Can naloxone help end overdoses in Indian Country?

WHITE EARTH RESERVATION, Minn. — She smokes cigarettes constantly. Her fingernail polish is flaking. She lives with her aunt and has pictures of Jesus on her walls. She wipes a spot of blood from her arm and drops a used needle into a red container embellished with a bright orange sticker bearing a biohazard symbol. Triina, 25, is an Ojibwe tribal member and was born and raised on the White Earth Reservation.

“I used to go hard and stay high for days and days,” said Triina, who agreed to be interviewed if her real name wasn’t used. “I don’t do it as much, and I don’t go as hard, and I don’t run like I used to. My body is not what it used to be.”

She crossed her legs on the edge of her bed and lit a cigarette, unsatisfied with her high. She couldn’t get her hands on heroin, her favorite drug, and settled for mainlining meth in the meantime. For Triina, drugs — from cocaine to heroin — can cost her a couple of hundred dollars a day.

“I do want to quit, and I am going to quit. I just don’t know when,” she said. “I don’t want to say, ‘I promise in three or four months I’m going to be sober,’ but hopefully I don’t OD before then, because the reality of this whole thing is always that.”

“Some of these reservations are millions of acres, and their law enforcement resources are stretched pretty thin,” Ellis noted. You’ve got a handful of officers trying to cover a large land base, which is a tremendous challenge.” Dr. Susan Karol, the IHS’ chief medical officer, agreed, saying, “Our highly rural locations make it hard for treatment to occur.”

Still, she is in favor of naloxone use.

“The fact that you can give naloxone at the scene immediately and then transport the individual from there to the next available facility actually saves you that hour or two it takes to get the individual from wherever they’re found to a medical facility for further care,” she said.

Another challenge facing the proposed delivery system is how little government funding is allocated to Indian Country. Congress sets funding for the BIA, and from 2014 to 2015, money for public safety and justice in Indian country increased from nearly $326 million to just over $328 million, with almost half of that allocated to criminal investigations and police services. Native Americans make up 0.9 percent of the U.S. population, or 2.9 million people. To put that into perspective, Chicago has a population of 2.7 million, and the Chicago Police Department has a budget of $1.2 billion.

“Additional funding from Congress, additional officers on the street would definitely enhance the program,” said Addington.

For some health experts, including Clinton Alexander, the program director of the Minnesota-based harm reduction program Sacred Spirits, a big-picture law enforcement strategy would also rethink approaches to addiction and arrest so that drug users wouldn’t have to fear police.

“If you and I are shooting up and you overdose and I know that cops are coming, then I’m out of there,” he said, referring to the fact that somebody found under the influence of drugs could be subject to criminal charges. “That’s what most people are doing. And if we’re waiting for law enforcement to administer [naloxone], that’s not effective. They’re not going to get there before they stop completely breathing.”