Combating Racial Disparity of the Opioid Epidemic: Healing to Wellness in the Saginaw Chippewa Tribe

Transcription

1 Combating Racial Disparity of the Opioid Epidemic: Healing to Wellness in the Saginaw Chippewa Tribe 18 th Annual Substance Use and Occurring Disorder Conference September 26, 2017 Su Min Oh, David Garcia, Joseph V. Sowmick

2 Disparity A great difference. The quality or state of being different. The condition of being unequal

3 Tell me and I will forget. Show me, and I may not remember. Involve me, and I will understand. -Native Proverb

4 Objective We will be able to: 1. Identify trends of drug overdose death among American Indians/Alaska Natives in Michigan; 2. Recognize the importance of culture as a treatment component for Native Americans; and 3. Describe the cultural teachings of the Seven Grandfathers and the Medicine Wheel.

5 Objective #1 1. Identify trends of drug overdose death among American Indians/Alaska Natives in Michigan

6 Data source and Case Definition CDC Wonder Online Database, Multiple Cause of Death Data, Drug overdose (=poisoning) deaths are identified by underlying cause-of-death codes X40- X44, X60-X64, X85, and Y10-Y14 Prescription opioids are identified by T40.2, T40.3, and T40.4 Heroin is T40.1 National Survey on Drug Use and Health (NSDUH), Michigan Treatment Episode Data Set (TEDS)

7 Related lingo Drug overdose death = Drug poisoning death Opioids = heroin and prescription opioids Prescription opioids includes natural and semisynthetic opioids (e.g., codeine, morphine, hydrocodone, hydromorphone, oxycodone, oxymorphone), synthetic opioids (e.g., methadone, fentanyl).

8 Background - US In 2015, over 52,000 individuals died of drug overdose from all manner of deaths in US, equivalent to 143 deaths per day. 43% of overdose deaths involving prescription opioids, equivalent to 433 deaths per week. Source: venturacountylimits.org/en/prevention/prescription-otc/prescribers

9 Prescription Pain Relievers Use According to the 2016 National Survey on Drug Use and Health (NSDUH): 4.7 million (19.0%) of aged were past year user of painkillers 8.7 million (35.6%) of adults 18+ were past year user of painkillers

10 Misuse of Painkillers? [CATEGOR Y NAME], [VALUE]% Aged [CATEGOR Y NAME], [VALUE]% Adult 18+ [CATEGOR Y NAME], 94.6% [CATEGOR Y NAME], 87.8% 4.7 million past year pain reliever users 8.7 million past year pain reliever users

11 Background - MI In 2015, 1980 died of drug overdose deaths in Michigan, equivalent to 5 deaths per day. 44% of overdose deaths involving prescription opioids, equivalent to 2 deaths per day. Source:

12 Number of deaths Age-adjusted rate per 100K Total Drug Poisoning Deaths in MI, Total Drug Poisoning Deaths, MI,

13 Manner of drug poisoning deaths Homicide, 0.2 Undetermine d, 12.3 Undetermin ed, 30.8 Intentional, 8.9 Homicide, 0.3 Intentional, 18.1 Unintentiona l, 50.8 Unintentiona l, 78.6 Year 2000 Year 2015

14 Percentage Drug poisoning death by opioids vs all other drugs, MI, % % All other drugs Opioids

15 Age-adjusted rate per 100K Total drug poisoning deaths by demographics, MI, , AI/AN Male Female White Black Gender Age Group Race Asian

16 Age-adjusted rate per 100K Opioids involving deaths by demographics, MI, , Male AI/AN 8.0 Black 9.9 White Female Gender Age Group Race

17 Age-adjusted rate per 100K Total drug poisoning deaths among American Indian/Alaska Native (AI/AN), MI, Female 32.1 Male 10 0 Gender Age Group (showing age group with reliable rates)

18 Age-adjusted rate per 100K Opioids involving Deaths among American Indian or Alaska Native, MI, Years Female 21.3 Male 0 Gender Age Group (showing age group with reliable rates)

19 Previously, the NSDUH AI/AN were more likely to have needed treatment for alcohol or illicit drugs in the past year, compared to other racial/ethnic groups (17.5% vs 9.3%) Among persons who needed alcohol or illicit drug use treatment, AI/AN were more likely to have received specialty substance use treatment, compared to other racial/ethnic groups (15.0% vs. 10.2%) Among persons who needed but did not receive treatment, AI/AN were more likely to feel the need for and make an effort to get treatment (4.3% vs. 1.5%) Source:

20 Need for and Receipt of Treatment for Substance Use Problem among aged 12+, 2016 Needed Tx Needed and Received Tx Needed but did not receive Tx White % % Black % % AI/AN % %

21 Still Few Challenges Transportation Low insurance coverage Low socioeconomic status Stigma associated with substance abuse Discomfort in the westernized treatment delivery system Shortage of opioid treatment programs Shortage of integrated culturally relevant substance abuse treatment models Source: Dickerson DL, Spear S, Marinelli-Casey P, Rawson R, Li L, H Y-I. American Indians/Alaska Natives and substance abuse treatment outcomes: Positive signs and continuing challenge. Journal of Addictive Diseases. 2011;30:

22 Michigan Treatment Episode Data Set (TEDS) Admission, 2016 Race Number (%) Alaska Native 16 (0.0) American Indian 592 (0.8) African American/Black 9,834 (13.6) White 40,531 (56.0) Asian 133 (0.2) Other Single Race 4,689 (6.5) Two or More Races 16,302 (22.5) Native Hawaiian or Pacific Islander 84 (0.1) Refuse to Provide 205 (0.3) Total 72,386 (100.0)

23 Referral Source, Treatment Episode Data Set (TEDS) Admission, 2016 American Indian/Alaska Native Michigan Individual or self-referred Criminal Justice alcohol/drug abuse treatment provider

24 Primary Drug of Abuse, TEDS Admission, 2016 Primary Drug of Abuse American Indian/ Alaska Native Michigan Alcohol Prescription opiates Heroin Marijuana

25 MAT among primary prescription opiates or heroin admissions, TEDS Admission, 2016 Medicated Assisted Treatment American Indian/Alaska Native Michigan Yes No

26 Reason for Termination, TEDS Discharge, 2016 American Indian/Alaska Natives Michigan Completed Dropped Out Terminated Transfer Incarcerated Death

27 In Brief Overdose rates were higher among AI/AN, compared to other racial groups. The highest overdose rates occurred among those 25 to 54 years old, and the opioid overdose death rate was especially high for adults 25 to 34. No significant overdose mortality gap between men and women among AI/AN. AI/AN were more likely to have needed treatment for substance use problems and more likely to receive treatment, compared to other racial groups.

28 Community Transportation (-) Poverty (-) Stigma (-) Culturally relevant prevention and treatment (+) Family Generational Trauma (-) Parenting (+) Individual Substance Use Problems (-) Mental Health Issues (-) Adverse Childhood experiences (-) Treatment seeking (+)

29 For more information Su Min Oh Substance Abuse and Treatment Section Office of Recovery Oriented Systems of Care Behavioral Health and Developmental Disabilities Administration Michigan Department of Health and Human Services

30 Objective #2 2. Recognize the importance of culture as a treatment component for Native Americans

31 Healing to Wellness in the Saginaw Chippewa Indian Tribe September 26, 2017

32 Healing to Wellness Core Team Patrick Shannon, JD, Ed.D., MPH, Senior Chief Judge David Garcia, LMSW, ACSW, Behavioral Health Administrator Carol Jackson, Tribal Court Magistrate Joseph V. Sowmick, Hon.Ph.D., Healing to Wellness Coordinator Aubree Gross BS, Healing to Wellness Case Manager Cathy Matthews, Tribal Court Probation Officer Jennifer Wassegijig, Tribal Court Probation Officer Karmen Fox, Nimkee Health Clinic Director Margaret Steslicki, Nimkee Health Clinic Medical Director Donielle Bannon, Chief of Tribal Police

33 Saginaw Chippewa Tribal Court Staff

34 Introduction The Healing to Wellness Program is a voluntary, alternative sentencing program that allows participants to obtain a full range of services to assist them in leading a drug and alcohol free life. The program offers comprehensive services that are specifically coordinated and managed including, but not limited to, substance abuse treatment, judicial oversight, random drug screening, assistance in obtaining housing, education, mental health, family counseling, traditional teachings, and any other identified needs while participating in the program. The Healing to Wellness team is a multidisciplinary team whose purpose is to provide the best intervention with each participant to allow them to become healthy and productive members of their Tribal Community.

35 Mission The Healing to Wellness Program is designed to reduce recidivism, family violence and death caused by substance abuse by leading participants down the Red Road. By embracing cultural teachings of the Seven Grandfathers and the Medicine Wheel, we provide our clients with a sense of pride and responsibility to themselves and their Tribal community.

36 Four Paths of the Red Road 1) True change comes from within 2) There must be a vision 3) There must be a great teaching 4) There must be a healing forest

37 Seven Grandfather Teachings Honesty Truth Wisdom Bravery Love Respect Humility

38 Cultural Approaches to MAT - Western Medicine is strengthened through cultural approaches (Examples: Sacred Pipe, Sacred Fire, Eagle feathers, smudge, drum, shakers, jingle dress dancers, sweat lodge and fasting teachings) - Four Sacred Medicines (Tobacco, Sweetgrass, Sage and Cedar)

39 What come from the heart touches the heart - Medically (physicians and medicine people) - Assisted (sponsors and Elders) - Treatment (therapy and lodge)

40 Goals of Healing to Wellness Reduce criminal recidivism among chemically addicted offenders. Increase the number of offenders who remain drug and alcohol free. Increase the benefit and reduce the cost to the community for providing services to chemically addicted offenders.

41 Four Phases of Healing to Wellness Treatment Phase I: Cleaning Phase (4-8 weeks) The main focus in Phase I is assisting the participant in becoming sober; participants will complete the required assessments for the Healing to Wellness Program, including physical, dental, and optical exams as well as a Behavioral Health assessment. Treatment Phase II: Action Phase (16-24 weeks) The main focus of Phase II is getting into action with recovery. Participants will focus on the steps necessary to stay clean and sober. Treatment Phase III: Building Phase (12-16 weeks) In Phase III, participants will begin shifting towards a primarily educational focus geared towards assisting the participant in creating a healthy new lifestyle while living in recovery. Treatment Phase IV: Maintenance Phase (9-12 weeks) The purpose of Phase IV is to support the participant in maintaining his/her new healthy lifestyle and to encourage them to be a part of their community.

42 Current Client Data

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46 Three stages to develop an integrative plan to heal our community: Prevention, Interdiction and Treatment Prevention (involvement at Tribal, federal, state and local levels) Member of the Michigan State Opioid Commission Board Member of Michigan Association of Treatment Courts Families Against Narcotics Chapter HARP Heroin Action Reduction Plan (Office of National Drug Control Policy-White House) County Jail MAT for Tribal inmates Relationship with the University of Michigan School of Public Health MAT Training 2016 Brain Health Training 2017 Assigned a Graduate Student 2017

47 Three Stages (continued) Interdiction Medically Assisted Treatment (Naloxone or Vivitrol) Arrest with a treatment plan in mind Address Intergenerational Trauma of Abuse and Neglect in a spiritual way Focus on Client unmet needs Treatment Continual Review of inpatient and outpatient options Tribal Residential Treatment Center Tribal Action Plan Healing to Wellness Program

48 A Cultural Teaching: The honor of one is the honor of all The Healing to Wellness Program has been developed to help participants achieve total sobriety and is designed to promote self-sufficiency as well as to return participants to the Tribal community as productive and responsible community members. Healing to Wellness is voluntary and is a participant s personal choice. The Judge, Coordinator, and other team members are present to guide and assist participants, but the final responsibility is the participants. Participants must be motivated to make this change and commit to a drug and alcohol free life.

49 Miigwetch (thank you) Joseph V. Sowmick, Hon.Ph.D. (989)

50 Objective #3 3. Describe the cultural teachings of the Seven Grandfathers and the Medicine Wheel

51 Medicine Wheel Teachings What are they and how they can be beneficial to treatment of Native Americans David Garcia LMSW ACSW Behavioral Health Administrator Saginaw Chippewa Indian Tribe

52 The Four Directions The Seven Doorways

53 The Medicine Wheel The Traditional Native American community is the area of discussion in this presentation. The Native American community is as diverse as any community with many different aspects. Therefore some generalizations are assumed throughout this presentation.

54 The Medicine Wheel Although the Native American community consists of hundreds of Tribes/Nations, the information in this presentation is universal within the native communities. This Traditional Native American value system offered in this presentation will heighten an awareness to more than the native individual but will bring forth an understanding of how a person relates to self, community and environment in the native way.

55 The Medicine Wheel This process will include explanations of the Medicine Wheel, which is a symbol found across North America. The holistic approach utilized in this presentation is the basis to the learning style of most indigenous people. There are some variations of teachings and order of explanations for the Medicine Wheel which vary from region to region. The basic understanding is prevalent throughout the Native American traditional community.

56 The Directions and Colors North White West Black Blue Green East Yellow South Red

57 The Elements Fire Air Sky Earth Water

58 The Seasons and The Time of Day Night Winter Autumn Evening Spring Dawn Summer Noon

59 Adult The Time of Life Elder Eternity Infant Youth

60 Maturity The Powers of Creation Renewal Creation Birth Growth

61 Introspection The Perspectives Objectivity Omnipresence Enlightenment Subjectivity

62 The Medicines of the Wheel Purity Wisdom Awareness Evaluation Realization Introspection Vision Light Dreams Illumination Compassion, Trust, Love, Change, Teachings

63 The Animals, Minerals, and Plants Buffalo-Quartz Birch Tree Grizzly Jasper Mullein Eagle Fire Opal Dandelion Coyote / Deer Carnelian Agate-Wild Rose

64 The Medicine Wheel The traditional teachings offered in this part of the presentation are from the woodland area of the Three Fires People. The Three Fires People are the three main tribes; Odawa, Ojibway, and Potawatomi.

65 The Medicine Wheel... has seven conceptions that are derived from the Wheel, that there are; The Four Aspects of Human Nature The Four Colors The Four Seasons The Four Symbolic Races The Four Sacred Plants The Four Elements The Four Grandfathers

66 The Medicine Wheel... teaches us that we have four aspects to our human nature. Physical Emotional Mental Spiritual These four aspects must be developed equally. We must try to maintain our physical strength in balance with the other aspects of our human nature.

67 The Four Symbolic Races The Medicine Wheel teaches us that there are four symbolic races on Skikimikwe (mother earth) all are part of the same human family brothers and sisters living in the same Skikimikwe. African - Black Anglo - White Asian - Yellow Anishinaabe (native) - Red

68 The Four Sacred Plants Sema: (tobacco) is offered each day to Gizhemnidoo (creator) in giving thanks and prayer. Sema is offered to the animals of the air, water, and ground when they are killed for their food or for their use. We say Miigwetch (thank you) for the spirit of the animal for giving of self. Giizhik: (cedar) is used for prayer and burned for smudging. A daily drink of cedar tea keeps one in good health. Giizhik is hung in our homes and vehicles for protection and good health. * Smudging is when you burn the plant, forming smoke to purify the source.

69 The Four Sacred Plants Muskodewisk: (sage) is used for prayer at the end of each day. It is used to smudge the area prior to event, meeting, etc., to cleanse and make ready the room area for the event. A periodic drink of sage tea strengthens the heart and body system. It is used to spice our food, adding value to what we eat. Wiingash: (sweetgrass) is burned to smudge ourselves daily. We smudge our head to clear our minds and negative thoughts. Our eyes, ears, and mouth to see, hear and say only good things. We smudge the rest of our body and pray to keep it in good health; that our hands, arms and legs will work towards the benefit of all people. A braid of Wiingash is hung in the home, and car for protection.

70 The Four Elements The Medicine Wheel teaches us about the four elements. Each is distinct and powerful and each is part of the physical world. All require respect because of their gift of life: Ishkode fire Aki earth Nibiish water Nooden wind Man and Woman must show respect and thankfulness by caring for the environment in ways Big and Small.

71 NIIWIN MISHOMSAG (The Four Grandfathers Direction) These four grandfathers are the spiritual guardians of the four direction. We receive emotional, mental, spiritual, and physical strengths from the grandfathers. Waabinong East East is the direction for birth and rebirth. Rebirth meaning new things to learn on a new level of understanding. It is the direction from which light comes into the world and therefore the direction of illumination. It is the direction of guidance and leadership. The gifts of beautiful, clear speech that helps others to understand can be achieved. For all these, we pray. Ask the Eastern Spiritual Grandfather, who intercedes, to the Creator, for a new level of understanding towards your new level of education.

72 ZHAAWINONG - South South The gifts of the south are the direction of the sun at its highest point. It is the place of summer, of fullness, of youth, of physical strength and vigor. And so we pray for this strength. It is also a time of preparing for the future, of getting ready for the days ahead. The south is also the place of the heart, of generosity, of sensitivity to the feelings of others, of loyalty and love. The most difficult and valuable gift to be sought in the south of the Medicine Wheel is the capacity to express feelings openly and honestly.

73 EPINGISHIMOK - West West The greatest lesson to be learned from the teachers of the west is to accept ourselves, as we really are, both spiritual and physical beings, and to never cut ourselves off from the spiritual part of our nature. We pray to stay on the path of life in a good way with out thoughts and actions. If we do wrong, stumble and fall away from the good path, then we need to pray to the Grandfathers of the west to help us get back on the True Path of Life.

74 GIIWEDINONG - North North The north is the place of winter, of the white snow that reminds us of the white snow reminds us of the white hair of our elders. It is the place of true wisdom. The white polar bear teaches us strength and survival. We pray for the strength that will keep us well. Keep us from sickness. Survival sometimes means physical survival. That there is enough food and wood to keep us warm. We also need to pray that we survive emotionally and mentally, against loneliness, depression, etc., and that our spirit and heart is strong.

75 The Medicine Wheel This important teaching tool helps us to see and understand things that we cannot readily see or understand because they are ideas: The SEVEN GRANDFATHER TEACHINGS: Love Truth Respect Wisdom Truth Humility Honesty

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77 How does that work with Western Interventions Medicine Wheel East South West Motivational Interviewing *Pre-contemplation Pre-contemplation *Contemplation Contemplation *Preparation *Action Maintenance Stages of Grief Denial Anger Bargaining Depression North *Maintenance Acceptance

78 The Medicine Wheel We have briefly explored some of the important concepts that have continued to be taught through the use of the Medicine Wheel. These are basic human qualities, which can benefit all races. The Medicine Wheel helps us to see purpose and understanding in our lives. Living without symbols would mean experiencing life without it s full meaning.

79 Lastly, I want to make it clear that these Medicine Wheel Teachings take a life long commitment of walking this Sacred Red Road to truly understand. Please use this information with respect. Thank you Miigwetch