Fatal drug overdoses shot up during the peak of Covid-19 in 2020. And as the dust settled on the pandemic, it quickly became clear that one demographic group had fared far worse than any other: Native Americans.
Now, to combat the drug crisis and its disproportionate impact on indigenous people, the federal government is launching an initiative specifically meant to bolster research into addiction and overdose within native communities.
But the roughly $270 million project goes a step beyond simply studying Native American drug deaths. Instead, the National Institutes of Health is effectively handing over the reins by providing funding and infrastructure for communities to steer the research themselves.
“Tribes want to lead research, they want to be directly funded to lead research, and they want the research to reflect the priorities of their communities,” said Kathy Etz, the director of Native American Programs at the National Institute on Drug Abuse. “What we’re doing here is supporting tribes and Native American-serving organizations to do what they want.”
The initiative, known as the National Collective Research Effort to Enhance Wellness or N-CREW, is the largest effort ever to specifically target drug use and overdose among native communities.
It comes amid a continued national drug overdose crisis: Roughly 100,000 Americans died in the 12-month period most recently reported by the Centers for Disease Control and Prevention. The age-adjusted death rate among Native American and Alaska Natives was the highest among any demographic: 65.2 deaths per 100,000 people.
The program is being run jointly by NIDA, the National Institute of Neurological Disorders and Stroke, and the National Center for Advancing Translational Sciences. It draws its funding from the HEAL Initiative, a long-running NIH program meant to address the drug crisis and develop non-opioid painkillers.
The multi-phase project will focus on both pain treatment and substance use. Its main goals are twofold: First, bolstering research capacity within native communities, and second, using the data to aid in local public health decision-making.
For many communities, N-CREW is well-timed. Many had already begun conducting their own community health needs assessments, and they were clamoring for more resources to address the ongoing crisis. Native Americans have long suffered disproportionately from disease and death related to alcohol. Opioids and methamphetamine have become far more prevalent in recent years, adding yet another dimension to a multifaceted substance use epidemic.
Yet major information gaps remain about the specific nature and causes of the overdose epidemic’s toll on native people. One of the biggest issues that N-CREW aims to tackle is what Etz referred to as a “data genocide” — the reality that Native American communities are often effectively “invisible” in large government data sets.
The new research undertaking is slated to run for seven years, with the first two years dedicated to support projects as they plan and develop new research and data-collection mechanisms. The agency said in a press release that the full planned expenditure of $268 million is “pending the availability of funds.”
Other arms of the federal government have also worked to bolster research focused on indigenous communities and to implement ethical safeguards, staging a workshop for investigators who study native communities in 2021.
“More and more, tribes across the country are saying: Hey, our voice gets muted in this process,” said Ronny Bell, an epidemiologist at the University of North Carolina’s Eshelman School of Pharmacy. “One of the things we wanted to be able to say in this process is that right off the bat, we’re going to establish infrastructure that allows us to hear from the community.”
Notably, Bell said, N-CREW funding and resources are being made available to all indigenous communities, including Alaska Natives and Native Hawaiians. Often, federal programs meant to aid native people are exclusive to federally recognized tribes. Broader eligibility means that tribes like the Lumbee Tribe of North Carolina, of which Bell is an enrolled member, can also take part in the project.
“I think it’s amazing that focus and funds are being set forth for natives that are most at risk and struggling,” said Aurora Conley, the co-founder of a harm reduction program serving the Bad River Band of Lake Superior Tribe of Chippewa Indians in northern Wisconsin. “I hope to see more efforts than just Narcan distribution as we come together to heal our people and our communities. We are historically strong nations that have survived many atrocities and, with support, we can holistically be able to help our own.”
But federal health programs specifically targeting minority communities are not without their pitfalls, especially when it comes to Native Americans. The U.S. government’s long history of war, violent expulsion, and broken promises to the tribes it displaced still looms large — as does its broader legacy of mistreating research subjects from marginalized communities, as in the infamous Tuskegee syphilis study.
But N-CREW is hardly shying away from that context, Etz, the NIDA official, said in an interview.
“That context is the foundation of this program: The acknowledgment that communities know what will work for them, that they have knowledge we couldn’t possibly have,” Etz said. “This program will not succeed if we don’t develop trusting relationships and deep partnerships with the communities we’re working with.”