Responding to the Opioid Crisis in MN Native Communities
Responding to the Opioid Crisis in MN Native Communities
For over a decade, the prescription pain killer and heroine abuse crisis has had a hold on communities across the U-S. Opioid overdoses tripled between 2000 and 2015.
In 2015, Minnesota had more American Indians dying from overdoses than any - other -state.
That same year, well over half of pregnant Native women gave birth to babies with opioids in their systems.
Many American Indians in Minnesota are wrestling with how best to help people heal from the addiction AND the historical trauma at the root of this crisis.
Reporter Melissa Townsend explores the unique nature of addiction in Native communities, and how it is - or isn’t - shaping a response to the current crisis.
Hey, Melissa here. I just wanted to say all those stats that Marie just read are important. They are meant to convey that this is a crisis in Minnesota’s Indian country. That said, there’s often a lot of bad news about Minnesota’s Indian country in general - and it can make people feel hopeless and tune out. Well, don’t tune out — because in this story there is a lot of hope. Ok, let’s get started.
SECTION 1 - FROM ALCOHOL TO OPIOIDS
Of course there was heroine and other opioids in the 1960s and 70s, but back then most American Indians struggling with addiction — drank.
DAVID: I don’t think there ’s anyone my age that hasn’t been left sitting in a car outside a bar somewhere in Mpls or up on the rez…
David Saice is an Ojibwe man from Minneapolis. As a kid he lived in a housing project on the north side with his parents and his siblings.
DAVID: You know your ma and dad are going out and they have friends that are going out. so they pile you in the car and everyone sits in the car …[2-3 kids] …and they go into the bar and get… a bunch of chips and pops and bring it back out and say we’ll be back out in a little while.
He says back then, there were a bunch of Indian bars in South Minneapolis along this one section of Franklin Avenue.
DAVID: You walk by a car and see a bunch of kids in it, you think nothing of it. they just keep going. … it was a diff. time.
These days, David still lives in Minneapolis, but those bars are gone, and those kids are gone.
And now when David thinks about alcohol and drug addiction, he thinks about prescription pain killers and heroine…
DAVID: Personally i’d say at least 30 people i know …are on pain meds bc they are in pain constantly. a loT of them have went through surgeries and you know, prescribed pain meds …
[purple rain cut]
David works in the maintenance department at the county morgue. On the day we talked he was getting phone calls from friends asking if Prince had been brought in. The musician had been found dead that morning. We’ve since learned — he died from an overdose of opioid pain medication.
SECTION 2 - WHERE WE ARE NOW & HOW WE GOT HERE
JOHNSON: Purdue Pharma is one of the most profitable companies…90% of their revenue comes from one drug — OxyContin.
Dr. Christopher Johnson, is an emergency room physician in a suburban Minneapolis hospital. He serves on the Minnesota Medical Association’s Opiate Task Force.
In the 1990s a pharmaceutical company Purdue Pharma set out on an unprecedented marketing campaign to sell their new opioid pain killer called OxyContin.
They paid doctors, medical school professors and other leaders in the medical industry to advocate for OxyContin — and to say that it wasn’t addictive.
JOHNSON: They said opiates were less than 1% addictive
Oxycontin shot to the top of the list of pain killers prescribed for things like back pain and joint pain.
The campaign increased prescriptions for all opioid pain killers.
In the 20 years between 1991 and 2011 prescriptions for opioid pain killers tripled.
Now we know that was all wrong.
JOHNSON: 4:16 … it’ s bad medicine, it’s bad science.
In 2007 Purdue Pharma was found guilty in a court of law for their manipulative tactics.
JOHNSON: They were found culpable for misleading info for de-emphasizing the risks of addiction by cherry picking science … suggest that opiates were not that addictive.
But that did not stop the tide of opioid prescriptions and addiction…
AL JAZEERA AMERICA : https://www.youtube.com/watch?v=WkkF9M9h3XA&list=PLW4wRvrGlUYmFTPnQP7CkVsxFDNFhDqcD&index=2
PBS NEWSHOUR: WOMEN AND BABIES: https://www.youtube.com/watch?v=DbeVhMye9NQ&list=PLW4wRvrGlUYmFTPnQP7CkVsxFDNFhDqcD&index=47
CBS THIS MORNING: CDC ASKS DOCS TO BACK OFF OPIOIDS — https://www.youtube.com/watch?v=xR2_2njgQ9k&index=60&list=PLW4wRvrGlUYmFTPnQP7CkVsxFDNFhDqcD
Even as the nation is hit hard by this, it’s disproportionally harder on Native communities.
SHARYL: Addiction is a spirit …that thrives on chaos and pain and fear and it’s had a strangle hold on this community for a long time …and it is using weak and wounded people to attack …
Sharyl Whitehawk has been an addictions counselor in Native communities in Minnesota for over 16 years.
Early on in her career her mentor Dennis Hisgun gave her this perspective.
SHARYL: If you’re doing a good job, that spirit of chaos is going to be threatened by you, going to attack you, you know you’re doing a good job when that starts happening bc you have become a threat.
Sharyl and others HAVE become a threat.
Generations of Native who struggled with alcohol and drug abuse have gotten sober.
But the current opioid addictions crisis seems to be a whole new level of chaos.
Nationally, the dominant non-Native culture is focused on medically assisted treatment or M-A-T. — that’s where clients are given methadone or Suboxone or another opioid to meet their cravings.
But many American Indians are concerned that - because of their specific culture and history - M-A-T programs shouldn’t be the sole focus for Native people.
SECTION 3 - NATIVES SPECIFICALLY - A Caveat
Before we go much further, we need to talk.
There is this awful stereotype in the world — the drunken indian.
The idea that all American Indians are addicts.
Talking about Natives and addiction, can make it seem like we’re reinforcing that racist and hurtful stereotype.
So let’s get a few thing straight — number one…
REZNIKOFF: There is no genetic — something about being Native biologically - no…
Dr. Charlie Reznikoff is an addictions doctor at Hennepin County Medical Center in Minneapolis Minnesota.
REZNIKOFF: Opiates don’t care what your race is - white or black, native or what you are - they are equally cause addiction in everyone.
There is a genetic predisposition to addiction among family members — but not among specific races or cultural groups.
REZNIKOFF: If you have had another addiction - to alcohol or tobacco - you are more likely at risk to opioids.
REZNIKOFF: If you have had a traumatic childhood, a violent childhood - you are more vulnerable as well.
Many believe THIS is part of the reason addiction rates are higher in Native communities.
Now, many people of all backgrounds have stories of abuse and neglect.
These are traumatic events - the clinical acronym is ACES - adverse childhood experiences.
American Indians in the United State are a diverse bunch, but there is a unique, shared history that you might say - is full of ACES.
It’s commonly called historical trauma.
ANTONY: My name is Antony Stately.
Antony Stately is an expert on historical trauma.
SECTION 4 -STATELY STORY
He lives in Shakopee Minnesota with his Dakota partner and his twin sons.
The boys are 9 years old.
Antony says they do well in school, they go to cultural events, they have long hair, they play hockey and lacrosse.
He thinks about them as he begins to talk about his own childhood in an Indian Boarding School in Chamberlain South Dakota.
ANTONY: My mother, mother, father, their parents, great grandparents, I’m 4th generation boarding school survivor.
Indian families across North America were forced to send their children to boarding schools.
Officially the boarding school era was between 1860 and the 1920s, but some Natives went to boarding school into the 1990s.
Antony spent his first years in Minneapolis. He was 6 and a 1/2 when he was sent away.
ANTONY: Some horrible things happened to me in boarding school, like they happened to lots of diff. people, many many tribal communities and individuals — sexual abuse, physical abuse.
ANTONY: This memory stands out for me when i was there. I was 10 yrs old at the time, I decide not to go to church. I was going to pretend to be sick and stay in my dorm. Well… because I didn’t show up for church, they made an example out of me the next week at church. The shaved all my hair off and they pranced me out in front of everyone at church, down the center aisle, all the kids were laughing and it was pretty clear without saying the words — this is what will happen to you if you decide to do what you want to do instead of conforming.
Antony says he was angry and resentful for being sent away to this horrible place.
In his teenage years, he became addicted to alcohol and drugs.
ANTONY: When I was 15 or 16, i got into a very very, one of the biggest fights i ever had with my mother. Now i had great respect for my mother, never raised my hand or any of those sorts of things. But we were arguing about something and i got angry and i yelled at her and i was crying and i said i want to know why you sent me to that place. That place was horrible. Do you have any idea what they did to me.
Well, of course i had no way of knowing that she probably did have tremendous knowledge of what they did to me, she went to boarding school and probably experiences the same things. It’s just something we never talked about.
As he’s talking he sometimes taps a water bottle cap on the table.
ANTONY: She was crying - there was alcohol involved, I might even have been drunk when this was happening. But what she said to me was I had not choice. She broke down in tears, I had no choice. She told me about this story about how Hennepin County welfare basically said, if you can’t take care of your children… We’re going to take them away from you.
His parents weren’t together at the time, and his mom was broke.
ANTONY: Essentially my mom said - i sent you to St. Joe’s - you and your brothers and sisters because i knew that if i got you taken away from me, i’d never get you back.
Antony says this was a pivotal moment.
ANTONY: As soon as I understood all these things that had happened to me as a child and all these things that were happening to my family, I could let go of how angry i was at her
And things began to shift.
ANTONY: Of course it wasn’t instantaneous - i didn’t get sober the next day! [laughter] but the point being is that it created this seed of self-awareness where i started to understand the impact on my family and my community.
SECTION 5 - STATELY ON HISTORICAL TRAUMA
Now, Antony Stately is 53 years old and he is Dr. Antony Stately…
a clinical psychologist specializing in multi-cultural community clinical psychology.
He works in tribal communities and lectures around the country about the connection between addiction, genocide, and what it takes for Native communities to heal.
ANTONY: Volcanoes, tsunamis, earth quakes -we have really good ways of understanding that right — acts of god. [just thinking that too - laughs] There isn’t a people on Earth that don’t have some creation story that helps us understand things like the big flood and those kinds of things.
What is different about those things from massacres and genocide and those kinds of things is that historically traumatic events are rooted in processes that are man-made, they are with intent to de-humanize, and intent to harm and intent to kill.
Antony says there’s no clear story about these events.
And the pain and loss and trauma is often handed down through generations in the form of addiction and violence and dis-ease.
ANTONY: When we have entire families and entire communities who are walking around still stuck in that place of mourning and specifically … in that anger, it makes us ripe for addiction. bc addiction is essentially about escaping something that make us uncomfortable.
When it comes to the current opioid crisis Antony says - we need to save people from overdose deaths. If that means using medically assisted treatment, he supports it.
But in the end American Indians need to be able to grieve and heal the soul wound created by generations of historical trauma.
[music up and then fades]
SECTION 6 - CULTURALLY SPECIFIC ABSTINENCE MODEL
Another perspective on the opioid crisis in Indian country comes from a movement that started in the 1970s and 80s.
Elwin Benton was a leader in this movement. He is Ojibwe.
He says, back in the 70s and 80s, American Indians were not faring well in state hospitals and white facilities.
ELWIN: … they were very uncomfortable and most of them did not complete treatment and back then they had a therapeutic me lieu which consisted of hard confrontation…sit them in a chair and cuss them out and make them feel lower than well crap [LAUGHS]
In response, pockets of American Indians across the country were creating culturally specific treatment programs.
The idea was that the historical and ongoing oppression of Natives in this country called for a specialized kind of addictions treatment.
ELWIN: Some medicine people in the SW appeared before the American Psychiatric Council and provided them with what they are doing and then were able to demonstrate that they had just as much success as psychiatrists who were working with american indians,… and so they start using what we call Native practitioners.
Elwin and others brought this knowledge to northern Minnesota and in 1977, they built MashKawisen.
They say it was the first Native owned treatment center in the United States.
[frog sounds in]
It’s here in the middle of the woods in Sawyer Minnesota. Near the Leech lake and Fond Du Lac bands of Ojibwe.
The sounds of the surroundings drift in through the windows.
The is a sweat lodge in back and the pow wow grounds are next to the parking lot.
[frogs sounds out]
It’s an inpatient treatment program —
Staff here don’t believe in medically assisted treatment for opioid addicts.
Here, they believe addicts need to be abstinent from all drugs ands alcohol —
and they need to dive deep into their traditional cultural healing practices.
Studies prove spirituality - as in an active belief in a higher power - helps achieve sobriety.
At Mashkawisen, clients use traditional medicines - sage, sweet grass, cedar, tobacco
[weave drum in]
They join in circle around the drum to find the heartbeat… to get centered… to build sober relationships with other Natives.
SHARYL: The dominant culture would say we’re hoaky, crazy or weird… but …
Sharyl Whitehawk agrees with Mashkawisen’s traditional spiritual approach. AGAIN, SHE is an Ojibwe addictions counselor in Minneapolis.
SHARYL: We knew that the unseen world was as real as the seen world. we did not doubt that we did not have negative feelings about that. we knew that, we trusted that. one of our greatest resources. that if you have a dream, or a hunch or see a sign, … that they were real and we could trust them and because of that it was a strength for us.
She says American Indians who haven’t grow up with tradition still respond to the traditional teaching and ceremonies.
SHARYL: It’s like there’s a cellular memory - when you hear it, you know it for a truth and it’s ringing for you.
SECTION 7 - DAVID SAICE AND TRADITIONAL SPIRITUALITY
This is what worked for David Saice.
He was that young boy with pop and chips in the backseat of the car - parked in front of the bar - on Franklin Avenue.
As a kid, it didn’t take long for David to do what he saw his parent doing.
DAVID: Probably about 8 yrs old when i had my first drink of alcohol.
As a teenager in the 70’s, he drank and did speed. He sold drugs too. Got in trouble.
He also got in a lot of fights.
DAVID: I was proud of who i was as a Native. … You gonna call me a drunken Indian, you’re going to see what it feels like to get beat.
One of these fights actually started David on his path to sobriety.
DAVID: I was about 20 and i ended up messing up my hand… i went to swing at someone and went through a light fixture and then the light so i cut some nerves in my hand and some stitches. They weren’t sure if i was going to get use back or not.
His sister talked him into going to a ceremony…
DAVID: Which I didn’t believe in at the time - I was still drinking and what not. They had everything set up in a house in St. Paul. The lights were completely turned out, you could barely see your hand in front of your face.
I talked to a couple of different elders about that and they said a long time ago before white people came here they used to have ceremonies in the day time and you could see the spirits coming in and everyone knew what was going on and there was no issue. but with the Europeans coming in here, everything had to be kept quiet cause they wold come take people away and lock them up.
In the U-S, traditional Native spiritual practices were outlawed until 1978.
Some whites called it devil worship.
Natives didn't do their ceremonies or talk about them in public.
You actually rarely hear a story like David’s. But they are many out there.
DAVID: All the windows had covers on them. I sat back in a chair, my head touched the wall. I could see lights coming in from the ceiling.. it looked almost like fireflies. they were singing some ceremony songs and people were praying. I could hear these gourds going around the room and I kept thinking how is this guy doing this without stepping on kids bc there were kids sleeping all over the floor.
That rattling sound of the dried seeds in the gourds… he was trying to track it as it moved around the room.
DAVID: And then they kept getting louder and louder from behind me, but my head was against the wall. and pretty soon my head got pushed away from the wall and they went up and down my right arm. And a week later i got all use of my hand back.
David says - that was it.
DAVID: A light came on for me. this is the way i’m going to live my life the rest of my life. quit drugs, alcohol, everything.
He found a traditional spiritual practitioner that he trusted and he’s been on the road ever since.
He credits his 34 years of sobriety to his traditional spirituality.
But you know what — he says it’s not for everyone.
He hasn’t even introduced his grown children to traditional teachings.
He says that would be too much like how the Catholic Church forced religion onto the reservations.
He wants people to be free to make their own choices.
That goes for medically assisted treatment too — if an opioid addict want s to be on Methadone or some other drug to be OK.
Sharyl Whitehawk has a different opinion.
SECTION 8 - SHARYL - GET TO THE ROOT CAUSES
SHARYL: It’s a struggle for me …
Again, Sharyl is Ojibwe. And she is an alcohol and drug counselor in Minneapolis.
SHARYL: I believe Methadone and Suboxone were created for short term use — supposed to assist people in a gradual detox… and then … - we have to get to these unresolved traumas and reasons that people relapse or switch addiction.
Sharyl Whitehawk speaks from experience.
Awful things happened to her as a kid, but she speaks about it candidly, calmly…
SHARYL: There was this one Sunday morning where i was really hungover and i had been at a party the night before, i had been raped. and it was just another horror on top of the rest of them. i was trying to plan the perfect suicide bc i couldn't take it anymore.
The horrors started for Sharyl when she was a baby living with her parents and her siblings in Wisconsin.
SHARYL: I have generations of people in my family who come from alcoholism and family violence and that’s what i was born into. it was not a safe place to be a little girl. There was drinking all around me, there was violence all around me of all kinds…(:22)
According to the National Violence Against Women Survey in 2000, more than half of American Indian women are raped at least once in their lifetime.
When Sharyl was 11, she got drunk for the first time.
SHARYL: 57:56 …it grabbed me by the throat bc it was the first time the depression and anxiety and pain and fear and terror and shame and all of it went away. And i drank as much as i could as often as i could until something stopped me.
She drank so much, by the time she was 16 years old, the alcohol was destroying her body.
SHARYL: 58:52 … i couldn't keep food down and i was bleeding from everywhere …doctors couldn’t figure out what was wrong with me. they sent me to the mayo clinic and that was the first time the doc shut the door and asked — do you drink alcohol?
SHARYL: 59:31 i said yes, … he said you have destroyed your entire digestive system and you are going to die.
It took another year or two until that Sunday morning in front of the church.
[music weaves in]
SHARYL: It was summertime … and the people inside were singing a song - i had never felt safe in my life, someone watching over me, taking care of me and they were singing a song …, it was God talking saying i will never forget you my people - i hold you in the palm of my hand, i will never forget my own. and for some reason - i had no experience with god, religion, spirituality - and i stopped in my tracks and for the first time I felt God. I felt creator. And then god was talking to me. and saying every painful thing that is happening to you is getting at you through alcohol. Get it out of your life and you are going to be OK.
She says it was like a little light inside her was lit.
Sharyl had no money for any kind of inpatient or outpatient treatment. She was 17 years old. So she went to AA.
SHARYL: The first time i walked in there was a much of old white guys in there and i thought what am i going to have in common with these guys— female, young, brown, laughs - but you know what — you got to give a meeting 3 tries before you can quit. So i said OK, I’ll sit down. they were full of wisdom and they were so kind and gentle to me. a few crusty ones, but a few who were so cool.
She went cold turkey and stopped drinking.
But without the drinking — Sharyl still had a problem.
The violence in her childhood had created a cycle.
First, something awful and violent would happen - this is the trigger…
And Sharyl — would get quiet…
SHARYL: Be invisible, check out, comply, do whatever they say and you’re going to get hurt no matter what but if you fight back you’re going to get hurt worse or maybe you might die.
And then she’d drink to go numb.
When she got sober - she was still around a lot of violence - still around the triggers.
So something awful and violent would happen, and she would stay quiet, but she didn’t drink to — so she was just be left there with all those horrible feelings.
Over time she worked with traditional spiritual elders and she worked with therapists and then she found…
SHARYL: This one lady, i call her the angel lady, she was an experiential and shame based therapist - something that was totally different - -she had me doing these hoaky, weird little things… laughs ..
Sharyl says the Angel lady taught her how to reparent herself.
SHARYL: It was really hard… she had me look for a picture of myself bc i couldn’t quite remember when my first sexual abuse started and she said look for a picture and you’ll know it… i put some tobacco out and got all these pics from my mom and this picture just stood out to me and i said this was it.
The Angel lady told Sharyl to buy a doll and sew the picture on its little belly.
SHARYL: She said that’s you, the little you that never got held and protected and told that everything was going to be ok and all that stuff. and everyday i want you to spend time with her …and tell her now you are strong and now you are wise and now you know how to take care of us and you’ll be safe. do that for month and come back.
Well i felt so dumb doing it at first but it was really powerful. now i can do it without the doll. now if something triggers me i immediately have that picture of myself in my mind and I in a spiritual way i wrap myself around her and i tell her all those things and we are OK.
Sharyl has worked for decades through Alcoholics Anonymous, different therapies and the White Bison program - an indigenous version of the 12 steps. She says the process gave her a totally new sense of peace and power in her life.
SHARYL:[laughs] … my life is really good now.
She wants that for every woman and man struggling with addiction.
She feels in the long term - drugs offered in medically assisted treatment — help people numb themselves from the horrible feelings that come from their triggers.
To heal, she says — you need to get off all the drugs, get in touch with your feelings and …set yourself on a whole new path.
SHARYL: We are all born for a higher purpose. the whole reasons that you are here is — it’s no accident, there is something you are meant to do. … if you just keep doing the next right thing … creator has a purpose for you.
[music out or in]
SECTION 9 - ENDING PART 1
I like how you sum this up for us. I like the way you’re guiding the listener. It’s really working.
You dear listener now have a pretty good lay of the land - a broad Native perspective on addiction and treatment.
Many American Indians are concerned that medically assisted treatment programs with methadone and suboxone do not tend to the underlying trauma feeding the addiction.
People are not healing.
But the fear of overdose and death has driven others to embrace medically assisted treatment.
AMY: I respect and honor culture and community i think it’s critical. but right now those children are dying in the streets, in the bushes… in the alleyways..
How will the wisdom gained over generations be used in this current crisis?
More on that in the next half hour.
You are listening to a special edition of Minnesota Native News.
Reporter Melissa Townsend explores what we know about addiction in the Native community, and how that wisdom is shaping a response to the current crisis.
SECTION 10 - OPIOID FREAK OUT
In the 70’s and 80’s alcohol was the primary drug of choice among American Indians struggling with addiction.
Actually, it still is the most common drug of choice among all people, Natives included…
Opioids - prescription pain killers, heroine and the like - are getting all this attention because their use has risen so dramatically over the past 10 years.
and so have deaths from overdoses
The U-S, overdose death tripled between 2000 and 2014.
There’s one other thing, with many illicit drugs, men use more than women, but not with opioids… Women and men are using them equally - that includes pregnant women.
Which means babies are being effected even before they’re even born.
And that’s got many people saying the work that helped countless Natives break their addiction to alcohol and other drugs - it’s not enough to fight the chaos of opioid addiction.
AMY: This opioid animal is different from anything we’ve ever dealt with before. That receptor in the brain is demanding that opioid.
More and more attention is being turned to medically assisted treatment or M-A-T. That’s when a person struggling with opioid addiction is given methadone or suboxone or another opioid to meet their cravings. these are called maintenance drugs.
SECTION 11 - M-A-T TUTORIAL
REZNIKOFF: I’ve recently heard 5-6k people are in methadone treatment, a couple thousand in sub treatment.
This is Dr. Charlie Reznikoff. He works at Hennepin County Medical Center in Minneapolis. He specializes in addictions medicine at its opioid treatment facility.
He is non-Native.
This is the clinic where he works. He’s walking me through the routine when a client who comes in for her dose of methadone.
REZNIKOFF: They check in, get a number. When their number comes up they come back to…
There are 16 methadone and Suboxone clinics in the state.
And they serve 65-hundred clients.
There are also 130 doctors with a special license to prescribe suboxone. They don’t have to be affiliated with a treatment clinic like this one.
And the state does not collect information on how many patients they serve.
REZNIKOFF: Then they come back here and they meet with a nurse and the nurse does a brief evaluation, confirms their identify etc, see how things are going. They dispense a methadone dose. And then some patients have privileges where they can take medicine home with them so at that point they pick up their medicine to go home with.
Dr. Reznikoff’s clinic primarily dispenses methadone because…
REZ: 17:35 …methadone is pennies —
But it can be hard to figure out the right dose because it’s a powerful drug.
REZNIKOFF: there is a risk a person gets too high a dose and their sleepy all day…
Suboxone is the brand name for Bupenorphine.
It’s making headlines as a better alternative to methadone,
It’s not as strong as methadone so it’s easier to dose.
but its more expensive…
REZNIKOFF: Bupenorphine is $8 as much has 10 for a single dose.
He says studies show both suboxone and methadone are effective in saving lives, reducing incarceration, and reducing infections like Hep C and HIV.
Also, they stay in your system for a long time. You can take them just once a day. And they reportedly block other opioids.
Last thing — Dr. Reznikoff says all the studies show both bupenorphine - or suboxone - and methadone are safe for long term use.
In fact, when a person tapers off she puts herself at risk.
Because if she relapses …
REZNIKOFF: Statistically that’s a risk for OD and death.
But some people do taper off.
Alright, got all that? Good.
SECTION 12 - RULE 25
[sound of walking up stairs]
No matter what kind of treatment you end up with — you start in a place like this.
I’m at the Indian Health Board in south Minneapolis. I have an appointment with Richard Wright, a drug and alcohol counselor here. He’s Ojibwe, from Leech Lake Band of Ojibwe.
Generally, when a person decides to - or is forced by the courts to - seek treatment, they start with a Rule 25.
In Minnesota, it’s required for anyone needing public assistance to pay for treatment.
It’s a comprehensive report detailing the person’s life and drug use history. It can take about 2 hours to complete. The counselor, in this case Richard, uses it to recommend a treatment plan.
Sometimes you have to wait 2 weeks between the time you decide to get treatment and the time you can get an appointment to do this.
There just aren’t enough counselors to meet demand.
As you might imagine, some people drop out in that time.
[sound of meeting with Richard]
Richard Wright’s office is cozy, there’s soft lighting and carpeted floors, there’s a braid of sweet grass hanging on the wall. There are no windows.
RICHARD: The first thing I would do is introduce myself, and say my name is Richard and on my rez they call me Crow. that’s my indian name, and i ask them if they have an indian name and i would ask them, what name can i use with you …
The Rule 25 report is computerized, the curser blinks, waiting for answers.
None of these questions are included in the report.
RICHARD: What tribe are you? Did you grow up on the rez? Are you aware of the cultural practices of your tribe and what are some of the ways that you heal?
Richard asks the client about herself and what drugs she uses…
RICHARD: A lot of them, they are fearful of this instrument and rightly so. if we take an american indian woman who is pregnant - everything she tells me is going to lead to the removal of her baby, so she is going to try to deceive me as much as she can [laughs] and i’m watching her do that and i feel sorry for her.
Richard has worked in chemical health with American Indians since 1989.
He believes in traditional medicines.
RICHARD: This here is the fourth medicine. It’s called sweet grass because you can smell it - its sweet smelling. [me] If we light it and we burn it, and it spreads in the room, then all the bad spirits will be asked to leave. If i’m treating a person then i would want to know if they were familiar with this ritual and did they want to use it in their healing…
He believes dealing with addiction is one step in a healing process …
and that healing takes intensive, tailored support…
He believes abstinence from drugs and alcohol is the goal.
That’s what he believes, but his job - when it comes to an opioid addict - is to recommend a treatment plan.
RICHARD: What i’m trained to do is send them to a methadone clinic.
He’s got some problems with that.
SECTION 13 - MAT CRITICISM
You often hear criticisms of methadone clinics and more broadly - medically assisted treatment programs.
People say — you’re just replacing one drug for another or it’s a free high.
They also say it doesn’t lead to healing the unresolved trauma that drives the addiction in the first place.
It’s also putting more drugs on the streets — addicts can get high off suboxone and methadone so the drugs get diverted and they’re sold illegally.
In some cases these drugs have actually become people’s first drug of choice.
Richard is concerned about all those things — but he’s got another beef.
For him, given the history that got us to this point — a business that runs off of addicted Indians… that’s… unsettling.
RICHARD: Methadone programs are industry programs. Yea, it’s making a lot of money.
Some Methadone clinics in Minnesota have upwards of a thousand patients.
Intensive residential treatment programs are reimbursed for only 16 patients at a time.
Methadone clinics serve more people and thus generate more revenue.
Plus the state reimburses treatment programs on a per day, per person basis — so a methadone patient can be on the drug for the long term — many many days.
A residential treatment programs lasts only 30, 60 or 90 days.
Richard Wright says methadone and suboxone clinics have a financial incentive to keep people on the drugs.
So he offers his clients some advice…
RICHARD: I always tell my people who come in here. i say you don’t have to be on this forever. talk to you doctor. when you get to the methadone clinic, tell your doctor that you don’t want to be on this forever…..
Or better yet - he’d like them to go cold turkey.
Richard and Sharyl Whitehawk say there is a case to be made for getting off the drugs and getting intensive help.
SHARYL: I have a daughter who became addicted to Oxy after a really terrible car accident and she had to detox cold turkey. It was horrible. Excruciating. She said mom, — that horror of what that felt like to detox is my greatest relapse prevention tool.
RICHARD: It’s manageable. It’s doable. You go through a lot of pain but in 6-7 days it’s gone.
But there is one big exception.
In 2015 over half of American Indian newborn babies in Minnesota were dependent on opioids.
Even Richard who favors the cold turkey approach says pregnant women addicted to opioids need to use methadone or suboxone - at least for a while.
That is what Ashley did.
SECTION 14 - ASHLEY/PREGNANT WOMEN
[AMBI SOUND: Child trips over cord and cries… child calmed down, laughing, talking with mom]
Ashley lives with her 2 year old daughter Maddie in south Minneapolis. She is Ojibwe.
Those are not their real names because Ashley asked me not to use those.
ASHLEY: She had to be in the hospital for 2 weeks bc they said she was showing signs of withdrawal. They had her on a real small dose of morphine. they said she was doing great, it was just her first couple of days. bc she was crying a lot.
Ashley’s from Minneapolis. She lived there until she was 7. Then here mom died. Her dad wasn’t totally in the picture, her grandma couldn’t take care of Ashley and her brother, so she went to live with her Aunt in Canada.
ASHLEY: It was good up there … I grew up traditional so I know my culture…
She got into a relationship with a boy who quickly became abusive… she fled Canada knowing he wasn’t allowed into the United States.
Back in Minneapolis, she says she lost connection with her traditional teachings.
Eventually she started taking pills.
ASHLEY: I was 19 at the time. I was hanging around with my oldest brother. They were already into the Oxy’s when they were big back then.
Oxy is OxyContin. Thanks!
ASHLEY: I I was doing vics and perks, not addicted, just doing them for fun.
Vics are Vicodin and percs are Percocet. Thanks again!
ASHLEY: I liked how it brought me up when i was feeling down.
It was around that time she met another young man.
ASHLEY: I had met my daughter’s dad… [daughter talks] we started off talking and kicking it - it was supposed to be a one night stand it didn't turn into that.
She ended up getting pregnant right away. She didn’t know it until she was having a miscarriage.
ASHLEY: That’s when I started with the oxys. i went from vics, to perks to oxys.
She got arrested a few times, was in and out of drug court and treatment centers. She’d quit pills for a while and then picked them up again.
She wasn’t really paying attention to birth control or that sort of thing.
And then there came a turning point that changed her life.
ASHLEY: In 2011 i got pregnant with my son. i carried him until i was 25 weeks pregnant. I thought I was going to be ok, just quit cold turkey. I didn't tell my midwife that I was using. she asked and i said no.
Ashley’s midwife is Amy Langenfeld. She works at Indian Health Board in Minneapolis. She is non-Native.
AMY: With most drugs we want you to stop all drugs and alcohol in pregnancy. If you read parenting mags and such they are going to tell you not to even eat baloney, cold cuts, soft cheese… But the concept of opioids is opposite of that.
Amy says it’s the withdrawals that really hurt the baby.
AMY: It’s cuts the oxygen to the fetus and significantly increases the risk of death and damage to that baby.
But at the time Ashley was too scared to tell Amy about the pills.
This is a nice echo of Richard’s sadness over working with pregnant women.
ASHLEY: I thought she was going to call someone on me. I was paranoid bc i was already on the run, i was pregnant, I was using. in my eyes i just look like this bad person so I didn’t say anything about it.
And midwife Amy — knows this — she’s worked with a lot of women in Ashley’s shoes.
AMY: The first thing i do is validate their bravery. They just came into a white woman they don’t know and told them something that historically would have gotten their baby taken away. I get them connected to a methadone clinic, as a pregnant woman they go to the front of the line. and it’s a long line…
A dose of Methadone lasts 27 hours. As long a you take one dose a day - there are generally no withdrawals.
Ashley didn’t know any of this.
Nice use of music here
She had already quit the pills and suffered through the withdrawals.
She thought she was doing the right thing. But…
ASHLEY: I was going in to go see if i was having a boy or a girl …the day before the appointment i felt my son moving around, but not moving around as much. As soon as she put the thing on, you couldn’t see his heart beat — he was already gone.
They induced labor and Ashley gave birth - to her son - the next day.
She’s not sure if her withdrawals are what ended his life. Its an unanswered question in her mind.
ASHLEY: I felt guilty… i don’t know if it was me or natural causes but… In my mind I thought this is a lesson. i didn’t know what the lesson was at the time…
Ashley relapsed back into using pills.
And then — she found out she was pregnant again.
ASHLEY: And I was like oh god - here we go again. I was just scared. I instantly called my midwife and i told her - i was pregnant and i was crying. i was like i don’t know what to do. I don’t want to lose the baby, i don’t know if i should just have an abortion -… so at the time Amy was like OK we can get you in. I was in there the very next day. she knew i was using and …she … she helped me get through the weekend. ..
Ashley sort of stops talking here. she looks like she’s 1000 miles away. I ask her what she’s thinking about.
ASHLEY: My son - just trying to piece everything together. Like when i say i try to take the good from the bad… the creator wouldn’t just put him in my life just to put him in my life. he came into my life for a learning experience. He wasn’t a mistake. My son helped me become a better parent for my daughter
SECTION 15 - PROJECT CHILD
Midwife Amy Langenfeld works with Hennepin County Medical Center Obstetrics department, the county’s Addiction Clinic and another county service called Project CHILD.
In the 5 years between 2010 and 2015 the collaborative worked with nearly 70 opioid addicted expectant moms - like Ashley.
All but 2 of them went home with their babies. When moms use illicit street drugs, the baby is taken by chid protection immediately.
The collaborative is not culturally specific and they highly encourage staying on methadone.
[bring in kid sound]
When Ashley was first pregnant with her daughter, midwife Amy Langenfeld helped her and her boyfriend both got on methadone.
She says from the beginning she was fixed on tapering off after the baby came.
And she did.
Now - she takes care of her energetic 2 year old daughter and her 6 year old niece.
Ashley rents a house, she has a full time job, and a car and she’s planning on going to school soon.
With all these strong opinions about Methadone and medically assisted treatment.
I wondered how Ashley’s experience differs from someone who has decided to stay on methadone.
Of course, everyone in this situation has a unique experience - but I visited with a woman named Nicole.
SECTION 16- NICOLE
[sound of lock box on table]
Nicole keeps her methadone in a plastic bag in this lock box on the top shelf of her closet — out of reach of her children.
She is Ojibwe. She doesn’t want to use her last name.
She’s been on methadone for nearly 3 years.
NICOLE: I don’t tell many people because they’re like - well, you’re not really sober. and I’m like yea, i am. i got my children back, I’m living a good life, I’m functioning daily. it’s a way of thinking, I’m not out there involved with people who are drug dealers, i changed my whole life, yes I am.
Nicole’s addiction started in 2009 with oxyContin - swallowing the pills, then snorting them, then shooting them…
When the OxyContin pill changed to a gelcap you couldn’t crush them anymore… so she moved to heroine.
NICOLE: The way I feel when i think about it, I just feel sad. It was just dark and sad. i can’ t even listen to songs from that time bc they remind me of being dope sick or me feeling hopeless.
She was in and out of treatment for years. Until finally, she had had enough…
NICOLE: I said, I’m just done, i’m so sick of living like this i’m going to get in treatment and do what i got to do.
And she did it.
She got on methadone and successfully finished a intense outpatient treatment program.
She doesn’t practice traditional teachings, but she says her belief in God and her church is really a great support.
She rents a spacious house on the north side of Minneapolis with her boyfriend who is also in recovery.
And now that she has regained custody of her children, she is busy taking care of them.
NICOLE: I just try to show them love. You know I didn’t get a lot of love when i was younger. You know, so I try to make them feel good about themselves. I think I would have turned out a lot better if I would have got these things. You know what I mean?
SECTION 17 - THE NEED FOR HEALING
To this point Ashley and Nicole’s experiences on methadone are pretty similar.
Both have kicked the illicit drug use and regained a relatively stable life.
But sobriety - however you define it - is a lifelong process …
and methadone is one step…
Midwife Amy Langanfeld is a huge advocate for methadone and suboxone during pregnancy but even she says …
AMY: Once their baby is born, they’re just themselves again. Often women don’t get to adequately heal from that addiction, their self worth is usually not restored or developed, so it’s very easy for them to regress back to the emotional pain management of the illicit drugs. there are very few programs that support postpartum women.
Ashley recently broke up with her boyfriend — Maddie dad. So she’s on her own.
ASHLEY: I was let down by my mom bc you know this woman was supposed to raise me and be here for me it’s not her fault … I think it is kind of her fault for passing away - it’s kind of harsh to say that but in my eyes, if you know you have kidney failure, you’re not supposed to drink ,why do you keep drinking? I don’t know if anyone else has felt that before about a loved one or anyone.
She’s still off the pills, but she’s drinking.
ASHLEY: It’s mostly thursdays. That’s my me time to be able to go out and have some drinks, get drunk and then go back to work.
Nicole is still on methadone, she has her children, a stable income, a solid home. ..
But just like Ashley, some old wounds still need to heal.
NICOLE: It’s hard for me to trust sometimes, you know. It’s so embedded in you cause you grew up like that from not trusting the cops, don’t trust he white people. And then with alcoholic or drug addict parents…I was on my own at 13 years old. literally on my own. You know so - around people that you have always watch, wonder if they are telling you the truth or with your head over your shoulder because you don’t know what they’re going to do. You grew up in theta environment, you grew up not trusting.
Nicole is working with a group of Native women in Minneapolis to build a supportive housing complex for women who have struggled with opioid addiction
It would focus on healing with traditional Native teachings and different therapy options.
Nicole says she thinks it might be a place where she could find some people she could trust.
NICOLE: When someone lived the life i lived, i feel like a connection to them you. Like, oh she gets me.
The group is looking for funding.
Which brings us to our last consideration — besides experience and theory and opinion — there is money.
Money earmarked for opioid addiction treatment is generally headed in a different direction — toward medically assisted treatment.
What kinds of treatment are being supported by federal, state and tribal funds?
SECTION 18 - FEDERAL, STATE & TRIBAL FOCUS
[FOX NEWS - OBAMA ANNOUNCEMENT OF FUNDS FOR TREATMENT]
Congress hasn’t approved that billion dollars, but if they do, 970 million of it would support medically assisted treatment programs like methadone or suboxone.
REZNIKOFF: Methadone is Pennies.
970-million dollars is a lot of pennies.
In Minnesota, state official are also saying they want to increase medically assisted treatment.
They say it’s a good alternative to illicit drugs…it reduces overdose deaths, cuts drug trafficking and a lot of the crime that goes along with it.
But many American Indians say there needs to be more money for deeper treatment to address the pain the drives the addiction.
In Minnesota, People are waiting as long as a month between their Rule 25 and a spot in a residential treatment program.
[WHITE HOUSE video fades in]
OBAMA: Hey Everybody. I’ve got a special guest with me this week.
In May 2016 the White House produced a video featuring President Obama and the musician Macklemore - who has struggled with his own opioid addiction.
MACKELMORE: I know recovery isn’t easy or quick, but along with a 12 step program, treatment has saved my life.
President Obama list some actions his administration is taking to help people get treatment…
OBAMA: And under Obamacare, health plans in the marketplace have to include coverage for treatment.
Yes, Obamacare calls for coverage of addiction treatment.
But specific insurance directives in the Minnesota Exchange, are actually undermining some treatment programs that don’t offer suboxone or methadone.
SECTION 19 - TRIBAL RESPONSE - FOND DU LAC
Rick Colsen runs the Tagwii Recovery Center.
It’s a long term recovery center for natives run by natives on the Fond Du Lac Band of Lake Superior Chippewa’s reservation in Northern Minnesota.
The program is funded by tribal, state, federal and dollars.
RICK: Early on we have figured out how to do treatment with opioid addicts - really focusing on case management services so that things outside of treatment start to stabilize so we can start working with that client internally much faster.
When a person comes to Tagwii saying they want treatment, Colsen’s staff first helps them get into a 30, 60 or 90 day in-patient treatment program.
Colsen calls it a detox period.
Once they finish, clients can spend up to 18 months here at Tagwii.
RICK: There’s lots of research the longer you keep a client engaged in treatment activities, the more successful they are.
Colsen does not want to start a medically assisted treatment program with suboxone or methadone, but he thinks he might have to.
RICK: With the affordable care act and more people on state funded insurance companies, we have to get first prior authorization to place them in in-patient treatment - we don’t always get that…
When they do get insurance company’s authorization for treatment, sometimes the patient isn’t allowed to finish out the program…
RICK: They are getting diverted into Suboxone or Methadone programs and being discharged within 10 days.
That is — they get sent home early from treatment with a prescription to a maintenance drug.
And they don’t come back to Tagwii for counseling and case management.
Rick says, he loses them.
It’s unclear how often this is happening, but Rick and others are concerned.
Fond du Lac and Mill Lacs Bands of Ojibwe and others are working with the state of Minnesota to change the rules for insurance companies on the state’s exchange.
SECTION 18 - TRIBAL RESPONSE - LEECH LAKE
It’s clear there are differing opinions about the value of medically assisted treatment.
Rick Colsen runs a program that does not embrace the practice.
But our last story is about a tribe that does.
The Leech Lake Band of Ojibwe has been running its own Suboxone program since 2009.
It’s the oldest tribal Suboxone program in the state.
The number of clients hovers around 90.
Like most other M-A-T programs — it is controversial.
Becky White is the program’s Director.
She is Ojibwe.
BECKY: A lot of the community members say that we are just giving out a pill to take care of pills that they are already taking. This is not true.
The program does not gear people towards tapering - that’s an individual’s decision.
But Becky says clients have to see a counselor or case manager weekly. They have to attend 2 group meetings a month, and they have to produce a clean urine screenings. No illicit drug use.
There’s one other common criticism of the program —you guessed it - its business side.
Many are unsettled that their own tribe is making money off tribal members who are struggling with addiction.
I don’t have the financials for the program, but Becky White says it’s doing very well financially. Here’s how she explains it.
BECKY: It’s going well. I don’t think I want to say anything more about … [is that a point of tension in the community] I can tell you how we are helping in the community - we help with funding of other buildings…
She says money from the Suboxone program has helped rehab a nearby homeless shelter, build a brand new tribal justice center and an assisted living facility for elderly people.
BECKY: So, yes, we are bringing in revenue and that revenue is helping our community.
LeRoy Staples Fairbanks is on the Leech Lake Tribal Council and he used to work at the opioid program.
LEROY: It could become perception that people become dollar signs at that point, it’s definitely not an economic development venture for us - that we are going to make money off of people and it’s going to save us.
He says the financial success of the program allows the tribe to explore opening their own in-patient facility, and shift focus to prevention.
LEROY: With the kind of drug use everything is so disconnected. We need to get the community element back together, to helping one another again, real long term stuff. [trails off]
Leroy and I are talking in his office.
He’s behind his desk and at this moment he reaches for a blue post.
He peels it off his computer monitor.
Written in pencil, in all caps it says HEALING CEREMONY.
He says he’s been thinking for a while that the tribe needs to turn its focus to healing as a community.
Like Antony and Sharyl, Ashley and Nicole — tribal communities may be able to find a way to turn this opioid addiction crisis into an opening for deep healing.
To come out stronger than they were before.
For this special edition of Minnesota Native News, I’m Melissa Townsend.
The opioid and heroin abuse crisis has hit the U.S. hard, with overdoses tripling between 2000 and 2015.
In Minnesota, Native communities struggle with helping people heal and the historical trauma at the root of this addiction crisis.
Melissa Townsend reports.