NCAI Opioid Initiative


The National Congress of American Indians (NCAI) is working with tribes to help end the opioid epidemic in tribal communities. The problem of opioid supply and demand are significant in AI/AN communities, and solutions require collaboration across multiple sectors.

This work grew out of the work of the NCAI Substance Abuse Task Force and input from tribes at NCAI meetings and events. This webpage includes the latest resources for tribe to help address this growing problem in our communities.


The opioid epidemic in American Indians and Alaska Natives (AI/ANs) is basically a problem of supply and demand.  Opioids include: 1) prescription products such as oxycodone, hydrocodone, morphine, methadone, and fentanyl; and 2) illegal drugs including heroin and illicitly manufactured fentanyl.

Opioids — a problem of supply and demand

The opioid epidemic is complex and has resulted from the following problems of supply and demand:

Supply — opioids are made available for overuse and abuse through the following sources:

• Provider prescription and over-prescription
• Overuse of opioids in pain management practices
• Pharmacy supply - improper access, diversion or security breaches
• Impaired provider access, diversion, self-prescription
• Community access through drug dealers, theft of prescribed opioids
• Pharmaceutical company distribution of large amounts of opioids in communities
• Illegal manufacturing

 Demand — opioids are available and in demand due to the following issues:

• Lack of access to appropriate care for conditions requiring pain management
• Use for relief of mental health issues, trauma, chronic stress
• Cause of substance abuse/addiction, overdose, neonatal abstinence syndrome
• Usage by impaired providers
• Poverty, unemployment and economic opportunity in drug trafficking, sales, theft
• Lack of access to prevention/treatment/recovery services
• Lack of funding to address the opioid epidemic

Solutions — a wide variety of opportunities in multiple sectors

The solutions to the opioid epidemic require solutions in many areas, including the following:

Health provider/system education, training, monitoring, security

• Providers – pain management education, drug prescribing guidelines, drug monitoring programs
• Pharmacy – education/counseling patients on proper use, potential for abuse, security measures to prevent diversion, double signatures for dispensing
• Identification and treatment for impaired providers
• Increased access to specialty care, referral funding for conditions requiring pain management

Opioid addiction prevention, treatment, recovery strategies

• Better diagnosis of addiction, access to treatment/recovery services, inpatient/outpatient treatment, medication assisted therapy, naloxone use
• Strategies to address root causes: trauma, chronic stress, mental health counseling/treatment
• Additional funding for grants to communities for interventions
• Education and treatment guidelines for neonatal abstinence syndrome

Law enforcement strategies

• Enhanced arrest/convention of drug trafficking, diversion, theft, illegal manufacturing
• Drug court options for addicts instead of jail/prison time
• Increased access to treatment/recovery services for the incarcerated

 Community strategies

• Community opioid emergency declaration
• Community needs assessment, strategic planning, collaboration with other stakeholders
• Community awareness, education, wellness and prevention activities
• Naloxone distribution
• Community economic development strategies
• Implementation of the recommendations of the Tribal Behavioral Health Agenda

Litigation strategy

• Pharmaceutical company oversupply – seek economic and injunctive relief to prevent future abuses

Federal/State/Local government efforts

• Education and awareness of opioid crisis, available resources, collaboration with tribes
• More data/research on needs, solutions, sharing of best and promising practices
• Increased resources for provider, treatment/recovery, law enforcement and community strategies


Policy briefs and reports

Tribal Leaders Toolkit: Strengthening our Nations 2018 - Addiction Task Force. This toolkit includes the latest policy brief on the opioid epidemic from the NCAI Policy Research Center, a briefing paper on the 2018 Opioids Legislation, and presentations from tribes on their efforts to address the opioid epidemic in their communities.

Research Policy Update: The Opioid Epidemic: Definitions, Data, Solutions (March 2018).  This update provides information on the complexity of the opioid epidemic, and provides information on definitions, current data for the U.S. and AI/AN overdose deaths, and discusses the origins of this epidemic along with possible solutions.

Responding to the Opioid Crisis: An Update for Tribal Leaders (Summer 2017). This brief summarizes impact trends of the opioid crisis in Native communities and provides tribal leaders with recommendations for prevention and intervention to protect the health of their citizens.


NCAI Policy Research Center Monthly Webinar Series: Neonatal Opioid Withdrawal Syndrome (NOWS) in American Indians and Alaska Natives. This webinar in July 2018 featured an overview of Neonatal Opioid Withdrawal Syndrom by CAPT Ted L. Hall Pharm D, BCPP, RPh, Ho-Chunk Nation Director of Pharmacy/Chief Pharmacist, IHS Heroin, Opioids, and Pain Efforts (HOPE) Committee - Perinatal Substance Use Workgroup Co-Chair. 

NCAI Opioid Initiative Monthly Webinar Series: Tribal Litigation Options to Combat the Opioid  Epidemic. This webinar in April 2018 featured an update on litigation options for tribes to combat the opioid epidemic.

NCAI Policy Research Center Monthly Webinar Series: The Opioid Epidemic - IHS Response to a National Crisis. This webinar in March 2018 featured a review of what the Indian Health Service (IHS) is doing to address the opioid epidemic in AI/AN communities. The speaker was CAPT Cynthia Gunderson PharmD, Vice Chair of the IHS Heroin, Opioids, and Pain Efforts (HOPE) Committee.


NCAI 2019 Executive Council Winter Session, Washington DC - Addiction Task Force, February 11, 2019 - View Agenda (coming soon!)

NCAI 75th Annual Convention & Marketplace, Denver CO - Opioids Breakout Session, October 23, 2018 - View Agenda

Senate Committee on Indian Affairs – Oversight Hearing on “Opioids in Indian Country: Beyond the Crisis to Healing the Community”

NCAI 2018 Mid Year Conference, Kansas City, MO - SAMHSA Tribal Listening Session, June 3, 2018 - View Tribal Leader Letter; Breakout Session on "Utilizing Federal and Community Resources to Overcome the Opioid Epidemic," June 4, 2018 - View Agenda

Tribal consultations

NCAI 2018 Mid Year Conference, Kansas City, MO - SAMHSA Tribal Listening Session, June 3, 2018 - View Tribal Leader Letter

Opioid Consultation and Listening Session – NIH, SAMHSA, IHS
Monday, May 21, 2018
Prior Lake MN
For more information, visit:

Funding opportunities

Search for funding opportunities on sites such as,, 

Partner Resources

SAMHSA – Tribal Behavioral Health Agenda