Research on a Great Lakes Indian Reservation: Prevalence of Oxycontin Use and Treatment Needs

1. 9• 16 • 11UMSARC Member Symposium SANDRA L. MOMPER, MSW, PhD Assistant Professor, University of Michigan School of Social Work Isabelle Kappeler, Research Associate Rebecca Cunningham, Research Assistant Research on a Great Lakes Indian Reservation: Prevalence of Oxycontin Use and Treatment Needs

2. 3.1 million people report being American Indian or Alaska Native (AI/AN) 4.9 million are AI/AN and another race and ethnicity About 33% under age 18; 26% is general population stats Median age is 29; 35 is general population stats (U. S. Census, 2009) The Population

3. Great Lakes Indian Reservation. 125,000 acres- 95% is wilderness. Tribe manages the lodge, casino, grocery store, gas station, social services, health center, housing, head start, community center, boys and girls club, fire station, recycling center, fish hatchery and legal departments. The Tribe

4. 7, 335 tribally enrolled members. 1,044 enrollees reside on the Reservation. Total of 2,738 residents. Tribal Community

6. Neighborhoods • Diaperville • Birch Hill • Old Odanah • New Odanah • Frank’s Field Diaperville Birch Hill Old Odanah New Odanah Frank’s Field

7. Dissertation mixed method study of gambling: results indicated a need to gather substance use data from tribal members (NIMH funded; 2005). Conducted exploratory focus groups (N=12) in the form of “talking circles” to gather data on gambling, alcohol, smoking, and drug use: results indicated a need to gather more data on Oxycontin use and abuse(UMTRN funded; 2007). Prior Studies

8. “There's more pills than anything around here than what it used to be 'cause everybody used to be into weed. But then it started to grow into pills and coke. What really got bad around here is Oxycontin, Vicodin” “It didn’t used to be—prescription drugs-but now it’s really, really bad” Talking Circle Comments

9. “Nowadays, people are really doing some bad things to get these prescription drugs…“You got people breaking into other people’s houses and threatening them--They’ll steal it.” • “Our tribal council passed a resolution that we're not allowed in our clinic (Indian Health Service) to write a prescription for anyone of those pain-killing medications, Oxycontin, we can't do it unless the person is terminal.” •  “I was going to school. I was supposed to graduate this year, but the pills and stuff--I just didn’t go all the time when I had pills and messed up.” More Comments

10. “People are buying them from people that are getting them. I don’t think that the people that get them are using them as much as those who don’t have a prescription.” • “We keep saying we're gonna quit. If we (our friend group) got together and said we're really gonna do this and like pulled together every day and just--we probably could do it. But it'd be hard. You know?” More Comments

11. Oxycontin is the strongest prescription painkiller on the market, Schedule II drug, meaning it has a high potential for drug addiction, only available by prescription (DAWN report, 2002). After introduction in 1996 sales increased such that by 2002 Oxycontin became the most frequently prescribed brand-name narcotic medication (e.g., over 300,000 prescriptions in 1996 vs. 7 million prescriptions in 2002) with sales of over $1 billion annually (GAO, 2003). Oxycontin Information

12. According to the Drug Abuse Warning Network, emergency room visits related to narcotic analgesic abuse have increased from 1999 to 2001 with a 186.3% mention of oxycodone abuse as the reason for the visit (Crane, 2003). New Mexico study between 2000 and 2005 reports an increase in death rates (325%) among female prescription opioid users (Shah et al., 2007). The Midwest, where this study occurred, is considered one of two rural regions of the U.S. which has the highest increase in the use of Oxycontin (U.S. Census, 2000b). Oxycontin Information (cont)

13. Tribal participants reported that some sources of Oxycontin were obtained from elderly and disabled members who were attempting to supplement meager incomes by selling part of their Oxycontin prescriptions for other’s non-medical use. These data are consistent with the reports of increases in diversion of Oxycontin prescriptions in poor rural areas as diversion is a source of income (Cicero et al., 2007; Hays, 2004; GAO, 2003). Oxycontin Information (cont)

14. “Oxycontin Use and Abuse on a Great Lakes Indian Reservation: Prevalence and Treatment Barriers” American Indians have higher rates of prescription drug use when compared to other races (SAMHSA, 2006). Little is known about Oxycontin use on poor rural Indian reservations. What is especially troubling is that only 10 (4% of all) American Indian or Alaska Native substance abuse treatment facilities offer Opioid Treatment Programs (SAMHSA, 2006). UMSARC Funded Study (2009)

15. To gather qualitative data from key informant interviews with providers services on the prevalence of Oxycontin use and abuse on this reservation as well as substance abuse services, barriers, and treatment needs. • To gather quantitative data from community members to gain insight into the prevalence of Oxycontin use and abuse within their families and the reservation community. Also, to gather data on existing substance abuse services, barriers and treatment needs. Specific Aims

16. Qualitative & Quantitative • Service Provider Interviews (N=10) • Community Survey (N=398) • Tribal members’ & providers’ views on substance use/abuse (Oxycontin). • Grounded Theory and content analysis approach (Neuendorf, 2002); codes, themes, and theories derived. • Quantitative analyses also. Methodology

17. Demographics -Interviewees

18. 1)High rate of Oxycontin use/abuse on the Reservation “It is a problem here on the reservation. …almost every new client that I get has got some history with Oxycontin or some type of narcotic.” “There’s lots of drug dealers here on the reservation that sell Oxycontin.” “I have responded to some deaths where the folks were narcotic prescription drug users.” Interview Themes/Illustrative Quotes

19. 2) Use of Suboxone as treatment for opioid withdrawal (mixed views) PROS “It prevents the withdrawal….that’s why people continue using opiates, because the withdrawal is so horrible.” “But I believe it gets…just gives people a chance to start making some sense of their lives….they also need to get into a program, and develop a new lifestyle, and go to AA.” Interview Themes (cont)

20. 2) Use of Suboxone as treatment for opioid withdrawal (mixed views) CONS “I see it as you’re just substituting one drug for another….I can’t understand the medical model. They’re saying, Well we have this abuse and why treat it with another…with the same thing?” “So how do we know what Suboxone does, and that it isn’t the same thing? That they’re just giving them something with a different name.” “I’m concerned about people that…a woman that was on it that’s in childbearing age…what happens if they conceive?” Interview Themes (cont)

21. 3) Need more money for substance abuse treatment “There’s got to be more programs like this for our Indian Health service….I think alcoholism and drug abuse is going to remain a problem until our funding agencies, our government takes a more active role…and that doesn’t only involve reservations, but all over.” “It has to have an extended period of follow up….something that everybody in that family is involved with….” “You need to have a mental health person on staff to do some therapy.” “I would like to see a center where there’s apartments….on the rez….have AODA workers, mental health case workers.” Interview Themes (cont)

22. 4) Need culturally sensitive treatment “It (a treatment group) doesn’t necessarily always have to be the topic of the night (substance use)…learn a new skill….braid sweet grass tonight.” “You know I’d like to see something like that (Indian culture, and spirituality) done closer….that would be ideal (to have on the reservation).” Interview Themes (cont)

23. Gathered data at various locations on the Reservation • Grocery Store • Elderly Center • Teen hang outs Elicited Tribal Members to “Get the Word Out” Survey Results

24. Survey Demographics (N = 398)

25. Oxycontin Users by Demographics

26. Problem of Selling and Using Oxycontin on the Reservation

27. Data confirmed high rate of Oxycontin use/abuse. Data much needed by tribal AODA and PI to pursue funding towards culturally sensitive treatment. Tribal community member input on survey implementation was integral in conducting culturally sensitive participatory research. Implications

28. Data shared with tribal AODA office. Designing a culturally appropriate intervention with AODA staff and tribe. Co-writing a NIDA grant to pilot an Reservation based intervention. Duplicate the intervention on other Reservations. Now What?

29. Miigwetch to tribal members, and the tribal Research Associate, Isabelle Kappeler. This study was supported by the University of Michigan Substance Abuse Research Center (UMSARC) grant# PG: U026036 and in part by the National Institute of Drug Abuse (NIDA) grant # 3 R01DA022720-02S2. Thanks to Rebecca Cunningham, RA, U of MI, SSW and Debbie Tauiliili, Data Analyst. Acknowledgements