Principle 1

American Indian, Alaska Native, and other Indigenous communities throughout the United States have endured centuries of colonization and historical trauma resulting from governmental policies such as land theft, forced relocation, and the boarding school system (Gameon & Skewes, 2021; Grandbois & Sanders, 2009; Yamane & Helm,2022; Gonzalez, et al., 2022; Walters, et al., 2011). These attacks on Indigenous cultural practices, values, spirituality, and ways of knowing have disrupted our ways of taking care of ourselves and our communities (Grandbois & Sanders, 2009). Many Indigenous communities are on paths of rebuilding these cultural connections, which include a variety of cultural practices unique to each tribe (Yamane & Helm, 2022; Rowan, et al., 2014). These practices may include participating in ceremonies, practicing cultural and traditional artwork, engaging in traditional food gathering, connecting with the lands and waters, and hosting drumming groups, among others. Cultural and traditional practices have supported Indigenous communities in maintaining health even amidst collectively experienced trauma and harmful events (Bourke, et al., 2018; Gonzalez, et al., 2022), and continue to support communities through the opioid overdose crisis (ICAD, 2019). The opioid and overdose crises affect tribal community members physically, emotionally and spiritually, and we encourage investment in cultural reclamation and revitalization, the passing of traditions and ceremonies to the next generations, and honoring, recognizing and upholding Indigenous cultural, traditional, and experiential knowledge.

Indigenous culture is medicine, treatment, and well-being (Bassett, et al., 2012). Yet, the legacy of colonization and resulting stigmas surrounding substance use mean that not all Indigenous peoples are able to engage with traditional and cultural ways. There is a need to ensure access to cultural practices, healing, and teachings among all Indigenous Peoples, including those who abstain from substance use, are using substances, or changing their patterns of substance use. We are all on a healing journey and deserve access to cultural teachings and traditional activities that will support wellbeing.

Guidelines for how the tribal opioid settlements can be spent have been created by the Tribal Settlement Trust Directors. These guidelines are called the Approved Uses, which strongly emphasize the need for funding American Indian and Alaska Native cultural teachings and traditional activities; pages 18-20 of the Approved Uses document include a section dedicated to ‘Tribal Abatement Strategies’ (Section D). The Approved Uses document cites support for “culturally appropriate activities, practices, teachings or ceremonies” and includes five main sections: traditional activities associated with cultural identity and healing; culturally competent integrated treatment models; culturally grounded community prevention; peacekeeping and wellness courts; and community workforce development and training. Specific examples of these activities are provided within this Tribal Abatement Strategies document, and while it is not an exhaustive list, it provides a variety of examples of potential cultural and traditional activities that a tribe may consider supporting. These include working with traditional healers, spiritual healers, and practitioners in healing, participating in sweat lodges, and investing in cultural and linguistic immersion programs.

How can tribes adopt this principle?

1. Use the Tribal Abatement Strategies to craft spending plans that include cultural and traditional activities for prevention, harm reduction and treatment services, programs and approaches for opioid use.

In the spirit of supporting cultural and traditional healing in tribal communities, funds can be allocated to activities such as: cultural practices that bring people families and communities together to learn about opioid prevention, harm reduction and treatment, to weave prevention, harm reduction and treatment messaging into cultural practices where appropriate, and to support individuals impacted by opioid use on their healing journeys. Specific examples drawn from existing literature, tribal programs and comments from listening sessions can be found here.

2. Allocate funds toward researching and documenting wise practices.

We know that many tribal communities lack access to high quality data. Some communities have high-impact, culturally-grounded, substance-use related programming available in their community, but do not have this work documented or evaluated so that they can share with other communities.

3. Utilize different types of evidence when creating opioid-spending plans (e.g. cultural, experiential, academic, etc.) and build evidence-base with data sovereignty principles.

Given the lack of access to data, it is important that we use the evidence that we have and invest in building out our evidence-base. We can do this through investing in tribal public health research and surveillance, including evaluating promising practices centered in Indigenous ways of knowing. This work must be conducted with principles of data sovereignty in mind as data play a role in “advancing Indigenous innovation and self-determination” as described by the CARE Principles for Indigenous Data Governance. In addition to academic research, we can also incorporate the cultural knowledge that tribal communities have, and the experiential knowledge we have gained through surviving throughout this opioid crisis.

References