A Closer Look at Opioid-Related Mortality: A Focus on American Indians and Alaskan Natives

By Iris Smith Ph.D.


Indigenous groups are often marginalized and face discrimination, and struggle to protect their rights at both the collective and individual level. While indigenous populations represent a relatively small percent of the population in a region, they are more likely to experience significant disparities in access to services and disparities in physical and behavioral health outcomes. As such, it is important to gather accurate data on the severity and scope of culture-specific risk and protective factors for these groups (Wyatt et al., 2015; Lauricella et al, 2016). 


Over 400 sovereign nations comprise the indigenous populations of North America. Drug overdose rates have steadily increased across all U.S. populations over the last 10 years. However, overdose rates among American Indian (AI) and Alaskan Native (AN) have been disproportionately high compared to other subgroups. Few studies have examined historical trends and associated risk factors within these groups. Between 1999 and 2019, opioid-related mortality rates increased from 5.2/100,000 to 33.9/100,000 among AI/AN groups in the U.S. Mortality among  AI/AN women increased from 3.9 to 26.1/100,000 and from 6.5 to 42.1 among men. Compared to other U.S. racial and ethnic groups, rates of opioid-overdose mortality are generally higher and they are more likely to die from opioid/alcohol and opioid/ methamphetamine combinations.[1]


Depression is often cited as a risk factor for substance use disorders (SUDs) as well as suicidal behaviors for the general population. AI/AN populations are disproportionately affected by suicide compared to other U.S. populations, with a suicide rate estimated to be 250% higher than the general U.S. population.1 However, it is not known what proportion of opioid overdoses are “intentional” suicide attempts. [2] The Centers for Disease Control and Prevention (CDC) estimates that across the U.S., approximately 8% of all opioid overdoses are suicides or suicide attempts.[3]


Despite the heterogeneity within the AI/AN population, indigenous children have a higher risk of death by suicide, depression, posttraumatic stress disorder, substance use disorders, and learning difficulties. AI/AN groups constitute the smallest U.S. ethnic group yet have the greatest disparities in health care. Risk factors that contribute to mental health and substance use include posttraumatic stress, historical trauma, acculturation-related issues and cultural conflicts, poverty, and living in rural environments. Protective factors include family and social connectedness, and adherence to traditional religions and beliefs.  Understanding of the social and cultural issues underlying these conditions is critical. [4]


Recent research on the prevalence of both mental health issues and substance use-related mortality is a reason for concern. The most effective prevention approaches are likely to occur as a result of active engagement and collaboration with AI/AN community members. A participatory approach to research, prevention and treatment that includes active collaboration with tribal leaders and community members is critical to understanding the risks and protective factors within individual AI/AN communities and creating effective programs that meet their needs.





Center for Culturally Responsive Evaluation and Assessment (CREA):  CREA is located in the College of Education at the University of Illinois at Urbana-Champaign.  It is an international community of scholars/practitioners that exists to promote a culturally responsible stance in all forms of systematic inquiry including evaluation, assessment, policy analysis, applied research, and action research.  (https://crea.education.illinois.edu/ )

Lauricella M, Valdez JK, Okamoto SK, Helm Ss, Zaremba C (2016), Culturally Grounded Prevention for Minority Youth Populations:  A Systematic Review of the Literature.  Journal of Primary Prevention, 37; pg. 11-32. PMID: 26733384; PMCID: PMC4738149

Substance Abuse and Mental Health Services Administration (SAMHSA) (2019) Tip 61: Behavioral Health Services for American Indians and Alaska Natives.  https://store.samhsa.gov/product/TIP-61-Behavioral-Health-Services-For-American-Indians-and-Alaska-Natives/SMA18-5070

Whitley P, LaRue L, Fernandez SA, Passik SD, Dawson R, Jackson RD (2022) Analysis of Urine Drug Test Results from Substance Use Disorder Treatment Practices and Overdose Mortality Rates, 2013-2020.  JAMA Netw Open, 2022 Jun, 5(6): e2215425. PMID: 35657623

Wright, A. L., Wahoush, O., Ballantyne, M., Gabel, C., & Jack, S. M. (2016). Qualitative Health Research Involving Indigenous Peoples: Culturally Appropriate Data Collection Methods. The Qualitative Report, 21(12), 2230-2245. Retrieved from https://nsuworks.nova.edu/tqr/vol21/iss12/5


[1] Qeadan, Madden EF, Mensah NA, Tingey B, Herron J, Hernandez-Vallant A, Venner KL, English K, Dixit A. (2022). Epidemiological Trends in Opioid-only and Opioid/polysubstance Related Death Rates Among American Indian/Alaska Native Populations from 1999-2019: A Retrospective Longitudinal Ecological Study.  BMJ Open 2022; 12:e053686. Doi:10.1136/bmjopen-2021-053686.

[2] Pergolizzi J, Breve F, Magnusson, Nalamasu R, LeQuang JAK, Giustino V (2021).  Suicide By Opioid:  Exploring the Intentionality of the Act. Cureus 13(9): e18084.  DOI 10.7759/cureus 18084.

[3] Oquendo MA & Volkrow ND (018.  Suicide: A Silent Contributor to Opioid Deaths.  New England Journal of Medicine 378, pg.1567-1569.

[4] Livingston R, Dally RS, Guerrero APS, Walkup JT, NOvins DK (2019).  No Indians to Spare:  Depression and Suicide in Indigenous American Children and Youth. Child and Adolescent Psychiatric Clinics of North America (28(3); pg. 497-507

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