You know, justice is a relative term," he said. "But the way I look at it, in this moment we have an opportunity to save lives going forward. Getting these dollars now is important. So I feel good about the measure of justice we have."
A model for other communities hit hard by opioids?
Public health experts say it will be years before there's data showing whether these new programs reduce opioid addiction and bring down overdose deaths among the Cherokee.
But Gone of Harvard says Native American communities across the U.S. are doing innovative things to help their people heal from addiction.
"Our peoples are still around and are growing and are charting better futures," he said. "We need to recognize that peoples' resilience carries through."
Brenda Barnett says she hopes the Cherokee Nation will emerge as a model for how communities across the U.S. respond to the opioid-fentanyl crisis.
"We're poised to do a better job than anything out there. Our people, they're not throwaway because they have this disease," she said.
With financial help and healthcare from the tribe, her son, Ryan, is one of the success stories. He's been in recovery, drug-free for five years; at age 31 he's back in college.
As they sat at their kitchen table, Brenda put a hand on his arm and told him she's proud of his recovery.
"It makes me feel good to know she's proud, she trusts me," Ryan said.
Back on his farm, Gary Walker watches as his kids play out in the field and says he, too, is hopeful new programs funded by opioid settlement money will make a difference.
"I think it will help. I'm proud of our tribe," he said, noting that with support from the Cherokee Nation, Mazzy and Ransom are recovering.
"They are thriving. With treatment and help from the tribe and the state and different places, we went through therapies and they are currently thriving."
Copyright 2023 NPR. To see more, visit https://www.npr.org.