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Wendt DC, Marsan S, Parker D, Lizzy KE, Roper J, Mushquash C, Venner KL, Lam A, Swansburg J, Worth N, Sorlagas N, Quach T, Manoukian K, Bernett P, Radin SM. Commentary on the impact of the COVID-19 pandemic on opioid use disorder treatment among Indigenous communities in the United States and Canada. J Subst Abuse Treat 2020; 121:108165. [PMID: 33097315 PMCID: PMC7546255 DOI: 10.1016/j.jsat.2020.108165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
This commentary focuses on how some Indigenous communities in the United States (U.S.) and Canada are addressing the opioid epidemic within the context of the COVID-19 pandemic, from the perspective of the co-authors as researchers, clinicians, and pharmacists working within or among Indigenous communities in three eastern Canadian provinces and two western U.S. states. The pandemic has likely exacerbated opioid use problems among Indigenous communities, especially for individuals with acute distress or comorbid mental illness, or who are in need of withdrawal management or residential services. In response to the pandemic, we discuss first how greater prescription flexibility has facilitated and even increased access to medications for opioid use disorder. Second, we describe how Indigenous-serving clinics have expanded telemedicine services, albeit not without some challenges. Third, we note challenges with restricted participation in traditional Indigenous healing practices that can be helpful for addiction recovery. Fourth, we mention providers' worries about the pandemic's impact on their patients' mental health and safety. We argue that certain treatment transformations may be helpful even after the pandemic is over, through enhancing access to community-grounded treatment, decreasing stigma, and promoting patient self-efficacy. COVID-19 pandemic has challenged opioid use treatment for Indigenous peoples. Treatment has been aided through expanded telemedicine and prescription flexibility. These adjustments may expand future treatment access to Indigenous communities.
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Affiliation(s)
- Dennis C Wendt
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St., Room 614, Montreal, Quebec H3A 1Y2, Canada.
| | - Stéphanie Marsan
- Department of Family and Emergency Medicine, Université de Montréal, Centre Hospitalier de l'Université de Montréal, 1051 Sanguinet St., Montreal, Quebec H2X 0C1, Canada.
| | - Daniel Parker
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St., Room 614, Montreal, Quebec H3A 1Y2, Canada.
| | - Karen E Lizzy
- Cowlitz Tribal Health, 15455 65th Ave S, Tukwila, WA 98188, USA.
| | - Jessica Roper
- Eskasoni Mental Health Services, 4555 Shore Rd., Eskasoni, Nova Scotia B1W 1K3, Canada.
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, 955 Oliver Rd., Thunder Bay, Ontario P7B 5E1, Canada.
| | - Kamilla L Venner
- Department of Psychology, Center on Alcoholism, Substance Abuse, and Addiction, University of New Mexico, 1 University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA.
| | - Alice Lam
- Canadian Research Initiative in Substance Misuse (CRISM) Quebec-Atlantic Node, Centre hospitalier de l'Université de Montréal, CRCHUM - Pavillon R, 900 St-Denis St., Montreal, Quebec H2X 0A9, Canada.
| | - Jennifer Swansburg
- Canadian Research Initiative in Substance Misuse (CRISM) Quebec-Atlantic Node, Department of Psychology, Dalhousie University, 1355 Oxford St., P.O. Box 15000, Halifax, Nova Scotia B3H 4R2, Canada.
| | - Nancy Worth
- Kahnawake Shakotiia'takehnhas Community Services (KSCS), P.O. Box 1440, Kahnawake, Quebec J0L 1B0, Canada.
| | - Nicholas Sorlagas
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Seattle, WA 98105, USA.
| | - Tania Quach
- Kateri Memorial Hospital Centre (KMHC), 10 River Rd., Kahnawake, Quebec J0L 1B0, Canada.
| | - Kristapore Manoukian
- Proxim Pharmacie Kristapore Manoukian, Inc., P.O. Box 2231, Kahnawake, Quebec J0L 1B0, Canada.
| | - Payton Bernett
- Department of Educational and Counselling Psychology, McGill University, 3700 McTavish St., Room 614, Montreal, Quebec H3A 1Y2, Canada.
| | - Sandra M Radin
- Alcohol and Drug Abuse Institute, University of Washington, 1107 NE 45th St., Seattle, WA 98105, USA.
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Wendt DC, Hartmann WE, Allen J, Burack JA, Charles B, D'Amico EJ, Dell CA, Dickerson DL, Donovan DM, Gone JP, O'Connor RM, Radin SM, Rasmus SM, Venner KL, Walls ML. Substance Use Research with Indigenous Communities: Exploring and Extending Foundational Principles of Community Psychology. Am J Community Psychol 2019; 64:146-158. [PMID: 31365138 PMCID: PMC6777961 DOI: 10.1002/ajcp.12363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Many Indigenous communities are concerned with substance use (SU) problems and eager to advance effective solutions for their prevention and treatment. Yet these communities also are concerned about the perpetuation of colonizing, disorder-focused, stigmatizing approaches to mental health, and social narratives related to SU problems. Foundational principles of community psychology-ecological perspectives, empowerment, sociocultural competence, community inclusion and partnership, and reflective practice-provide useful frameworks for informing ethical community-based research pertaining to SU problems conducted with and by Indigenous communities. These principles are explored and extended for Indigenous community contexts through themes generated from seven collaborative studies focused on understanding, preventing, and treating SU problems. These studies are generated from research teams working with Indigenous communities across the United States and Canada-inclusive of urban, rural, and reservation/reserve populations as well as adult and youth participants. Shared themes indicate that Indigenous SU research reflects community psychology principles, as an outgrowth of research agendas and processes that are increasingly guided by Indigenous communities. At the same time, this research challenges these principles in important ways pertaining to Indigenous-settler relations and Indigenous-specific considerations. We discuss these challenges and recommend greater synergy between community psychology and Indigenous research.
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Affiliation(s)
- Dennis C Wendt
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - William E Hartmann
- School of Interdisciplinary Arts and Sciences, University of Washington-Bothell, Bothell, WA, USA
| | - James Allen
- Memory Keepers Medical Discovery Team - American and Rural Health Equity, Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | - Jacob A Burack
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Billy Charles
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | | | - Colleen A Dell
- Department of Sociology, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Daniel L Dickerson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dennis M Donovan
- Department of Psychiatry and Behavioral Sciences, Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - Joseph P Gone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anthropology, Harvard University, Cambridge, MA, USA
| | - Roisin M O'Connor
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sandra M Radin
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - Stacy M Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Kamilla L Venner
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Melissa L Walls
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
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Venner KL, Donovan DM, Campbell ANC, Wendt DC, Rieckmann T, Radin SM, Momper SL, Rosa CL. Future directions for medication assisted treatment for opioid use disorder with American Indian/Alaska Natives. Addict Behav 2018; 86:111-117. [PMID: 29914717 PMCID: PMC6129390 DOI: 10.1016/j.addbeh.2018.05.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 04/06/2018] [Accepted: 05/21/2018] [Indexed: 01/01/2023]
Abstract
The U.S. is experiencing an alarming opioid epidemic, and although American Indians and Alaska Natives (AI/ANs) are especially hard hit, there is a paucity of opioid-related treatment research with these communities. AI/ANs are second only to Whites in the U.S. for overdose mortality. Thus, the National Institute on Drug Abuse convened a meeting of key stakeholders to elicit feedback on the acceptability and uptake of medication assisted treatment (MAT) for opioid use disorders (OUDs) among AI/ANs. Five themes from this one-day meeting emerged: 1) the mismatch between Western secular and reductionistic medicine and the AI/AN holistic healing tradition; 2) the need to integrate MAT into AI/AN traditional healing; 3) the conflict between standardized MAT delivery and the traditional AI/AN desire for healing to include being medicine free; 4) systemic barriers; and 5) the need to improve research with AI/ANs using culturally relevant methods. Discussion is organized around key implementation strategies informed by these themes and necessary for the successful adoption of MAT in AI/AN communities: 1) type of medication; 2) educational interventions; 3) coordination of care; and 4) adjunctive psychosocial counseling. Using a community-based participatory research approach is consistent with a "two eyed seeing" approach that integrates Western and Indigenous worldviews. Such an approach is needed to develop impactful research in collaboration with AI/AN communities to address OUD health disparities.
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Affiliation(s)
- Kamilla L Venner
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, MSC03 2220, Albuquerque, NM 87131, USA.
| | - Dennis M Donovan
- Alcohol & Drug Abuse Institute and Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631, USA
| | - Aimee N C Campbell
- Department of Psychiatry, Columbia University Medical Center and New York State Psychiatric Institute, 1051 Riverside Drive, Room 3719, Box 120, New York, NY 10032, USA
| | - Dennis C Wendt
- Alcohol & Drug Abuse Institute and Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631, USA
| | - Traci Rieckmann
- School of Public Health, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Sandra M Radin
- Alcohol & Drug Abuse Institute and Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1107 NE 45th Street, Suite 120, Seattle, WA 98105-4631, USA
| | - Sandra L Momper
- School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI 48109, USA
| | - Carmen L Rosa
- Center for the Clinical Trials Network, National Institute on Drug Abuse, 6001 Executive Blvd, Bethesda, MD 20892, USA
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Radin SM, Kutz SH, LaMarr J, Vendiola D, Vendiola M, Wilbur B, Thomas LR, Donovan DM. Community perspectives on drug/alcohol use, concerns, needs, and resources in four Washington State Tribal communities. J Ethn Subst Abuse 2015; 14:29-58. [PMID: 25560464 DOI: 10.1080/15332640.2014.947459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Community-university teams investigated substance use, abuse, and dependence (SUAD) and related concerns, needs, strengths, and resources in four Washington State Tribal communities. A total of 153 key community members shared their perspectives through 43 semi-structured interviews and 19 semi-structured focus groups. Qualitative data analysis revealed robust themes: prescription medications and alcohol were perceived as most prevalent and concerning; family and peer influences and emotional distress were prominent perceived risk factors; and SUAD intervention resources varied across communities. Findings may guide future research and the development of much needed strength-based, culturally appropriate, and effective SUAD interventions for American Indians, Alaska Natives, and their communities.
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Affiliation(s)
- Sandra M Radin
- a Alcohol and Drug Abuse Institute, University of Washington , Seattle , Washington
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Radin SM, Banta-Green CJ, Thomas LR, Kutz SH, Donovan DM. Substance use, treatment admissions, and recovery trends in diverse Washington State tribal communities. Am J Drug Alcohol Abuse 2012; 38:511-7. [PMID: 22931087 PMCID: PMC3736985 DOI: 10.3109/00952990.2012.694533] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Qualitative and quantitative data and participatory research approaches might be most valid and effective for assessing substance use/abuse and related trends in American Indian and Alaska Native (AIAN) communities. METHOD Twenty-nine federally recognized AIAN tribes in Washington (WA) State were invited to participate in Health Directors (HD) interviews and State treatment admissions data analyses. Ten Tribal HD (or designees) from across WA participated in 30-60-minute qualitative interviews. State treatment admissions data from 2002 to 2008 were analyzed for those who identified with one of 11 participating AIAN communities to explore admission rates by primary drug compared to non-AIANs. Those who entered treatment and belonged to one of the 11 participating tribes (n = 4851) represented 16% of admissions for those who reported a tribal affiliation. RESULTS Interviewees reported that prescription drugs, alcohol, and marijuana are primary community concerns, each presenting similar and distinct challenges. Additionally, community health is tied to access to resources, services, and culturally appropriate and effective interventions. Treatment data results were consistent with interviewee-reported substance use/abuse trends, with alcohol as the primary drug for 56% of AIAN adults compared to 46% of non-AIAN, and other opiates as second most common for AIAN adults in 2008 with 15% of admissions. LIMITATIONS Findings are limited to those tribal communities/community members who agreed to participate. CONCLUSION Analyses suggest that some diverse AIAN communities in WA State share similar substance use/abuse, treatment, and recovery trends and continuing needs. SCIENTIFIC SIGNIFICANCE Appropriate and effective research with AIAN communities requires respectful and flexible approaches.
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Affiliation(s)
- Sandra M Radin
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA 98105, USA.
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Radin SM, Neighbors C, Walker PS, Walker RD, Marlatt GA, Larimer M. The changing influences of self-worth and peer deviance on drinking problems in urban American Indian adolescents. Psychol Addict Behav 2006; 20:161-70. [PMID: 16784362 DOI: 10.1037/0893-164x.20.2.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study explored the changing relations among self-worth, peer deviance, and alcohol-related problems in a sample of 224 urban-dwelling, American Indian adolescents. Data were collected annually at 7 time points to test a proposed mediational model. As expected, peer deviance mediated the relation between low self-worth and alcohol-related problems in younger adolescents; however, this relation did not hold as participants became older. In older adolescents, low self-worth and peer deviance directly and independently contributed to alcohol problems. Possible explanations for and implications of these findings are discussed in terms of developmental changes during adolescence.
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Affiliation(s)
- Sandra M Radin
- Addictive Behaviors Research Center, University of Washington, Seattle, 98195-1525, USA.
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