Dr. Anna Miller sits with her legs pulled up, boots kicked off, in an exam chair at Cherokee Nation W.W. Hastings Hospital. She’s waiting for her first Suboxone patient of the day. She knows the odds are stacked against these patients struggling to get off opioids. She’s seen firsthand how crooked the path to recovery can be. She also knows she has a few singular advantages, unique to Indian Country, in tackling the crisis.
But those advantages are double-edged — and all too swiftly can turn into obstacles. There is, for instance, the fact that health care is free to members of Cherokee Nation, as it is for most Native Americans under longstanding treaties with the US government. “The great advantage is that I basically have socialized medicine,” Miller said, though she’s quick to point out the care didn’t come without a cost: “Free is not the right word to use. It’s something that was earned by their ancestors in a treaty.”
At the same time, providers said, because there’s no cost, it can be hard to get patients to fully commit to sticking with the long process of recovery. They don’t lose a lot of money if they decide to drop out.
Then there’s the close-knit nature of the tribe. That can be a huge help to doctors — the medical staff knows exactly which neighbors or relatives to call to track down a patient who hasn’t shown up for his Suboxone strips. But the strong connections binding the community can also drag down individuals trying to overcome addiction. It’s hard to break habits when you’re surrounded by so many friends with the same cravings for opioids.
The rate of drug-related deaths among American Indian and Alaska Native people has almost quadrupled since 1999, according to the Indian Health Service. It’s now double the rate in the US as a whole. Oklahoma — home to the 120,000 citizens of Cherokee Nation — leads the country in prescription painkiller abuse.
“It’s a problem for the entire country,” said Chuck Hoskin, the secretary of state for Cherokee Nation. “But we are up against it in Cherokee Country.” About half of
Despite the long odds, Miller and the only other doctor in the Suboxone program, Dr. Charity Holder, find the work worthwhile. “When people really start to realize the enormity of the problem,” Miller said, “they realize maybe it’s not that these are bad people. It’s that they have a disease that needs treatment.”
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