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Working with Nevada Tribal Community to Expand MAT

The Opioid Response Network (ORN) is working with Nevada and its tribal communities to expand the use of medications for addiction treatment (MAT) in its tribal communities with a goal of long-term sustainability.

STR (States Targeted Response) and SOR (State Opioid Response) Project Manager Michelle Berry submitted a request to the ORN soon after the grant was launched in May 2018. Since then, ORN has been working with the Nevada team to facilitate a series of trainings about MAT throughout Nevada with tribal leaders, the medical community, law enforcement and first responders. (you can’t say MAT trainings as that implies waiver for many)

“We really wanted anyone who is engaged with this population to be there just so they could have a good grasp of what MAT is and how it works,” STR/SOR Project Coordinator Morgan Green said. “It was really nice to see that broad range across the community brought together to learn about this approach”

Tribal communities have been hit particularly hard in the opioid crisis. According to the National Institutes of Health, “American Indians and Alaska Natives (AI/AN) have been significantly impacted by the opioid crisis, with AI/AN and Non-Hispanic Whites having the highest rate of overdose deaths and diagnosis for OUD. AI/AN had the highest drug overdose death rates in 2015, were second to Whites in 2017, and had the largest percentage change increase in the number of deaths from 1995 to 2015.”

Working within the tribal communities can be extremely rewarding but at times challenging. Each community has its own values, beliefs, and traditions—and at times do not support the use of medications in treatment. Tribal communities face unique barriers to treatment, as they may be quite isolated, even urban centers, and have cultural beliefs that must be considered, Green noted. Some tribes’ “cultural beliefs have traditionally been against the idea of introducing a separate medication because it could compromise the purity of the spirit. You need to treat the spiritual side of someone, not just the medical or behavioral.” This approach emphasizes the need of providing an integrated care approach and building a more robust behavioral health infrastructure. One of the most significant missing components for many tribes is a lack of behavioral health resources, she said.

Green pointed out that one of the most critical parts of going into a tribal community is to find a strong local advocate who can help facilitate the process. Within Nevada they have been fortunate to identify an advocate who has been a member of one of the local tribes who sits on the statewide Tribal Consultation as well as directors of some of tribal clinics. Having strong advocates within the tribal communities is valuable to provide both important feedback and awareness of needs within the community as well as a valuable voice to peers. This helps jump start the conversation about the use of evidence-based practices in treating addiction and specifically the effectiveness and need for medications in treating opioid use disorders. “What we have learned is that it is critical to go into the communities as a partner who is ready to work side-by-side with the community to meet their needs and not push our own agenda,” Green said.

While opioid prescribing has dropped markedly in recent years—as much as 50 percent—substance use disorders continue to plague all populations in Nevada, Green said. Methamphetamine is a growing problem, as is fentanyl, which is now often being found laced in meth. ”Our goal is to provide resources that the various tribes will find valuable and they can tailor to their particular needs.”

The ultimate goal of the meetings on MAT is to increase knowledge, access and availability for treatment for those who are struggling with OUD in these communities and increase the number of clinics that offer evidence based clinical practices. “Every single tribe is a little bit different and they all have different needs,” Green said. “We’re trying to provide the opportunity. I think that’s what has been lacking for these communities.”

If you want to plan a training about MAT in your community, please submit a request at www.opioidresponsenetwork.org. A TTS will respond within one business day.