Transcript Research on a Great Lakes Indian Reservation

RESEARCH ON A GREAT LAKES
INDIAN RESERVATION:
PREVALENCE OF OXYCONTIN USE AND
TREATMENT NEEDS
9• 16 • 11 UMSARC Member Symposium
SANDRA L. MOMPER, MSW, PhD
Assistant Professor, University of Michigan School of Social Work
Isabelle Kappeler, Research Associate
Rebecca Cunningham, Research Assistant
THE POPULATION
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)
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THE TRIBE
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.

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TRIBAL COMMUNITY
7, 335 tribally enrolled members.
 1,044 enrollees reside on the Reservation.
 Total of 2,738 residents.

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NEIGHBORHOODS
• Diaperville
• Birch Hill
• Old Odanah
• New Odanah
• Frank’s Field
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PRIOR STUDIES

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).
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TALKING CIRCLE COMMENTS

“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”
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MORE COMMENTS

“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.”
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MORE COMMENTS

“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?”
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OXYCONTIN INFORMATION

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).
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OXYCONTIN INFORMATION (CONT)

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).
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OXYCONTIN INFORMATION (CONT)

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).
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UMSARC FUNDED STUDY (2009)

“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).
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SPECIFIC AIMS

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.
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METHODOLOGY

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.

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DEMOGRAPHICS -INTERVIEWEES
Characteristics of Service Provider Interviewees
(N=10)
Age Range
50 – 70 yrs
Gender
Male
2
Female
8
Tribal Affiliation
Chippewa/all
Years in Role
5mos– 24 yrs
Services
Provided
CHR, Indian Health worker, AODA
counselor, Indian Child Welfare
worker, Community Health
worker, Outpatient Counselor, etc
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INTERVIEW THEMES/ILLUSTRATIVE QUOTES
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.”
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INTERVIEW THEMES (CONT)
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.”
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INTERVIEW THEMES (CONT)
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?”
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INTERVIEW THEMES (CONT)
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.”
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INTERVIEW THEMES (CONT)
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).”
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SURVEY RESULTS

Gathered data at various locations on the
Reservation
 Grocery
Store
 Elderly Center
 Teen hang outs
Elicited Tribal Members to “Get the Word Out”
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SURVEY DEMOGRAPHICS (N = 398)
Age Range
18-80 years old
Male
48%
Female
52%
Marital Status
Single
40%
Married/Cohabitating
36%
Div/Sep/Widowed
18%
Other
6%
School Status
Full Time
7%
Part Time
5%
Not in School
88%
Highest Grade Completed
High School
36%
GED
17%
Beyond High School
47%
Employment Status
Unemployed
38%
Full Time
13%
Part Time
38%
Retired
7%
Student
4%
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OXYCONTIN USERS BY DEMOGRAPHICS
Oxycontin Users
Lifetime n (%)
Past Year n (%)
Past Month n (%)
Gender
Male
50 (46.7)
32 (47.8)
24 (51.1)
Female
57 (53.3)
35 (52.2)
23 (48.9)
31 (sd 11.7)
31 (sd 11.8)
32 (sd 12.4)
Single/Never Married
54 (51.9)
33 (50.8)
24 (53.3)
Married (Legally/Spiritually)
12 (11.5)
9 (13.9)
6 (13.3)
Co-Habiting
20 (19.2)
12 (18.5)
9 (20.0)
8 (7.7)
4 (6.2)
3 (6.7)
Widowed
1 (1.0)
1 (1.5)
1 (2.2)
Other
9 (8.7)
6 (9.3)
2 (4.4)
None
0 (0.0)
0 (0.0)
0 (0.0)
Grade School
1 (0.9)
1 (1.5)
1 (2.1)
Some High School
17 (16.0)
10 (15.2)
9 (19.2)
High School/GED
38 (35.9)
26 (39.4)
19 (40.4)
50 (47.2)
29 (43.9)
18 (38.3)
Unemployed
50 (46.7)
30 (44.8)
21 (44.7)
Employed Part-Time
13 (12.2)
8 (11.9)
6 (12.8)
Employed Full-Time
34 (31.8)
23 (34.3)
14 (29.8)
Retired
2 (1.9)
2 (3.0)
2 (4.3)
Student
8 (7.5)
4 (6.0)
4 (8.5)
Average Age
Marital Status
Divorced/Separated/Not CoHabit.
Educational Status
Some Education Beyond High
Sch.
Employment Status
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PROBLEM OF SELLING AND USING OXYCONTIN ON THE RESERVATION
Oxycontin
n (%)
Problem of Selling and Using
Very Serious
171 (43.4)
Fairly Serious
72 (18.3)
Not Too Serious
22 (5.6)
Not Serious At All
17 (4.3)
Never
50 (12.7)
Rather not say
47 (11.9)
Don’t know
1 (0.3)
Missing
14 (3.6)
Seen Selling and Using in the Past Year
Almost every day
76 (19.3)
At least once a week
55 (14.0)
Once or twice a month
36 (9.1)
A few times a year
24 (6.1)
Never
128 (32.5)
Rather not say
57 (14.5)
Don’t know
1 (0.3)
Missing
17 (4.3)
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IMPLICATIONS
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.

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NOW WHAT?
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.

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ACKNOWLEDGEMENTS
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.
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