New Brookings Report Underscores Need for Data, Funding, and Medicaid Reforms to Address Fentanyl Crisis in American Indian and Alaska Native Communities

On December 4, 2024, the Brookings Institution published their report, The Impact of Fentanyl on American Indian and Alaska Native Communities. This report analyzes how American Indian and Alaska Native (AI/AN) communities are harmed by the fentanyl crisis and highlight policy failures that have led to a disproportionate impact on AI/AN populations. The purpose of the report is to explore the factors that contribute to fentanyl use by AI/AN populations to then inform Congress, federal agencies, states, and Native nations how to respond to and treat substance use.

Disproportionate Fentanyl Overdose Rates Among AI/AN Populations

The report highlights how AI/AN communities have been uniquely impacted by the fentanyl crisis. For example, the highest rate of U.S. age-adjusted fatal drug overdoses in 2020 and 2021 were among AI/AN populations, at 42.5 and 56.6 deaths per 100,000 respectively. In 2022, the age adjusted fatal drug overdose rate for the AI/AN population was 65.2 drug deaths per 100,000, a rate over twice as high as the national average of 32.6 per 100,000.  The report states that while this data is devastating, it is likely insufficient and inaccurate due to racial misclassification and data suppression and highlights that more AI/AN relevant data is necessary to improve policies intended to address drug-related mortality in AI/AN populations and save lives.

Need for Data, Funding, and Medicaid Reforms

Additionally, the report notes the need for evidence-based explanations for the disproportionate harm in AI/AN communities. However, it’s mentioned that even when Native nations and tribal organizations engage in reducing drug related harms, there are structural and funding barriers that prevent them from asserting self-determination and providing the necessary care or interventions. The federal barriers identified are lack of collaboration on Medicaid policy, restrictions on Medicaid reimbursement, and insufficient funding for IHS. The report also highlights the need to look into contributing factors and public health crises (i.e. suicide) that impact death and overdose rates.

Policy recommendations are provided to overcome the barriers identified. The key areas discussed in the report include:

  • Expand funding for data collection and analysis of the fentanyl crisis’s impact on AI/AN communities
  • Additional funding for tribal treatment and prevention programs, including culturally tailored treatment options
  • Health care and insurance regulatory reforms to improve access to treatment for AI/AN patients and to improve quality of treatment for substance use disorders available to AI/AN communities
  • State-level assessments to identify barriers faced by AI/AN communities in relation to education, health care, and justice for AI/AN populations with collaborations formed between tribal, state, and federal governments to address the root causes of health-related disparities

Recommendations specific to UIOs are under the topic of “health care and insurance regulatory reforms:”

  • Native nations, IHS, and UIOs not be subject to the “four walls” interpretation (42 CFR § 440.90), which restricts reimbursement for services performed in community settings.
  • CMS should create a pilot program that waives restrictions on Medicaid reimbursement for services provided to incarcerated AI/AN persons by Native nations, IHS, and UIOs.
  • HHS should offer technical assistance and financial support to Native nations and UIOs to expand capacity to offer community-based health care services.
  • CMS should make it a priority to reform how Native nations, IHS, and UIOs receive reimbursement to cover all forms of treatment offered, consistent with tribal determinants of health.

This report can be utilized as an educational tool by those within AI/AN communities, including those in urban areas. The recommendations provided would allow UIOs the ability to expand their efforts and be provided additional funding or resources to address substance use, notably in combating the fentanyl crisis.

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PRESS RELEASE: National Council of Urban Indian Health Announces New Partnership with Alzheimer’s Association

National Council of Urban Indian Health Announces New Partnership with Alzheimer’s Association

FOR IMMEDIATE RELEASE

Washington, D.C. (December 5, 2024) – The National Council of Urban Indian Health (NCUIH) and the Alzheimer’s Association recently announced a new partnership aimed at promoting brain health and increasing support for American Indian and Alaska Native (AI/AN) people living in urban settings affected by Alzheimer’s and other dementia. NCUIH and the Alzheimer’s Association will work together to engage urban AI/AN communities to raise concern and awareness of Alzheimer’s disease and all other dementia and to provide care, support, and information about advance care planning for the people impacted by dementia.

“Our partnership with the Alzheimer’s Association aims to provide vital support to American Indian and Alaska Native communities facing the challenges of dementia,” said NCUIH CEO Francys Crevier, JD (Algonquin). “This collaboration underscores our shared commitment to culturally tailored resources and services that honor Indigenous peoples’ unique traditions, experiences, and resilience. Together, we are working to ensure that no elder or family feels alone in navigating this journey.”

AI/AN individuals are more likely to develop Alzheimer’s or other forms of dementia than white Americans, yet they often have less access to health services and timely diagnosis. Twenty-seven percent of AI/AN individuals live in poverty, proportionately more than any other group and double the rate of 14 percent of Americans generally.

“We are delighted to collaborate with the National Council of Urban Indian Health to extend our outreach to American Indians and Alaska Natives living in urban settings,” said Dr. Carl V. Hill, chief diversity, equity and inclusion officer at the Alzheimer’s Association. “This partnership will enable us to provide essential disease-related information, care, and support resources while encouraging increased participation in Alzheimer’s and dementia research.”

Along with the partnership, the Alzheimer’s Association will offer educational programs and webinars to urban AI/AN communities. It will work to connect affected individuals and families in these communities to care and support resources, including the Association’s free 24/7 Helpline, referrals to local resources, and care consultation. In addition, the Alzheimer’s Association will sponsor and participate in NCUIH’s 2025 annual conference in Washington, D.C., on April 22-24, 2025.

About NCUIH

The National Council of Urban Indian Health is a national representative advocating for the 41 Urban Indian Organizations contracting with the Indian Health Service under the Indian Health Care Improvement Act. NCUIH is devoted to the support and development of quality, accessible, and culturally competent health and public health services for American Indian and Alaska Native people living in urban areas.

NCUIH respects and supports Tribal sovereignty and the unique government-to-government relationship between our Tribal Nations and the United States. NCUIH works to support those federal laws, policies, and procedures that respect and uplift Tribal sovereignty and the government-to-government relationship. NCUIH does not support any federal law, policy, or procedure that infringes upon or in any way diminishes Tribal sovereignty or the government-to-government relationship.

About the Alzheimer’s Association

The Alzheimer’s Association is a worldwide voluntary health organization dedicated to Alzheimer’s care, support, and research. Our mission is to lead the way to end Alzheimer’s and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Our vision is a world without Alzheimer’s and all other dementia®. Visit alz.org or call 800.272.3900.

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NCUIH Contact: Meredith Raimondi, Vice President of Policy and Communications, mraimondi@ncuih.org

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Culture is medicine. People are medicine.

Front entrance to the Urban Indian Center of Salt Lake in Salt Lake City, Utah.

Front entrance to the Urban Indian Center of Salt Lake in Salt Lake City, Utah.

About the Urban Indian Center of Salt Lake

Established in 1974, the Urban Indian Center of Salt Lake (UICSL) provides care for the American Indian and Alaska Native (AI/AN) communities in the greater Salt Lake City area. Their extensive list of services includes medical, behavioral health, social, and Traditional Healing programming. Demonstrated throughout the programming at UICSL, community and cultural connections are focal points for wellness and healing. The strength found in cultural identity, and the bonds people create with each other are fundamental aspects of these programs and within Indigenous concepts of health.

Clinic and behavioral programs notice board highlighting different events and resources for UICSL patients.

Clinic and behavioral programs notice board highlighting different events and resources for UICSL patients.

Kristie, a registered dietitian, and Allyson, a therapist, presented on UICSL’s Traditional Healing programming with NCUIH at the Association of American Indian Physicians (AAIP) conference in the summer of 2024.

Given that the Salt Lake City AI/AN community consists of members from many different Tribes, UICSL consciously allows everyone to practice their specific traditions and does not enforce the practice of any one tradition. For instance, some patients are court-mandated to attend UICSL programs who may or may not be comfortable practicing another Tribe’s tradition or customs. UICSL is mindful of making space for people to receive care in a method best suited for their background and comfort.

Special Diabetes Program for Indians (SDPI) Activities:

UICSL’s Special Diabetes Program for Indians (SDPI) incorporates standard medical interventions, nutrition, and traditional practices to best treat the patient, their community, and their needs.

A drum from the Calling Back Our Spirit workshop (Photo credit: UICSL).

A drum from the Calling Back Our Spirit workshop (Photo credit: UICSL).

The UICSL fitness program “In the Steps of Our Ancestors” is a running and walking group for all ages and all levels that runs regularly at the SLC Olympic Oval, rain or shine, as part of their SDPI program activities. This running group helps improve fitness and enhances participants’ social bonds and community connections. Participants might start barely able to finish one lap around the track but eventually, over time, go on to complete 5k races. The running groups create a sense of camaraderie where participants push each other to finish and cheer them on. Outside of the “In the Steps of Our Ancestors” group, UICSL offers an on-site gym with a physical trainer on staff. They conduct gym sessions and other exercise activities like All Nations Yoga in the park, archery, Zumba, Fitness Thursdays with an Indigenous focus, etc.

UICSL also offers cooking classes under SDPI to highlight the benefits and increase the consumption of more Traditional Foods. UICSL staff stress the importance of mindset when harvesting, preparing, and cooking with their patients so that the best intentions go into preparing nourishing meals. These cooking demonstrations happen on-site in the UISCL kitchen, and the produce is often sourced from a nearby community garden. UICSL partners with chefs from various Tribes, allowing for a multi-Tribal approach. These partnerships allow greater freedom for UICSL, the chef, and the participants in what is considered Traditional Foods and create a broader representation of cultural and Tribal traditions for the over 250 cooking class participants.

Overall, food is a focal point for the community at UICSL. They often hold highly attended feasts for their community and recently initiated a food voucher program, providing pre-loaded grocery cards to patients to alleviate some financial hurdles around regularly accessing healthy produce.

Other Traditional Healing Programs:
A ribbon tote bag created during the Reaching Out to Relatives support group (Photo credit: UICSL).

A ribbon tote bag created during the Reaching Out to Relatives support group (Photo credit: UICSL).

While many Traditional Healing programs fall under the SDPI umbrella, UISCL offers a variety of other programming that incorporates Traditional Healing to help address issues within the community. “Calling Back Our Spirit” utilizes the story of the drum and the traditions of drum making, drumming, and music to support intensive or general outpatient treatment for individuals with substance use disorder. The “Reaching out to Relatives” program illustrates the importance of connecting with oneself, one’s community, and cultural identity to promote mental health and larger healing. The community mental health support group teaches participants traditional crafts and the history behind their creations. The Medicine Pouch program is a community workshop for participants to learn more about traditional medicines and traditional wellness practices to utilize in their own lives. Participants craft medicine pouches and focus on creating positive experiences and maintaining balance throughout their lives through Indigenous frameworks.

Modern popular activities that promote happiness and wellness, such as gratitude, journaling, exercise, acts of kindness, and meditation, embody fundamental aspects of Indigenous views of health and wellness. UICSL helps promote these Indigenous practices through their programming to strengthen their community. For example,

  • Gratitude → offerings, ceremonies
  • Journaling → art, jewelry, songs
  • Exercise → dance
  • Acts of kindness → giveaways, gifting
  • Meditation → sweat lodge, prayer

In September 2024, UICSL celebrated its 50th anniversary by opening the doors to its new site in Murray, Utah, expanding its available services for patients! Future plans for UICSL include expanding its food prescription program, expanding staff, developing a nearby empty lot into a community garden, and opening an on-site pharmacy. For more information on UICSL, please visit https://uicsl.org/.

To see slides from the presentation, click here.

NCUIH and UICSL after their AAIP presentation. From left to right: Allyson Shaw, LCSW (UICSL), Kristie Hinton, R.D. (UICSL), Ryan Ward, MPH (UICSL) , Nahla Holland (NCUIH), Alexandra Payan, J.D. (NCUIH).

NCUIH and UICSL after their AAIP presentation. From left to right: Allyson Shaw, LCSW (UICSL), Kristie Hinton, R.D. (UICSL), Ryan Ward, MPH (UICSL) , Nahla Holland (NCUIH), Alexandra Payan, J.D. (NCUIH).

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