By Skye Hart, Technical Advisor, Indigenous Health and Drug Use Initiatives at Vital Strategies
The overdose crisis has had devastating impacts on families and communities across North Carolina and has disproportionately affected Native communities. Native people experience the highest rate of fatal overdose of any racial or ethnic group in the state, at a rate 2.5 times that of the overall state population, according to 2021 data. Despite this, Native communities often face limited access to resources and funding for overdose prevention services.
In 2021, pharmaceutical distributors made nationwide settlements to states for their role in the overdose crisis, and agreements on the allocation of funds to states and local governments were finalized by 2023. The state of North Carolina, as well as individual counties, could allocate funds from these opioid settlements to Tribes to address the overdose crisis.
Kicking Off the Conversation
As part of the effort to include Tribes in planning and spending the state opioid settlement funds, Vital Strategies, Community Organized Relief Effort (CORE), community researcher and consultant Tony V. Locklear and the United Katehnuaka Longhouse will be facilitating a listening session in April-May 2025 with Tribal leaders and decision-makers, and those working on overdose prevention and harm reduction work in Native communities.
The listening session will explore Tribes’ interest in requesting a set-aside from the opioid settlement funds, learn more about existing efforts in this area, identify champions and contacts from interested Tribes, and identify other stakeholders who should be a part of the conversation. The session will also begin to build a roadmap to accomplishing this goal and share resources regarding overdose prevention and harm reduction work in Indigenous communities. This listening session aims to catalyze this conversation and share resources with Tribes, with the goal of Tribes ultimately leading this effort. A follow-up working session will be held after the initial listening session.
How to Get Involved: Please reach out to Skye Hart (Tonawanda Seneca), Technical Advisor of Indigenous Health and Drug Use Initiatives at Vital Strategies, to get involved and join our email list.
For more information about including Tribes in the planning for opioid settlement spending, click here or see below.
Background and Resources on Tribal Inclusion in Opioid Settlement Planning
Funding determinations from the national opioid settlements were made using data that includes Native people. Tribes commonly face numerous barriers to providing adequate overdose prevention services, including limited funding. State recognized Tribes—including those in North Carolina—do not have access to the Tribal Opioid Settlements available to federally recognized Tribes, making it especially crucial to include state recognized Tribes in state opioid settlement fund planning and spending. By including Tribes in opioid settlement fund planning, new opportunities for partnerships on current or future overdose prevention services and data sharing initiatives can be identified.
Tribes—individually or collectively—have several options for accessing funding. At the state level, decisions regarding how to spend opioid settlement funds are made by the General Assembly through appropriations. Tribes could advocate for legislation for funding of programs and services that address the overdose crisis, detailing specific programs or program components that would be funded under the appropriation. Given the challenges of navigating the legislative system, especially for Tribes with limited administrative capacity, another possibility is to collaboratively advocate for a single entity to receive one pool of funding for all Tribes. This allows that entity to then non-competitively sub-grant out to each Tribe via a low-barrier process. Tribes could also request that the state create a Tribal consultation process for opioid settlement fund planning and spending, such as via the creation of a Tribal advisory group.
Success Stories from Other States
By setting aside funding from the opioid settlement funds for Tribes, North Carolina would be joining at least 10 states who have chosen to allocate opioid settlement funds to Tribes and Native organizations.
- In Washington, in addition to allocating $15.4 million for Tribes and urban Indian health programs for opioid and overdose response programs from 2023 to 2025, the Washington State Health Care Authority created dedicated opportunities for Tribes to provide input on the spending of settlement funds as part of its commitment to collaborating and consulting with Tribes. In 2024, the state committed to allocating at least $7.75 million annually from its opioid settlement funds to Tribes through 2031 if funds remain available. After this date, Tribes will continue to receive funds at a different rate.
- In Fiscal Year 2023, Wisconsin allocated $6 million in total from its opioid settlement funds to all 11 federally recognized Tribes that share geography with the state, for the purposes of “prevention, harm reduction, treatment, and recovery services for Tribal members.” Moreover, in Fiscal Year 2025, the State of Wisconsin again set aside $6 million, with all 11 federally recognized Tribes receiving funding. This spending decision was made following listening sessions with Tribal leadership.
More on Tribes and Native Communities Addressing the Overdose Crisis
Native communities across the continent have developed innovative approaches to addressing the overdose crisis, tailored to the unique cultures and needs of their communities. Two Native-led programs are highlighted below:
- The United Katehnuaka Longhouse’s Good Mind Initiative (North Carolina): The United Katehnuaka Longhouse (UKL) is a Native-led, eastern North Carolina-based nonprofit organization promoting cultural connectedness and revitalization as a way to heal the historical, intergenerational, and lifetime traumas that contribute to substance use disorder in Native communities. Through culture classes, talking circles, and community socials, UKL provides support to Native people who use drugs, breaks down harmful stigma around drug use, and promotes the health and well-being of Native people across the region, healing the historical, intergenerational, and lifetime traumas that contribute to substance use disorder in Native communities.
- Gwayakobimaadiziwin Bad River Harm Reduction (Wisconsin): The Gwayakobimaadiziwin Bad River Harm Reduction program provides harm reduction services to people who use drugs in their community including peer support, traditional healing, and referrals. They also offer lifesaving supplies including naloxone, fentanyl test strips, sterile syringes and syringe disposal services, safer smoking supplies, and wound care supplies. Bad River Harm Reduction offers these supplies in their community via peer-support delivery, and to people throughout Wisconsin through mail order. They also endeavor to confront the discrimination endured by people who use drugs and advocate for more humane law and policy.
In the words of co-founder Philomena Kebec, “We started our community-based harm reduction program to keep our relatives, friends and neighbors from dying from opioid overdoses. We keep doing it because harm reduction is a life-sustaining practice rooted in our traditional values of love, respect and forgiveness.”
For more information about Native-led overdose prevention approaches, the Johns Hopkins Center for Indigenous Health developed the Tribal Principles website. This resource was designed to guide spending of the Tribal Opioid Settlements, which are available to federally recognized Tribes, but it is also a helpful resource for more learning about and guiding Native approaches to healing from the overdose crisis beyond the context of the Tribal Opioid Settlements.
Visit the Tribal Principles website at https://www.tribalprinciples.cih.jhu.edu/
In addition, the National Harm Reduction Coalition published a Native Harm Reduction Toolkit for Native communities interested in starting or expanding services such as improving access to naloxone, providing medications for opioid use disorder, establishing syringe services programs, and creating appropriate opportunities for people who use drugs to participate in ceremony and other cultural activities. This toolkit covers Indigenizing and decolonizing harm reduction, reducing stigma, assessing need and community readiness, and engaging Tribal leaders and elders.
Visit the Native Harm Reduction Toolkit on the National Harm Reduction Coalition’s website at https://harmreduction.org/native-toolkit/