Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives

Abstract

The U.S. is experiencing an alarming opioid epidemic, and although American Indians and Alaska Natives (AI/AN) are especially hard hit, there is a paucity of opioid-related treatment research with these communities. AI/ANs are second only to Whites in the U.S. for overdose mortality. Thus, the National Institute on Drug Abuse convened a meeting of key stakeholders to elicit feedback on the acceptability and uptake of medication assisted treatment (MAT) for opioid use disorders (OUDs) among AI/ANs. Five themes from this one-day meeting emerged: (1) the mismatch between Western secular and reductionistic medicine and the AI/AN holistic healing tradition; (2) the need to integrate MAT into AI/AN traditional healing; (3) the conflict between standardized MAT delivery and the traditional AI/AN desire for healing to include being medicine free; (4) systemic barriers; and (5) the need to improve research with AI/ANs using culturally relevant methods. Discussion is organized around key implementation strategies informed by these themes and necessary for the successful adoption of MAT in AI/AN communities: (1) type of medication; (2) educational interventions; (3) coordination of care; and (4) adjunctive psychosocial counseling. Using a community-based participatory research approach is consistent with a “two eyed seeing” approach that integrates Western and Indigenous worldviews. Such an approach is needed to develop impactful research in collaboration with AI/AN communities to address OUD health disparities.

A Call to Action: A Systematic Review Examining the Failure to Include Females and Members of Minoritized Racial/Ethnic Groups in Clinical Trials of Pharmacological Treatments for Alcohol Use Disorder

“…Further, some minoritized racial/ethnic group members may be less willing to participate in medication trials because there is a mismatch between cultural views regarding healing and medication treatments in general. For instance, American Indian individuals tend to report a desire for complete healing, which they define as including abstinence from all drugs and pharmaceutical medications (Venner et al, 2018). American Indian communities also tend to perceive randomized trials as unacceptable or unfair, as the control group individuals or communities are seen as receiving lesser care (Dickerson et al, 2020).…”

Building Outreach and Diversity in the Field of Addictions

“…A prime example of this is the work by Venner et al at the University of New Mexico. Applying a culturally appropriate lens to evidence‐based interventions such as Motivational Interviewing, this group has improved accessibility and acceptability of medication for addiction treatment (MAT) for addressing the disproportionate impact of substance use related health disparities in American Indian/Alaska Natives 9,10 . Further, within the ongoing opioid crisis, there continues to be decreased initiation and engagement of Black, Latinx, and Native American populations in medication treatment for opioid use disorder (MOUD), while all of these groups have increasing rates of opioid overdose deaths 11 .…”

Substance Use Research with Indigenous Communities: Exploring and Extending Foundational Principles of Community Psychology

“…Furthermore, limited treatment access, availability, and utilization among many Indigenous communities exacerbate SU problems (Gone & Calf Looking, ). Sociocultural vulnerabilities and limited treatment infrastructure have been a clear challenge for many Indigenous Nations in light of the recent opioid addiction epidemic, which has had a disproportionately negative impact on many Indigenous communities (Mack, Jones, & Ballesteros, ; Venner et al., ).…”