Browning, Mont. – When the epidemic began in the summer of 2020, Justin Lee Littledog called his mother to tell her he was returning home from Texas to the Blackfit Indian Reservation in Montana with his girlfriend, step-son and son.
They moved with his mother, Marla Olinger, to a 300-acre farm in Rolling Prairie outside Browning, and Olinger remembers it as the best summer of his life. “I first met my first grandson, Arlene,” Olinger said. Soon another grandson was born, and Littledog found a maintenance job at Browning’s casino to support his growing family.
But over the next year and a half, things began to unravel. Friends and relatives have spotted Littledog’s 6-year-old stepson wandering the city alone. One day, Olinger received a call from her youngest son as a Littledog baby was crying in the background. He was briefly unable to wake up Littledog’s girlfriend.
Olinger asked Littledog if he and his girlfriend were using drugs. Littledog denied it. She explained to her mother that people were using a drug she had never heard of: fentanyl, a synthetic opioid that was 100 times more potent than morphine. He said he would not use anything so dangerous.
Then, in early March, Olinga woke up screaming. He left his grandchildren in his bed and went to the next room. “My son was lying on the floor,” she said. She was not breathing.
He followed the ambulance to Browning, hoping that Littledog had forgotten to take his heart medicine and would recover. He was pronounced dead shortly after the ambulance arrived at the local hospital.
Littledog was among four people who died of fentanyl overdose at a reservation that week in March, according to Blackfit health officials. An additional 13 people living in the reservoir survived the surplus, creating a staggering total for the approximately 10,000 indigenous population.
Keith Humphreys of the Stanford-Lancet Commission on the Opioid Crisis in North America says fentanyl has taken root in communities across Montana and Mountain West during the epidemic, after it became prevalent in most cases east of the Mississippi River.
Montana law enforcement officers have seized a record number of pale-blue pills that look like prescription opioids like oxycodone. In the first three months of 2022, Montana Highway Patrol seized more than 12,000 fentanyl pills, more than three times the total number in 2021.
Nationwide, at least 103,000 people died of drug overdoses in 2021, an increase of 45% from 2019, according to data from the Centers for Disease Control and Prevention. About 7 out of every 10 people died from synthetic opioids, primarily fentanyl.
Overdose deaths are disproportionately affecting Native Americans. According to a study co-authored by UCLA graduate student and researcher Joe Friedman, the overdose mortality rate among indigenous peoples was the highest among all ethnic groups in the first year of the epidemic and was about 30% higher than among whites.
According to the state Department of Public Health and Human Services, in Montana, between 2019 and 2021, opioid overdose mortality rates for indigenous people were twice as high as for whites.
Because, in part, Native Americans have relatively less access to healthcare resources, Friedman said. “While drug supplies are so dangerous and so toxic, staying safe requires resources and knowledge and skills and funding,” he said. “It simply came to our notice then. It requires access to healthcare, access to medicine. “
The Indian health service, which is responsible for providing healthcare to many indigenous peoples, has become meaningless in the long run. According to a 2018 report by the US Commission on Civil Rights, the cost per patient of IHS is significantly lower than that of other federal health programs.
“I think what we’re seeing now is deep-seated inequality and social determinants of health,” Friedman said, referring to unequal overdose deaths among Native Americans.
Stacey Keller, a member of the Blackfit Tribal Business Council, said she felt a lack of resources while trying to treat a family member. He said it was difficult to find a benefit for detoxing alone, let alone find one for treatment.
“Here’s our treatment facility, they’re not equipped to deal with opioid addiction, so they’re usually referred,” he said. “Some of the battles we’ve seen across the state and even across the western part of the United States have the potential of many medical centers.”
There is no medical specialist at the local medical center to oversee the passage of opioid withdrawal. Only two detox beds are available at the local IHS hospital, Keller said, and are often occupied by other patients. The healthcare system on reservation also does not offer drug-assisted treatment. The nearest locations for receiving buprenorphine or methadone – drugs used to treat opioid addiction – are 30 to 100 miles away. This can be a burden for patients who, according to federal rules, have to attend daily dispensaries approved for taking methadone or have to make weekly trips for buprenorphine.
Keller said tribal leaders have asked the IHS for help in creating resources for medical and other substance use, to no avail.
JB Kinlachini, IHS’s alcohol and substance abuse program consultant, said the agency had moved to allocate funds directly to the tribes to run their own programs.
The Rocky Mountain Tribal Leaders Council, a consortium of Montana and Wyoming tribes, is working with the Montana Healthcare Foundation to study the feasibility of a tribal-run medical center to build capacity specifically for tribal members. Tribes in both states, including Blackfit, have passed resolutions supporting the effort.
Blackfit political leaders declared a state of emergency in March after a fentanyl overdose. Shortly afterwards, some of the children of the tribal council chairman were arrested on suspicion of selling fentanyl from his home. The council removed Timothy Davis as chairman in early April.
The tribe has created a task force to identify both short- and long-term needs to respond to the opioid crisis. Blackfit Tribal Police investigator Misty Laplant is helping lead that effort.
Driving around Browning, Laplant said he plans to train more people on reservations for managing naloxone, a drug that contrasts opioid overdoses. He also wants the tribes to organize needle exchanges to reduce the spread of diseases like HIV and HIV. There is also hope, he said, that the restructuring of the Department of Tribal Health will create a one-stop shop for Blackfit Nation residents to find drug addiction resources on and off the reservation.
However, he said addressing some of the underlying issues – such as poverty, housing and food security – that puts communities like Blackfit Nation at risk for the ongoing fentanyl crisis is a huge undertaking that will not end soon.
“You can associate grief with historical trauma, generally unresolved traumas and what weakens our community,” he said. “If you look at the influence of colonialism and indigenous communities and people, there is a correlation.”
Marla Olinger is happy to see her son die and other people move to fight opioid and fentanyl addiction. As a mother struggling to find resources to save her son, she hopes no one else will have to go through that experience.
“It’s heartbreaking to see your children die unnecessarily,” he said.
The story is part of a partnership that includes Montana Public Radio, NPR and KHN.
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