Healing Through Culture: The Call for Culturally Specific Treatment for Native Americans Recovering from Opioid Addiction

Transcript

BILLBOARD:
[music bed]
Many believe addiction in Native American communities stems from the struggle to deal with generations of unaddressed trauma.

ANTONY: When we have entire families and entire communities who are walking around still stuck in that place emotionally.

Culturally specific treatment is key in helping Natives recover from drug addiction.

SHARYL: There is a cellular memory, when you hear it, it’s ringing for you.

In Minnesota right now, addiction to opioids — prescription pain killers, heroine and the like - is killing American Indians at a rate faster than in any other state.

More than half of Native babies born in Minnesota are dependent on opioid drugs.

ASHLEY: She had to be in the hospital for two weeks because they said she was showing signs of withdrawl.

In this documentary we explore the roots of culturally specific treatment and how it may help Natives struggling with addiction.

Healing through Culture from Minnesota Native News begins in a moment.

SECTION 1 - FROM ALCOHOL TO OPIOIDS
[1965 song]

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. T hey just keep going. … it was a diff. time.

Alcohol still is the most common drug of choice among all people, Natives included…

But opioids - prescription pain killers, heroine and the like - are getting a lot of attention because their use has risen so dramatically over the past 10 years — and so have deaths from overdoses.

And these days, 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 because they are in pain constantly. A lot of them have went through surgeries and you know, prescribed pain meds …

And David’s not sure how to help.

People need to get off the opioids but going through withdrawal is so tough —

He’s worried that if his friends and relatives stop getting the prescription drugs, they’ll turn to heroine, OD and die.

That’s why 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. It meets the cravings for the drug, but it’s safer than street drugs.

But many American Indians are concerned. Because of their unique cultures and history, those struggling with addiction need culturally specific treatment and abstinence from all drugs — or if you have to have M-A-T, taper off the drug as soon as possible.

We’ll explore this point of view over the next hour. But first, let’s look at 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

It worked.

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…

[vox of news tv headlines]

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 Whitehawk has been an addictions counselor in Native communities in Minnesota for over 16 years.

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 …

[music]

Before we go much further, we need to talk.

There is this awful and hurtful 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 like, 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. That Said…

REZNIKOFF: If you have had another addiction - to alcohol or tobacco - you are more likely at risk to opioids.

And lastly:

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.

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 no 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.

Now, Antony Stately is 53 years old and he is Dr. Antony Stately, a clinical psychologist specializing in multi-cultural community clinical psychology.

He specializes in the connection 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 - American Indians need to be able to grieve and heal the soul wound created by generations of historical trauma.

[music up and then fades]

The movement for culturally specific treatment 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. It was 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.

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. 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 wants people to be free to make their own choices.

That goes for medically assisted treatment too — if an opioid addict wants to be on Methadone or some other drug to be OK. Then he is OK with that.

SHARYL: It’s a struggle for me …

Sharyl Whitehawk has a different opinion.

We’ll hear her story after the break.

[music bed fades out]

SEGMENT B
[music bed fades in]

REJOINER: You are listening to Healing through Culture - a documentary about culturally specific treatment for Native Americans struggling to recover from opioid addiction.

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.

Again, Sharyl is Ojibwe. And she is an alcohol and drug counselor in Minneapolis.

Awful things happened to her as a kid, but she speaks about it candidly, calmly…

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: It grabbed me by the throat because 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: 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: 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 one S unday morning - Sharyl - hungover and depressed - found herself in front of a 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 prior to that, 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 counselors and then she found a therapist she calls the Angel lady.

SHARYL: She was an experiential and shame based therapist - something that was totally different.

Sharyl says the Angel Lady told her to buy a doll and find a picture of herself from when she first started being abused… and then sew the picture onto the doll.

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.

[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.

[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.

You often hear criticisms of methadone clinics and more broadly - medically assisted treatment programs.

People 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.

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.

Sharyl and Richard feel in the long term - drugs offered in medically assisted treatment — help people numb themselves.

To heal, SHARYL 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]

You dear listener now have a pretty good lay of the land - a broad Native perspective on CULTURALLY SPECIFIC addiction and treatment.

But the fear of overdose and death in the current opioid crisis is driving many 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.

More on that after the break.

[MUSIC :20]

SEGMENT C
REJOINER: You are listening to Healing through Culture - a documentary about culturally specific treatment for Native Americans struggling to recover from opioid addiction.

[MUSIC]

Addiction to prescription pain killers and heroine is different from addictions to other drugs and alcohol for a few reasons. Number 1, a person gets addicted faster and addiction spirals out of control faster. Number 2, overdoses are more deadly.

And 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.

In 2015, over half of American Indian newborn babies in Minnesota were born dependent on Opioids.

Many healthcare experts are saying, these babies and their moms have a better chance of survival with M-A-T.

AMY: This opioid animal is different from anything we’ve ever dealt with before. That receptor in the brain is demanding that opioid.

[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 because 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 because she was crying a lot.

Ashley’s from Minneapolis. She lived here 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: I was raised traditionally,so I have a lot of the teachings and I know about the ceremonies…

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 was already into the Oxy’s when they were big back then.

Oxy is OxyContin.

ASHLEY: All I was doing vics and perks…

Vics are Vicodin and percs are Percocet.

ASHLEY: I wasn’t addicted to them, I just 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.

Ashley 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.

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 pick them up again.

She wasn’t really paying attention to birth control or that sort of thing.

And then there came a turning point in her life.

ASHLEY: 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 told her - oh 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 magazines and such they are going to tell you not to even eat baloney, cold cuts, soft cheese right, so… But the concept of opioids is absolutely opposite of that.

Amy says it’s the withdrawals that really hurt the baby.

AMY: So withdrawls cut 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.

ASHLEY: I thought she was going to call someone on me. I was paranoid because I was using, so…

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. Then I get them connected to a methadone clinic, as a pregnant woman they go to the front of the line. ‘Cause as many people know, it’s a long line to get into a methadone clinic.

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.

She had already quit the pills and suffered through the withdrawals.

She thought she was doing the right thing.

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 he wasn’t 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. It’s an unanswered question in her mind.

ASHLEY: I don’t know if it was me or natural causes, but in my head I’m like this is a lesson. I didn’t know what the lesson was at the time…

[kid sound]

Ashley relapsed back into using pills.

And then — she found out she was pregnant again.

ASHLEY: And I was like - Oh God. I was just scared. I instantly called my midwife and I told her and I was crying. I was like I don’t want to lose the baby. I don’t know what to do. I don’t know if I should just have an abortion, I don’t know what I want to do. Amy was like OK we can get you in. I was in there the very next day. She knew I was using and she …

Ashley sort of stops talking here. She looks like she’s 1000 miles away. I ask her what she’s thinking about.

ASHLEY: Just my son, um - 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. He wasn’t nothing that… I don’t know, he helped me become a better parent and a better mother for my daughter.

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, Amy Langenfeld helped her and her boyfriend both got on methadone.

Ashley says from the beginning she was fixed on tapering off after the baby came.

And she did.

[kid sound]

Now - she takes care of her energetic 2 year old 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.

[sound of Ashley with daughter]

I spoke with another mom which a similar experience except she’s decided to stay on Methadone.

[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 a lot people because I don’t like the - well, you’re not really sober - and I’m like yea, I am. I got my children back, I’m living a good life. It’s a way of thinking. I’m not out there involved with people who are drug dealers and users, I changed my whole life, yes I am, you know.

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 because 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 she has regained custody of her children, so 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?

[music]

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 because you know this woman was supposed to raise me and be here for me. It’s not her fault …well, 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? So… 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. I feel like I can’t trust anybody still. It’s so embedded in you cause you grew up like that from not trusting the cops, don’t trust the white people. And then with alcoholic or drug addict parents… I was on my own at 13 years old, like literally on my own. You know so - around people that you always have 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 that 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, but on the federal level and here in Minnesota, money earmarked for opioid addiction treatment is generally headed in a different direction — toward medically assisted treatment.

This affects treatment options for everyone and it impacts what tribes can offer their citizens.

[music]

The Fond du Lac Band of Lake Superior Chippewa runs the Tagwii Recovery Center. It’s a long term recovery center funded by tribal, state and federal dollars.

Rick Colson is the Director.

CUT: RICK: Early on we have figured out how to do treatment with opioid addicts -…

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.

COLSEN:…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.

But since the Affordable Care Act, the tribe is having a harder time getting insurance authorization for in-patient treatment.

And 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.

The White Earth Nation, an Ojibwe tribe here in Minnesota has recently embraced medically assisted treatment.

They’ve started their own Suboxone program as part of a comprehensive culturally specific treatment program for tribal members.

Adam Fairbanks is its director.

ADAM: Our objective is to try and deal with the mental health issues, deal with chemical dependency, help people find their cultural identity through ceremony - help people heal.

The tribe has a short waiting list for the Suboxone program.

But, Adam reluctantly admits, they have a long waiting list for the culturally specific comprehensive part of the treatment.

ADAM: So, some people are trying to get in and are on M-A-T right now, but haven’t gotten to the level of care that they need to yet because of the capacity issues we face.

They need more money and more staff.

[music]

Our last story is from a tribe that runs the oldest tribal M-A-T in the state.

The Leech Lake Band of Ojibwe has been running its own Suboxone program since 2009.

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 sell itself as culturally specific.

And it doesn’t 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-it.

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.

[music here]

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.

SOC: You have been listening to Healing through Culture - a documentary about culturally specific treatment for Native Americans struggling to recover from opioid addiction. I’m Melissa Townsend.

Ending Credits.