A Maine tribe is using opioid settlement funds at a lodge to treat addiction

PRESQUE ISLE, Maine Outside the Mi’kmaq Nation’s health department is a dome-shaped tent, hand-built from saplings and covered in black canvas. It’s one of several sweat lodges on the tribe’s land, but this one is dedicated to helping people recover from addiction.

Up to 10 people enter the hostel at the same time. Stones heated with fire called grandmothers and grandfathers, because the spirits they represent are carried inside them. Water splashes on the stones, and the lodge fills with steam. It’s like a sauna, but hotter. The air is thicker, and it’s dark. People pray and sing songs. When they leave the lodge, it is said, they come out of the mother’s womb again. cleaned up reborn

The experience can be “a vital tool” for healing, said Katie Espling, health director for the roughly 2,000-member tribe.

He said recovering patients have requested sweat lodges for years as a cultural element to supplement the counseling and medication the tribe’s health department already provides. But insurance doesn’t cover sweat ceremonies, so until now the department couldn’t afford to offer them.

Last year, the Mi’kmaq Nation received more than $150,000 in settlements with companies that made or sold prescription painkillers and were accused of exacerbating the overdose crisis. A third of this money was spent on sweat.

Higher mortality rates

Health companies are paying more than $1.5 billion to hundreds of tribes over 15 years. This windfall is similar to the settlements many of the same companies are paying to state governments, totaling about $50 billion.

For some people, the lowest payout for tribes is due to their smaller population. But some tribal citizens point out that the overdose crisis has had a disproportionate effect on their communities. Native Americans had the highest overdose death rates of any racial group every year from 2020 to 2022. And federal officials say those statistics were likely understated by 34 percent because Native Americans’ race is often misclassified on death certificates.

Still, many tribal leaders are grateful for the settlements and the unique way the money can be spent: Unlike state payments, money sent to tribes can be used for traditional and cultural healing practices, from sweat lodges and smudging ceremonies to basketry and programs that teach tribal languages.

“To have these dollars to do this, it’s really been a gift,” said Espling of the Mi’kmaq tribe. “That’s going to be absolutely critical to the well-being of our patients,” because connecting with their culture is “where they’re really going to find the deepest healing.”

Public health experts say the underlying cause of addiction in many tribal communities is intergenerational trauma, the result of centuries of brutal treatment, including broken treaties, land theft and a government-funded boarding school system that sought to erase languages ​​and cultures of the tribes. Coupled with a long-standing lack of investment in India’s Health Service, these factors have led to lower life expectancy and higher rates of addiction, suicide and chronic disease.

Using settlement money to connect tribal citizens with their traditions and reinvigorate pride in their culture can be a powerful healing tool, said Andrea Medley, a researcher at the Johns Hopkins Center for Indigenous Health. and member of the Haida Nation. He helped create principles for how tribes can consider spending settlement money.

Medley said having respect for those traditional elements explicitly described in the settlements is “really innovative.”

“a drop in the bucket”

Of the 574 federally recognized tribes, more than 300 have received payments so far, totaling more than $371 million, according to Kevin Washburn, one of three court-appointed directors overseeing tribal settlements.

While that sounds like a large sum, it pales in comparison to what the addiction crisis has cost the tribes. There are also hundreds of tribes that are excluded from payments because they are not federally recognized.

“These abatement funds are like a drop in the bucket compared to what they’ve spent, compared to what they plan to spend,” said Corey Hinton, an attorney who represented several tribes in the opioid litigation and a citizen of the Passamaquoddy tribe. “Reduction is a cheap term when we’re talking about a crisis that’s still engulfing and devastating communities.”

Even leaders of the Navajo Nation, the largest federally recognized tribe in the United States, which has received $63 million so far, said the settlements cannot match the magnitude of the crisis.

“It’s going to hurt a little bit, but it’s only going to go so far,” said Kim Russell, executive director of the Navajo Health Department.

The Navajo Nation is trying to stretch the money by using it to improve its overall health care system. Officials plan to use the payments to hire more coding and billing employees for tribally-run hospitals and clinics. Those workers would help ensure reimbursements continue to flow to health systems and help maintain and expand services, including addiction treatment and prevention, Russell said.

Navajo leaders also want to hire more doctors who specialize in substance use treatment, as well as primary care doctors, nurses and epidemiologists.

“Building buildings is not what we want” from opioid settlement funds, Russell said. “We are building the nation.”

High stakes for small tribes

Smaller nations like the Poarch Band of Creek Indians in south Alabama are also strategizing to get settlement money going further.

For the roughly 2,900-member tribe, that has meant investing $500,000 — most of what it has received so far — into a statistical modeling platform that its creators say will simulate the opioid crisis, predict which programs will save the most lives and will help local officials decide. the most effective use of future settlement cash.

Some recovery advocates have questioned the model’s value, but tribal Vice Chairman Robert McGhee said it would provide the data and evidence needed to choose between efforts competing for resources, such as recovery housing or rehabilitation specialists. peer support The tribe wants to do both, but realistically, it will have to prioritize.

“If we can have that model and put the necessary funds into it and have the support, it will work for us,” McGhee said. “I just feel it in my gut.”

The stakes are high. In smaller communities, each death affects the entire tribe, McGhee said. The loss of a leader marks decades of lost knowledge. The passing of a speaker means further erosion of the native language.

For Keesha Frye, who oversees the tribal court and sober living facility for the Poarch Band of Creek Indians, using settlement money effectively is personal. “It means a lot to me to do good for this community because this is where I live and this is where my family lives,” he said.

Erik Lamoreau in Maine also brings personal connections to this work. More than a decade ago, he sold drugs on Mi’kmaq lands to support his own addiction.

“I hurt this community and it was very important for me to come back and try to right some of those wrongs,” Lamoreau said.

Today, he works for the tribe as a peer recovery coordinator, a new role created with the opioid settlement funds. Use your expertise to connect with others and help them recover, whether that means taking someone to court, working on their brief, working out together at the gym or organizing a cribbage club, where people play card games and socialize without alcohol. or drugs

Starting this month, Lamoreau’s job will also involve connecting customers looking for cultural elements of recovery with the new sweat service, an endeavor he sees as promising.

“The more in tune you are with your culture, no matter what culture it is, it connects you to something bigger,” Lamoreau said. “And that’s really what we look at when we’re in recovery, when we talk about spiritual connection. It’s something bigger than you.”

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