On December 16, 2021, Senator Warren (D-MA) and Representative Maloney (D-NY) reintroduced the Comprehensive Addiction Resources Emergency (CARE) Act (S. 3418/H.R. 6311). The CARE Act addresses the substance use epidemic by providing state and local governments with $125 billion in federal funding over ten years, Of the nearly $1 billion, the CARE Act sets aside $150 million a year in funding to Native non-profits and clinics, including to urban Indian organizations, Native Hawaiian organizations, and projects designed to test innovative service delivery and culturally informed care models to tackle addiction.

NCUIH worked closely with Congressional leaders to ensure the inclusion of urban Indians in this important legislative response to the Nation’s substance use epidemic and is pleased to endorse this bill. The bill was originally introduced in 2018 and is currently endorsed by over 175 national, local, and tribal organizations. In the Senate it was referred to the Committee on Health, Education, Labor, and Pensions. In the House it was referred to the Committee on Energy and Commerce, in addition to the Committees on Natural Resources, the Judiciary, and Oversight and Reform. It currently awaits further consideration.

“Many times, critical funding, even when appropriated in equitable amounts, does not reach across AI/AN urban communities, largely in part because when urban Indians are not specifically mentioned in legislative language they are most often excluded or forced to prove their eligibility under the intent of the laws created. NCUIH appreciates that the CARE Act has detailed specific language that ensures urban Indian organizations are listed as an eligible entity in this important legislative act,” wrote Francys Crevier (Algonquin), CEO of the National Council of Urban Indian Health (NCUIH).

Additional Information about the CARE Act

• Bill Text
• Press Release

Additional funds from the $1 billion include $790 million per year for grants to Tribal governments to help fight this crisis and invest in substance use prevention and treatment; $7.5 million in additional funding for Tribal nations and regional tribal epidemiology centers to improve data collection on overdoses; and 50 million a year to Tribal Colleges and Universities, Indian Health Service-funded organizations, and medical training programs that partner with Tribal nations and Tribal organizations to train Native health professionals to improve substance use disorder treatment services. This Act also provides $1 billion per year to expand access to the overdose reversal drug, Naloxone, to states to distribute to Tribal nations, first responders, public health departments, and the public.

Background

to the Indian Health Service, the opioid crisis and COVID-19 pandemic are intersecting with each other and presenting unprecedented challenges for American Indian and Alaskan Native (AI/AN) families and communities. Because of the pandemic, substance and opioid use and fatalities have significantly increased in low-income communities.

AI/ANs continue to be deeply impacted by the opioid crisis and continue to see an overwhelming increase of deaths, addiction, and overdoses above the National average. AI/ANs had the second-highest rate of opioid overdose out of all U.S. racial and ethnic groups in 2017, and the second and third highest overdose death rates from heroin and synthetic opioids, respectively, according to the Centers for Disease Control and Prevention.

Since 1974, AI/AN adolescents have consistently had the highest substance abuse rates than any other racial or ethnic group in the U.S. Staggering statistics such as these do not happen overnight, they are the direct result of intergenerational trauma caused by adverse childhood experiences such as alcoholism, drug abuse and domestic violence in a family, emotional neglect, incarceration of a family member, and physical or sexual abuse— which are known to lead to a higher risk of addiction and other behavioral and mental health problems later in life.

Unfortunately, the majority of the nation’s AI/ANs living on and off reservations have limited access to substance abuse services due to transportation issues, lack of health insurance, poverty, inadequate healthcare facilities and a shortage of appropriate treatment options in their communities. Some of the disparities in treatment that occur within the AI/AN population can be resolved through increased availability of culturally sensitive treatment programs. Studies have shown that cultural identity and spirituality are important issues for AI/ANs seeking help for substance abuse, and these individuals may experience better outcomes when traditional healing approaches (such as powwows, drum circles, and sweat lodges) are incorporated into treatment programs.

On December 23, 2021, the National Council of Urban Indian Health (NCUIH) submitted comments to the Department of the Interior (DOI) regarding the agency’s Federal Boarding School Initiative (Initiative). NCUIH reiterated its ongoing support for the Administration’s efforts to address the legacy of boarding school programs, while urging the Administration to use the Initiative to address the public health impact of boarding schools on urban American Indian and Alaskan Natives (AI/ANs). NCUIH emphasized the importance of studying not only the impact of boarding school programs for survivors, but also the lasting impact of the intergenerational trauma caused by boarding schools within urban AI/AN communities.

Background

On June 22, 2021, DOI Secretary Haaland issued a memorandum directing DOI to prepare a report addressing the “intergenerational trauma, cycles of violence and abuse, disappearance, premature deaths, and other undocumented bodily and mental impacts.” This Initiative came weeks after the discovery of 215 Indigenous children’s remains were found at a boarding school site in Canada. Secretary Haaland noted that to “promote spiritual and emotional healing in [AI/AN] communities, we [DOI] must shed light on the unspoken traumas of the past…no matter how hard it will be.”

Boarding schools and residential schools are a tragic thread in history that the United States and Canada share: The United States Government Indian Boarding School Policy authorized the forced removal of hundreds of thousands of Native children, as young as 5 years old, relocating them from their homes in Tribal communities to one of the 367 Indian Boarding Schools across 30 States. Between 1869 and the 1960s, the United States federal government stole Native children from their families to destroy their indigenous identities, beliefs, and traditional languages to assimilate them into white American culture through federally funded Christian-run schools.

NCUIH’s Role

Following Secretary Haaland’s memorandum, NCUIH issued a statement commending Secretary Haaland for beginning the process of holding the United States to account for the effects of its boarding school policy.  NCUIH also reiterated its support of the Initiative’s ability to address Indian Country’s historical trauma. NCUIH recognizes the deeply sensitive and emotional impact that federal boarding schools have on the AI/AN community at large, including the continued impact on the many UIOs we serve and their constituents. NCUIH exists, in part, because of the historic oppression of the AI/AN population including federal boarding schools that resulted in the growing AI/AN populations in cities.

Additionally, NCUIH endorsed the Truth and Healing Commission on Indian Boarding School Policies in the United States Act. This bill would create a Truth and Healing Commission on Indian Boarding School Polices in the United States. The Commission will provide a space for AI/AN people to speak about their personal experiences in government-run boarding schools and allow them to provide recommendations to the government. NCUIH is in full support of this Commission and hopes to see DOI establish a similar commission in the Initiative that includes a UIO representative to represent AI/ANs who reside in urban settings.

Importance of Including Urban Indians in the Initiative

In its comments, NCUIH urged DOI and the Administration to address the ongoing effects of Indian boarding schools on AI/AN health.  Specifically, NCUIH requested that DOI incorporate the following items into the Initiative:

• Partner with AI/AN organizations, including UIOs, to fully study and understand the impact of boarding school trauma and assist survivors in healing from this trauma.
• Study the lasting impact of boarding school policies, including intergenerational trauma, on the social determinants of health of contemporary AI/AN communities, including those in urban areas
• Include the UIOs representing the seventy percent (70%) of AI/ANs living in urban areas in DOI’s process through urban confer
  • NCUIH’s comments recognized the importance of Tribal sovereignty and the government-to-government relationship as vital to the Initiative, but noted failure to include UIOs in consultation will leave a significant portion of the AI/AN population without a voice
• Ensure a comprehensive assimilation of data by making all AI/AN communities true partners in the Initiative.

The DOI report on the investigation is scheduled to be finished in April 2022. NCUIH will remain close to the investigation and monitor for updates. NUCIH will also continue to advocate for the inclusion of UIOs in the process and encourage DOI to incorporate a study of the impact of the boarding schools on urban AI/AN health into the Initiative.

On November 29, CDC strengthened its recommendations on who should aim to complete a booster dose of the COVID-19 vaccine. This new recommendation urges that everyone ages 18 and older should receive a booster at least 6 months post completion of a 2-dose regimen, or 2 months post a single dose inoculation.

With the emergence of the Omicron variant, the importance of vaccination, and the use of boosters, as a prevention method is even more important. CDC Director, Dr. Rochelle Walensky also encouraged those who are unvaccinated to change that as soon as possible. Dr. Walensky also highlighted the importance of getting tested should you experience symptoms.

For more information, the Coronavirus Resources Center on the NCUIH website includes links to any recent guidance  or updates from federal agencies about COVID-19.