The Red Lake Nation Government Center. Photo by Max Nesterak/Minnesota Reformer.
REDBY — Whenever his phone rings in the middle of the night, Red Lake Nation Chairman Darrell Seki Sr. fears it’s because a loved one has overdosed.
Probably everyone on the reservation knows someone who’s died from opioids. It’s becoming increasingly common despite the tribe’s best efforts to bust dealers and channel users into treatment.
“We’ve been trying everything possible to stop this. But something is missing. We’re doing something wrong,” Seki told an audience of more than 100 people earlier this month at a summit tribal leaders convened to confront the opioid crisis.
“What is it that we have to do to stop this?” Seki asked.
The growing powerlessness tribal leaders feel with each funeral has forced them to consider a harm reduction approach — once too controversial to discuss — that focuses on minimizing the risks of drug use, while accepting that it will happen.
Harm reduction includes strategies like decriminalizing paraphernalia, creating safe injection sites, granting amnesty to people who call 911 for an overdose, providing clean needles and distributing the drug naloxone (or Narcan), which now routinely saves people from dying from overdoses. Canada, a leader in harm reduction, has even begun funding programs that provide prescription opioids to long-term users to offer a safer alternative to street drugs.
The recent Emergency Zhawenimin Opioid Summit — meaning “compassion” and “unconditional love” in Ojibwe — brought together tribal leaders and addiction experts as well as law enforcement leaders, state government officials, correctional officers and treatment patients.
The day-long summit was the first in a series of meetings the tribe plans to host in the coming weeks to craft a comprehensive plan to address the opioid epidemic based on a compassionate, public health approach. The tribe is seeking feedback from active drug users in addition to people in recovery and other community members.
“We have to be open-minded and look at the statistics of what works and what doesn’t,” said Red Lake Tribal Secretary Sam Strong. “Locking them up, throwing away the key does not work. That cycle of recidivism and addiction and the harm that it causes to our community unequivocally does not work.”
The opioid epidemic, supercharged in recent years by the rise of fentanyl, is growing deadlier. Drug overdose deaths hit a record high in Minnesota in 2021, with fentanyl involved in nearly 60% of the 1,500 overdose deaths.
The devastation the drug has wrought on Native populations has been particularly severe. Native people in Minnesota died from drug overdoses at a rate more than nine times that of white residents.
Fentanyl is approximately 50 times stronger than heroin and often cut into other drugs to increase potency, leading unsuspecting users to overdose. Increasingly, drug users seek out fentanyl for its cheap, powerful high despite the deadly risks.
At the same time, alcohol remains a persistent problem. Rather than be supplanted by opioids, alcohol deaths are increasing alongside drug overdoses and account for nearly as many Minnesota fatalities as drugs. As with opioids, Native Americans are by far the most likely of any group to die from alcohol-driven deaths, at seven times the rate of white residents.
Although Native Americans have long been stereotyped as genetically predisposed to alcoholism, research suggests underlying factors tied to poverty — including childhood trauma, homelessness and lack of access to quality health care — drive the disparities in addiction and drug abuse just as they do with other health ailments.
Embracing harm reduction requires conceding that opioids are here for the long-term and won’t be eradicated with the next sting operation or by getting every person with drug addiction into treatment.
“It’s hard to accept that,” Adam Fairbanks, a White Earth member and harm reduction consultant, told the audience. “Accepting that drug use is part of our world is really difficult.”
Fairbanks said punitive approaches like banishing members from the reservation backfire by pushing drug use underground and severing connections that are crucial to helping users stay safe and access treatment when they’re ready.
But creating programs to help drug users — including those who have no intention of getting sober — will likely face resistance from those who fear it will only worsen the epidemic by enabling users to harm themselves and the community.
Harm reduction proponents say that fear is misplaced, and that their strategies won’t just help drug users but also the people around them.
For example, decriminalizing paraphernalia may shield a drug user from a criminal charge but it also eliminates the incentive to litter used needles, which children can find in parks or on the side of the road.
A safe injection site may enable drug users to consume, but it also provides them somewhere to use away from children and relatives who don’t want to be around drugs. Research on safe injection sites — mainly conducted in Vancouver and Sydney — suggests providing a place for drug users to consume under medical supervision reduces overdoses and public use without increasing crime in the surrounding area.
Seki, the tribe’s chairman, said his priorities are building a sober house on the reservation and a detox facility to send people to instead of jail. He said he’s not sold on a safe injection site.
“I got to think about that… because that’s promoting what we’re trying to stop,” Seki said in an interview.
Red Lake has already adopted some harm reduction strategies in recent years, which were also initially met with skepticism. There is a needle exchange program on the reservation as well as Narcan distribution.
The tribe started a medicinal marijuana program, which offers an alternative to opioids for some pain management, and on Tuesday, the tribe will begin selling recreational marijuana. Alcohol remains prohibited on the reservation.
Red Lake also has a medication assisted treatment program using buprenorphine and naloxone (commonly known by the brand name Suboxone), which diminishes or even eliminates withdrawal symptoms and cravings.
That program, launched in 2016, faced initial resistance from people who thought abstinence was the only way to recover from addiction. They pointed out that people often stay on suboxone for years and even indefinitely. The skeptics have since been convinced of its effectiveness by seeing those on suboxone lead healthy lives, Strong said.
“It’s taking time for us to even embrace suboxone and some harm reduction methodologies, but we’re embracing it and we’re changing,” Strong said.
In 2019, Red Lake Nation opened Obaashiing Treatment Center in Ponemah, the tribe’s first in-patient treatment center with suboxone on site. The center is rooted in Ojibwe culture and spirituality and has a sweat lodge outside, a craft room to bead and make moccasins, and Ojibwe language instruction.
Betty Kimbrell, Red Lake band member and Obaashiing patient, said even she was skeptical of suboxone at first.
“My first thought was like, I’m just replacing one for another,” Kimbrell said. “But then I learned it’s not just a replacement.”
Kimbrell says she supports the tribe’s shift toward harm reduction, and says it should start by reviewing its codes and dropping the ban on paraphernalia.
Joshua Needham, another Red Lake band member and treatment patient, also supports legalizing paraphernalia and distributing Narcan. He said he’s used it at least 20 times to help other people and it’s saved his life.
Red Lake’s move toward harm reduction is part of a national trend and coincides with Minnesota’s massive shift in approach to drugs.
Earlier this year, the state Legislature legalized safe injection sites and possession of drug paraphernalia including needles and fentanyl test strips, while also increasing penalties for selling fentanyl.
The state budget includes over $200 million to address substance abuse by funding treatment facilities, housing for people exiting correctional facilities and peer recovery programs.
Beltrami County Sheriff Jason Riggs, who attended Red Lake’s opioid summit, said he’s trying to keep an open mind about harm reduction because he knows from his 22 years in law enforcement that simply arresting people hasn’t worked.
“We’ve got to come up with something else,” Riggs said.
As for legalizing paraphernalia and safe-injection sites: “I’ve got some mixed feelings about that, but I’m willing to see what it’s going to do,” Riggs said.
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