While much of the country is suffering, American Indians are particularly reeling from the opioid crisis. Some tribes say it amounts to an existential crisis.
In separate lawsuits filed this month, the Navajo Nation and Muscogee (Creek) Nation say the opioids crisis is stretching their budgets and resulting in an exodus of younger members, making it difficult to hand down traditions.
“A generation of children are going to grow up without their parents, and, for far too many, outside of the Navajo Nation the loss of their family and their culture will have a negative impact on their lives and on the vitality of the Navajo Nation as a whole,” said Navajo Nation Vice President Jonathan Nez.
It is so bad in Oklahoma that when Rep. Markwayne Mullin holds town halls, he ends up asking how many folks “haven’t” been affected.
“You won’t see a hand go up,” said Mr. Mullin, who has 19 Native American tribes in his district. “It’s devastating. You don’t have a single person, that I meet with, that doesn’t have a personal story or personal relationship [to addiction]. We’re seeing a dramatic increase in grandmothers and great-grandfathers and [great-]grandmothers raising children. You’re seeing homes devastated.”
Mr. Mullin, a Republican congressman and member of the Cherokee Nation, said there’s another danger from the sheer size of the problem: So many children are being with born with opioid withdrawal, and born to addicted parents, and there aren’t enough local homes to take care of them, forcing them to be displaced from the tribe.
“Beyond the heritage breakup, it’s the family breakup,” Mr. Mullin said, pointing to an office photograph of Indian-allotment land that’s been in his family for generations. “Indian Country, historically, has been very family oriented. We’re a very close-knit group.”
Hard-hit places in Appalachia and New England soak up headlines and bandwidth on opioids. President Trump highlighted the issue in New Hampshire during the 2016 campaign, and West Virginia is the focus of a House probe into “pill dumping.”
Yet the extreme poverty and isolation that fuels the addiction elsewhere has also left the American Indian community very vulnerable.
Federal data say the opioid overdose rate among American Indians is more than double or triple that of other minority groups, at 8.4 deaths per 100,000 people in 2014, compared to 3.3 among blacks and 2.2 among Hispanics or Latinos.
The overdose death rate among American Indians slightly edged that of whites — who saw 7.9 deaths per 100,000 — for all opioids, though the death rate tied to heroin alone came at a slower pace, at 3.7 compared to 4.4 for whites.
The rural American Indian population saw the largest percentage increase in deaths from 1999-2015 compared to any other racial and ethnic groups — a 519 percent increase.
“It just hasn’t been covered the same way yet by the press,” said Timothy Q. Purdon, who served as a U.S. attorney in North Dakota from 2010 to 2015 and is now representing the Standing Rock Sioux Tribe in its own lawsuit against opioid companies.
Heat maps of federal overdose data show struggles in Appalachia and pockets of the Northeast. Looking further west, it quickly becomes clear where the Indian reservations are: “They’re the ones that are bright red,” Mr. Purdon said.
Interior Secretary Ryan Zinke recently toured tribal lands to highlight the crisis and tout a joint task force that will interdict drugs headed for American Indian lands. It launched its first raids last month, seizing over $2.5 million in methamphetamine, heroin and other drugs.
“This administration has made combating the opioid epidemic a clear priority and the secretary is making certain this effort is executed on Indian Country,” said Interior spokeswoman Faith Vander Voort.
The Indian Health Service said it launched a committee, dubbed “HOPE,” in early 2017 to coordinate the response, is arming officers with overdose-reversing naloxone and updated a pain-management policy this year to align with the latest prescribing guidelines from the Centers for Disease Control and Prevention.
On Capitol Hill, Mr. Mullin is championing legislation that would allow tribes to compete for grant money directly from the federal government, rather than asking their respective states for a share of funding authorized by landmark legislation known as the Comprehensive Addiction and Recovery Act.
Major tribes, meanwhile, want a seat at the table as cities and states ask the opioid industry to pay a share of the tab.
“Tribes are sovereign. These are sovereign governments just like state governments,” Mr. Purdon said.
The Navajo filed suit in federal court in New Mexico against six companies in the opioid supply chain — Purdue Pharma, Endo Health Solutions Inc., McKesson Corporation, Cardinal Health, Inc., AmerisourceBergen Corporation, CVS Health Corporation, and Walgreens Boots Alliance, Inc.
Its complaint says distributors misstated or concealed the addictive risks of treating chronic pain with opioids, resulting in a high level of addiction and non-medical use of opioids. It also alleges the companies repeatedly failed to prevent diversion of pills to the street or failed to flag authorities about suspicious orders.
Among the defendants, CVS and Endo did not respond to requests for comment, while Walgreens said it does not comment on pending litigation.
Purdue Pharma said it’s trying “to be part of the solution,” saying its products account for less than 2 percent of opioid prescriptions, yet it developed three of the first four FDA-approved opioid medications with abuse-deterrent properties.
AmeriSource also said it is dedicated to doing whatever it can to decrease the diversion of prescription drugs, without interfering with clinical decision made by doctors.
The Healthcare Distribution Alliance, a national trade association whose members include Cardinal and McKesson, said the opioids crisis is a complex problem that requires “a collaborative and systemic response.”
“Given our role, the idea that distributors are responsible for the number of opioid prescriptions written defies common sense and lacks understanding of how the pharmaceutical supply chain actually works and is regulated,” said senior vice president John Parker. “Those bringing lawsuits would be better served addressing the root causes, rather than trying to redirect blame through litigation.”
The tribal nations suing, though, say something must be done.
They point to statistics showing American Indian youths are twice as likely as their white counterparts to abuse prescription opioids. Pregnant American Indian women are more than eight times as likely as white pregnant women to be diagnosed with opioids dependency or abuse.
“When you’re faced with a problem that affects all generations, that can lead to the death of the culture,” said Kevin Dellinger, attorney general for the Muscogee Nation, which filed suit April 3.
The National Indian Child Welfare Association says American Indian children are three times more likely to be removed by a state child welfare system than non-Native children, and more than half of adopted natives are placed in outside of their families and communities.
“It’s not the type of thing they can sustain over time,” said Richard Fields, an attorney representing the Cherokee Nation, which filed suit last year and is battling to hear the case in state court in Oklahoma.