Author: Nicholas Skoda

[00:00:01] Nikole The guilt and shame that comes with the other children not being present and say, you have a newborn. It’s tremendously difficult to watch the women go through. But having someone who could share those same emotions and not be judged like it’s just like the peer support, you know, having someone who’s going through or been through what you’re going through at the current moment just makes you not feel alone. You have, you know, you can share that without being judged. I think judgments, the big piece in this with the stigma of “I can’t believe she got sober for this kid, you know, or didn’t get sober for those children.” It’s hard. It’s really, really hard to say I am alone. I wasn’t the best mom with these previous children, but I’m doing the best I can for this new baby. But I’m still working on reunification with those children.  

[00:00:50] Narrator This is Countermeasures, brought to you by Emergent, maker of NARCAN^® Nasal Spray. Join us as we explore the shifting, complex world of the opioid crisis. Today, opioid overdose is a leading cause of accidental death. With so many families, loved ones, and friends behind these lives lost. This season, we’ll continue to explore some of the communities hit the hardest by the crisis. From prisons and construction sites to schools and elderly care. We will hear from changemakers offering a new way forward. For pregnant women and mothers who struggle with opioid dependency, caring for themselves and their children can be difficult. Access to compassionate and trauma informed care, basic services and support in their recovery can be difficult to find. Additionally, the guilt and stigma of opioid dependency can prevent them from seeking out and getting treatment for them and their children. Babies who are exposed to opioids in utero have unique needs and need unique support. Thankfully, there are organizations across the country that are helping mothers and children be successful, keeping more families together and setting them up for success. Tara Sundem is the co-founder and executive director of Hushabye Nursery in Phoenix, Arizona. Tara is a neonatal nurse practitioner with over 30 years of experience in the NICU. In 2015, she began to see a rise in babies coming to neonatal intensive care units that had been exposed to opiates. She learned that the hospital environment was not conducive to helping the babies through withdrawal. So she and her co-founder decided to start Hushabye.  

[00:02:36] Tara We opened our doors. We have a 12 bed unit here in Arizona where we can have Mom, baby, daddy stay in one room while baby goes through that acute withdrawal process, all while providing services for mom and dad to get them well. We started a program called the HOPPE program, which is Hushabye’s Opioid Pregnancy Preparation and Empowerment Program (HOPPE).  But essentially what it means is this you teach families what to expect, how to care for their baby. You give them all of this education which leads them to go, “I really am a good mom. I am a good dad.” They’re empowered and they know how to advocate for their little ones so that the little ones get the care that you and I would expect our babies to get. We are working today with 136 pregnant women that are struggling with substance use or have been prescribed medications for opiate use disorder, and our goal is, number one, healthy mom, healthy dad, healthy baby. And as long as it’s safe, keeping moms and babies unified, that is our ultimate goal. And, then looking at those families, helping them make sure that housing, food, transportation, that they have all of those barriers figured out and addressed so that they are able to take their babies home. We’ve served almost 800 babies today.  

[00:04:23] Narrator Babies exposed to opioids in the womb are born with neonatal abstinence syndrome. These babies need unique care which Hushabye provides, alongside help for their mothers.  

[00:04:35] Tara So neonatal abstinence syndrome or neonatal opioid withdrawal syndrome. So it’s NAS or NOWS. NAS means exposed to an opiate and any other substance. NOWS means only exposed to an opiate. But what it is, is it’s a constellation of symptoms that a baby has from or, or exhibits from opiate exposure while pregnant. Baby comes out usually within 24 hours, they start feeling it just like an adult. I had one mom explain to me a withdrawal as being worse than a migraine times 100. And when she said that, I was like that is exactly what we see with babies vomiting, diarrhea, inability to sleep, irritability, fever, sweats, chills. They cry.  They’re inconsolable. And it’s that constellation of symptoms gives them the diagnosis of any type of withdrawal. So our typical stay at Hushabye for a baby is, our goal is mom delivers in the hospital at 24 hours they do some testing that they have to do at the hospital. And then at about 26 to 28 hours, babies transfer to us along with Mom and Dad. We send an ambulance to pick up Mom. And it’s not urgent, but the ambulance picks them up, mom or dad, one can travel with the baby to Hushabye. We can get an Uber or medical transport for the significant other to be able to come and meet family or meet baby at Hushabye also. Baby comes in. Usually the baby that that we see initially is struggling. Having a really hard time screaming, irritable, frantic, can’t figure out how to eat and literally within 30 minutes quiet dark environment. We can shut the lights off and we have 1 to 1 caregivers. Meaning when Mom and Dad come in, they’re anxious from what had happened at the hospital. They’re exhausted. They haven’t showered. They haven’t eaten because they just haven’t been treated great. We’re like, get in the shower, get some clean clothes. Let’s get you some food. We have someone right here that’s going to hold your baby.That’s how we’re different at Hushabye then what the hospital is. The hospital, we just don’t have the hands. My peers do really good work with babies that are this big, or babies with heart issues, breathing issues, babies that are withdrawing need a different environment. And that is nonjudgmental, barrier free, trauma informed environment, which means that we’re looking at the whole entire, family system as the patients, not just the baby, because what we find is if we can de-escalate a mom and dad and we can get their energy being calm. I can put a baby that’s frantic into mommy’s arms, and that little one just melts and it’s like, oh, I’m back inside. This is the best thing. But we literally need to get mom and dad in the doors. Help them just take a few breaths, get them some food, get them a nap, have them meet with their peer support or their therapists to go, you know, that was really hard. I’m here. Thank goodness I’m here. And then we start doing more and more education with family or reinforcing what they learn prenatally. This soothing secrets, which are seven different techniques. You hold them sideline, you do a shush noise, which is mimicking mommy’s heartbeat, making sure that they can suck on a pacifier. We go through all of those things. What we found is this-  if we can get a baby to us within 24 hours, our average length of stay is eight days. Eight days. They’re able to get out of here, and we look to make sure that they are not being brought back into the hospitals, and they aren’t. What we’re able to do is make that baby’s baseline, that entire family’s baseline of calmness or anxiety is low. They’re very, I wouldn’t say they’re relaxed because I think they’re still anxious, but compared to where they are in the neonatal intensive care unit, the reason you see a difference is the environment for some.  

[00:09:29] Narrator Justin Phillips is the CEO and founder of Overdose Lifeline. Along with a wide variety of other programs to fill the gaps in treatment for opioid and substance use disorder. Overdose Lifeline recently opened Heart Rock Justus Family Recovery Center, a recovery home where women and children under the age of two can stay for up to 18 months.  

[00:09:51] Justin So at Heart Rock Justus Family Recovery Center, it’s really about recovery, supportive housing first and foremost. So we take women who are referred to us by the court or a treatment center. You have to have gone through some type of detoxification before you can come to us. We layer that recovery foundation with supports for pregnancy and all the unintended consequences that come with pregnancy and recovery that maybe are unrecognized at first. So, for example, perhaps you had children that you lost due to your substance use disorder. Perhaps you chose to give up your children due to substance use disorder. There’s a lot of trauma, and pregnancy comes with its own complications without adding on the layer of early recovery. So we involve occupational therapy, and we look at perinatal depression, and we really wrap the women around additional supports that are required for good maternal health care, in addition to recovery support.  

[00:11:00] Narrator Tara and Justin both emphasized that women generally, but especially mothers, are an underserved group that faced their own set of challenges. Some of the mothers coming into these programs have little or no experience caring for an infant. Navigating early motherhood alongside an opioid dependency or recovery journey can feel overwhelming and isolating.  

[00:11:21] Tara And so we have the HOPPE program, which provides education to families to ensure that they know how to get their babies through the withdrawal process. How do you help them soothe? Teaching them how to feed. Helping them know how to change a diaper. Which you kind of go, that’s a no brainer. But if you’ve never been taught, you’ve never babysat, you’ve never cared for anyone, you don’t know. Our families are very much those that are stigmatized and judged. And so in the hospital, when you’ve been judged going through labor, you definitely don’t want to ask that same person to go, ‘Can you teach me how to put a diaper on?’ You feel embarrassed, ashamed that you don’t even know that because you already have felt bad, because you have not been treated the greatest. And what we do is make sure that they know what to do. They know the signs and symptoms of withdrawal with their baby. They know what they’re looking for, and they can go into the hospital into that delivery knowing what to expect, knowing what their rights are, knowing what it’s going to look like if they have a C-section, and pain management. That is one program that we have. And then we do triple P parenting, which is an eight week, I think it’s eight weeks, maybe 12 weeks parenting class that I personally wish I would have had. They learn, you know, what are their beliefs and parenting and how they were raised and how to make it that, you know, why do we not spank anymore?  What is that, and why was that acceptable at one time? Why is it not? What does it do in the brain development? But it goes through all of those things.  

[00:13:10] Justin So at Heart Rock, we try to focus on all the elements of recovery and not just abstinence or harm reduction as it relates to drug use, but also good nutrition and how to have good nutrition, good self-care and exercise and and focus on, for example, those modalities that we know are beneficial to include meditation and yoga. And again, the perinatal supports that we provide, and the help through occupational therapy with parenting, there are very few houses like Heart Rock that allow women to come to recovery, supportive housing with their children, that also provide the additional supports that we provide. Because it’s challenging, but women have to choose between their children and their recovery often. And we know that recovery supportive housing is part of the best practice in the continuum of care of long term recovery. Some of the services that we provide and the supports that we provide, are really about the women’s place in the world, potentially alone in this pregnancy. So we provide doula services so the women don’t have to go to their delivery alone, because you often need an advocate in your delivery. And in substance use, we burn a lot of bridges, and we potentially have lost connection to family that would normally serve those roles without substance use disorder. We  provide support when the women have involvement with court, you know, so we go with them to court. We serve as advocates for them in court as well as for the children. When the Department of Children, Child Services involved, we then support advocacy around that as well.  

[00:15:02] Narrator Nikole Young is a director at Heart Rock Justus Family Recovery Center. This issue is particularly important to her as she’s been there herself. Nikole has recently reached five years of sobriety.  

[00:15:15] Nikole So a little bit about my story is that back in 2010, I went to a detox center at a hospital. I was detoxing pretty bad. All the symptoms,  I didn’t feel well. And I had a nurse come to me who had no experience in recovery. Substance use was not her story, nor was she affected by it immediately. Who kind of got the textbook advice for me, you know, asking me those questions,  “well, how does this make you feel?” She didn’t understand the process of what my brain goes through, when I put a substance in my body. So that kind of shut me down, it closes me out with people who don’t know what I go through or understand how my brain works. So I eventually relapsed. I mean, that’s just my story. When I went to a recovery house, in 2019, I had a staff member approach me and introduced me to the 12 steps. She had been what I’d been through. So she had depth and weight that could kind of catch me and say, hey, she’s got what I got. It gave me hope because she had beat this. She had fought hard enough to get where she’s at. She shared how she got there. And it’s that peer support that lets you know you’re not alone, you know, and you see other people and you have this community in this fellowship that have been through what you’ve been through. You know, our stories are a little different, but they’re exactly the same, if that makes sense. It allows you to connect on a level that no other person can connect with you on. And it’s so important just to have people say, “I’ve been there, you know, this is how I overcame that. I’ve been there, I’ve done that.” And that’s what I see a lot in the recovery house. In our house at Heart Rock is a lot of women say, “I don’t have my other kids, and I just delivered this baby, and I have all this guilt and shame that comes with it. And why couldn’t I do this for my other children? But I can do it for this baby.” There’s a lot of women here with that story, and they can offer that support and say, you know, I go through it too. We offer our Making our Moms Stronger group, and we do that to allow the women to learn how to express some of those emotions, while parenting. It is not easy to get sober and learn how to parent again and learn how to parent sober. It is so difficult and hats off to these women. My daughter had to go to foster care so I could get better. So they’re doing some big things, learning how to do this together, but it helps them relieve some of those emotions and speak about it and share their fears and ask the questions they can do with each other and with the child advocate present. So they can get that, yeah, they can bounce off each other. “Does this work for you?” No. “Does that work for you?” No. Or this works for me, “that sounds great.” And then we allow the women the 24 /7 support. If I need a break, I’m exhausted. I don’t have to go use a substance to keep me up. I can go take a nap because staff has my back and they will watch the kids ,if need be. I don’t have daycare today, but I still need to work to provide. We can help you out with that. We have someone here who’s hired directly for babysitting, so she can help out. They just have to put their childcare requests in any other time, you’d have to stay home. You can’t if you don’t have childcare. We help with that. We want them to be successful. We want them to learn how to do this self-sustaining. But in the beginning, you need help. You need that support. And that’s why it’s so important.  

[00:18:39] Narrator Peer support like that which Nikole and other members of the staff at Heart Rock can offer, is critical to these programs success. Tara shares Hushabye’s approach to peer support.  

[00:18:51] Tara Peer supports are probably our magic bullet here at Hushabye.  Having our moms, and we have two moms and a daddy, that have been through the entire program, be able to share their story, and help families understand, you know, “This is where I was at.” I mean, they’ll show pictures, they’ll show videos of their baby withdrawing. They will go through those times that they were still really struggling and very, very vulnerable, and being able to see what that does for someone that is struggling, it’s something that I can’t do. I have, you know, done very well in being able to help make an impact or a dent in many families’ lives with the opioid crisis. But my peer supports those with the lived experience. You just see families respond and cling on to them and they’re like, okay, you did it- how do I do it? We have one peer support that, she, over the years, tried to get well so many times. And with us she came to us five times. I think it was five times. We sent her to four different recovery centers. The fifth one was the first one she went to that she said it was awful and she ended up staying for a year, graduated from the program and doing great. But five times, five times she came back to her peer support and said, you know, this is why I didn’t do it, whatever. But she trusted her peer support. And every time she came back. Now, did she come back like that day and say, I left? No. But she came back in a couple weeks and said, “Okay, I really need help.” And every time the peer support and she was just like, okay, well let’s try this. And so peer supports, those with lived experiences, even those if you think of,  not even in the recovery community. When I was raising my kids, of course, I latched on to friends that had kids because you could sit there and chit chat about, “Oh, you’re doing this,” “My kids doing this,” ” How did you get over that?” “I got over this way.” You’re supporting each other. And that is what those with lived experiences are doing, their lived experiences, our experiences with raising kids and parenting while struggling or going through their recovery journey. It’s really the same thing,  just a little bit different. But it is the same thing. We need community and what we find and those that struggle with opiate use disorder or substance use disorder, any type of addiction, you isolate. And that is the thing that is just a deterrent to you being able to be successful in recovery. And I believe that the Hushabye program and our peer supports are able to build up that trust little by little. I always say get the families, get a little W, a little win and you get 3 or 4 little Ws, it’s that all of a sudden you have that big capitalized, capital W that big win and that big win, maybe we, you know, got you into detox or we send baby home with you or your DCFs case is closed. Nothing better than getting on one of our groups. We hold about 50, 50 to 60 groups a month, depending on the month. But getting in a group  and just doing that celebration in the first five minutes of my case is closed. Here’s my letter. And, you know, and they’re holding it up virtually or they have it with us, with them and they’re showing us, does this really say that it’s close? And it’s like,  “It does. You did all of this work.” 

[00:23:05] Narrator Many of the women who use services like Hushabye Nursery or Heart Rock face barriers to care and access.  

[00:23:11] Tara Yeah, the barriers that families encounter are enormous and they’re continuous. It can be anywhere from transportation. How do you get to the hospital having no phone? You know, insurance companies will say, well, we provide them with phones. Okay, but do you provide them with electricity to charge their phone? Do you provide them with the ability to go pick up the phone? Our insurance companies or Medicaid will pay for transportation to and from behavioral or medical appointments. But what’s interesting is our families, after they have their baby and the mom is discharged, baby is still in the hospital. Insurance will not pay for that mom to go visit that baby because the baby’s the client. It’s not the mom going to the hospital to get treatment. And so, many of our families get dinged by the hospital, by child welfare, saying “you didn’t visit your baby.” Okay, but they don’t have a car. They don’t have transportation, they don’t have electricity to charge their phone to be able to call, to get a ride. They don’t have jobs. All of those things. Stigma is a huge barrier to care. If you go somewhere and you don’t get treated well, why would you go back? And so I used to, when I was in the hospital, I didn’t understand opiate use disorder or substance use disorder and  I can’t say I totally understand. I learn every single day, but when I really didn’t get it, I would be like “this mom only got one prenatal visit,” and now I know when I’ve talked to families, I’m like, what was the barrier to getting you to your visits? And they’re like, ” they were so not nice to me. I do want to go back.” And I’m like, so they went to one appointment, but they didn’t go back because who would want to go back and get treated poorly? Many of my families don’t understand that they have that option to switch providers, to switch hospitals. They just have no clue that it’s an option. And so Hushabyes able to help them, or direct them to certain providers or hospitals that have been noted to be very trauma informed and treated other families well. So we have a mommy and daddy recommended provider list. Mommy and daddy recommended hospitals. Depends day, time, what staff is on, how they’re going to get treated. But there are definitely ones that are, more compassionate and meet these families where they’re at.  

[00:26:17] Narrator Nikole has experienced some of these barriers firsthand. Her daughter was not allowed to stay with her at the recovery house where she was detoxing.  

[00:26:26] Nikole So when I went to detox, my daughter stayed back with her dad, who was currently in active addiction. She came for a visit with me, and she hadn’t eaten. There was no food in the house. There was no clothes in the house to start school the following day. So I ended up keeping her with me at the recovery house. They didn’t allow children, so she had to go to foster care. She stayed in foster care for a year. But the difference I see from that to what’s happening here is I transitioned from not being a full time mom to being a full time mom. So that was a huge transition. It was very difficult. Just to take all those responsibilities on at once. At Heart Rock, they allow you to have those responsibilities and work with someone to have support, to be able to do those things. Thank God I had a foundation to be able to do so, because it’s a hard transition. But I did get to reunify with my children. Some of the women here at Heart Rock, recently we had a woman come in, she was on supervised visitations with her son. Recently, her case was just closed, and our son lives with us. Another success story, same mom, four year old child was in the termination parental rights status. She’s went to work. She’s dug in. You know, she’s had some challenges along the way, but she didn’t give up. She has now been reversed to reunification with her daughter. So those are huge stories that you don’t hear a lot of because you can’t do it alone. I mean, it’s been proven. The 12 steps are evidence based.  

[00:28:05] Narrator There is still a lot of stigma mothers with a history of opioid misuse face and seeking care.  

[00:28:11] Nikole The stigma in health care is still very much real. Very much real. I recently had a resident who delivered and self disclosed when she got there and was red flagged. Immediately social work came in and she had over a year of recovery. So it is there. And you know, she was kind of treated differently. But here’s the odd thing. She was prescribed narcotics. And she had asked them not to prescribe anymore. She did have a C-section so some of it was warranted. But when she had asked them to not prescribe her anymore, they were reluctant to stop the medication. So it’s kind of a double edged sword there.  

[00:28:53] Justin There is plenty of stigma as it relates to being a woman with substance use disorder and being a mother, and especially being pregnant, because some of these women have only found recovery into their pregnancy. So perhaps they did use substances during their pregnancy, and/or they have previous instances of losing children to the Department of Child Services. So they’re flagged in that way within the healthcare system especially. So we work really hard, which is one of the reasons why we provide an advocate during those appointments and during those. Birth deliveries, because there’s a very large amount of stigma around someone who uses substances in 2024.  

[00:29:39] Tara Do I feel that stigma is ongoing? I do. I think we’re getting better. I think at times you go, “Oh my gosh, this all went good. It’s working.” But do our families hit barriers over and over and over again? I have families that are not going to tell their kindergarten teacher that their baby was substance exposed. Even if it might help their little one. They know the implications of this teacher knowing that they struggled with substance use. That is just a ding and it’s just not going to be good. And so is it later on in life that they’re stigmatized? Yes. Medications for opiate use disorder are very stigmatized, even stigmatized in those that struggle with opioid use disorder, you see those individuals not being a support. But health care workers. Community members. We just don’t understand. And at times that I find that I’m like, “Oh I just said that.  That didn’t come out right.” Or I said that and I didn’t know that it was me being judgy. And then when my families say, when you said that this made me feel this way, I’m like, I had no idea. Now, do they feel comfortable with me? They do, because they know that I’m like, I am learning and I need you to tell me if I say something wrong. And if there’s something that makes you go, “I don’t want to come back,” I need to know, because otherwise that’s a barrier that we will never, ever overcome. And they’re really good at going, “when you said this, this is how it made me feel.” But how do you build that trust? You build that trust by meeting where they’re at. And our community is not meeting those that struggle,  where they’re at, always.  

[00:31:55] Narrator: Once mothers and families leave these facilities hushabye and Heart Rock, along with their community partners, set them up for continued success.  

[00:32:03] Tara Yeah, our community partners that we use are full range from housing, food, transportation, to employment. Helping someone, get their diploma. Helping them write a resumé. We’ve helped someone get a tire fixed because they just couldn’t get to their job. They didn’t have extra funding to be able to do that. We’ve helped get windows fixed in their house, because the Department of Child Safety said that it wasn’t safe unless the window was fixed using different community partners. Helping them fill out a one page application to get that $100 to be able to fix something, that it’s such a big barrier, that to me it would be here’s $100, fix it, get it done. To our families, they can’t, they don’t have the hundred dollars to fix it. Which means unfortunately, if they didn’t have Hushabye that baby would go to foster care because the window wasn’t fixed, and we’re able to do that. I would say on average when we meet a mom or dad, on average, the very first meeting, there’s 3 to 5 referrals to community partners, food, you know, you need rental assistance, you need electrical assistance, whatever that looks like. We partner with different food banks to make sure that our families have food while they’re here. We partner with the diaper bank to ensure that we have enough diapers on site for families and for the babies. We definitely have a niche, and we don’t need to overstep. We need to just stay and do what we do really well and use community partners for what they do so so well.  

[00:34:10] Narrator Tara, Justin and Nikole all stressed that there is a lot of work that still needs to be done. Hushabye Nursery and Heart Rock Justus Family Recovery Center are among a small group of facilities that exist that keep families struggling with opioid dependency and babies together. Many women are still afraid of being stigmatized or mistreated by health care providers and face barriers to treatment. There needs to be more education for health care providers, families and the general public about the needs of mothers, babies and their support systems who have been affected by the opioid crisis. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to help address public health challenges like the opioid crisis, visit emergent biosolutions.com. If this episode resonated with you, consider writing and reviewing countermeasures on your preferred podcast platform.  

Judith At the same time, though, my two sons around here, it became really big for kids to use OxyContin recreationally. And we had a young generation of a lot of people who got very addicted. And unfortunately, my son Roger, who was 18 at the time, and my son Corey, who was 15 at the time, both started a long life of addiction at that point. It’s still a battle for them, like they went from OxyContin. And then once you couldn’t find that anymore, it went to heroin. Now you can’t find heroin anymore, it’s fentanyl. And I said, like fentanyl makes heroin look like a cakewalk at this point. The amount of loss and deaths that we have due to fentanyl are just 100 times more than what they were with heroin. So on that personal note, I mean, I pretty much have lost my one son is living in the coast homeless, but my other son is living in the Bay Area and he’s living homeless. And I worry about him all the time. And I’m just work every day talking to him, trying to get him into treatment, you know. But the fentanyl is so hard for people to come off of that he doesn’t believe he can do it.

[00:01:29] Narrator This is Countermeasures brought to you by Emergent. Join us as we explore the shifting complex world of the opioid crisis. In each episode, we’ll hear from makers of positive change as they recount personal narratives of loss and perseverance and offer a way forward to a better future. Native American and tribal communities have been some of the hardest hit by the opioid crisis. Historical trauma continues to have lasting effects in these communities. In today’s episode, we will uncover how the opioid crisis has affected Native American communities, but also the programs that are helping people reconnect with their culture and community to help combat this crisis.

[00:02:23] Nathan Billy But when we look at the impact of the opioid epidemic in our tribal communities, especially one piece that is an important piece of that impact, but it’s only one piece, and that’s the available data that we have. So, for example, when you see reports or read reports specifically from the Centers for Disease Control and Prevention or the CDC, you will often see that American Indians and Alaska Natives report some of the highest rates, if not the highest rates of impact from opioids, including opioid overdose in general, opioid overdose related deaths. Recently, especially in our communitiesm that’s been the impact of fentanyl. And that may be a combination of either intentional fentanyl seeking, or it could also be substances and frequently is substances that contain fentanyl or that are compromised with fentanyl. And the person who is using that substance is just unaware that a lethal dose of fentanyl is within that substance. And so we can see through those reports, oftentimes those high rates that are reported that stretch back a decade, and that can be very daunting. But what I think is important to note is so much of that deficit based reporting is just not contextualized. So you might see all of the charts and the graphs, and they’re helpful in one sense, but it’s all too easy. I think at this point to get what I would think of a statistical fatigue. So we sort of have, you know, how many times can you be inundated with charts and graphs when the impact of what is actually happening in our tribal communities, we lose that personal focus, the sense that these are our relatives, you know, behind all of those data points, behind those numbers and behind those those charts and graphs. Why have we reported the highest rates? Why do we see the highest rates in our communities? There are very specific reasons for that. And sometimes those reasons there’s either for lack of time or lack of space on the report. It’s just not really fleshed out. And it’s important that we be able to do that.

[00:04:15] Narrator Nathan Billy is a member of the Choctaw Nation of Oklahoma and is the director of Behavioral Health programs at the National Indian Health Board, or NIHB based in Washington, D.C.. His family members went through the boarding school system that many Native Americans were forced to endure beginning in the early 19th century. The goal of these schools was to assimilate Native American children by forcing them to speak English and keeping them away from their families, culture and religion.

[00:04:44] Nathan Billy I think it’s really important. It’s impossible, really, to separate the opioid epidemic and its impact on tribal communities from the foundations in historical trauma and the historical trauma in our American Indian Alaska Native communities. It’s very specific. It’s very unique to us. And when we look back and see that that historical trauma that stems from colonialism, aggressive imperialism, takeover of land, where we see land dispossession, forced relocation, we have a history, for example, of federal Indian boarding school policies where the federal government, in collaboration with religious institutions, sought to create and did create entire systems of programmatic effort to assimilate us, to erase our identities, to really destroy us. And I think it’s interesting that when we look at something like the opioid epidemic or what is the way out, how do we heal from this? A lot of times we hear about we’ll be strong and be resilient and there’s self-care. And, you know, I think a good response to that is how in the world do you self-care your way out of a system that was designed to erase you? That’s a burden that no one should have to bear, but it is a burden that we are asked to bear repeatedly. Work on yourself. Show yourself. Help yourself, you know, pull yourself up by your bootstraps. And that mentality, that rugged American individualism, that Western mentality is easy to say when you haven’t been forcibly relocated, when you haven’t had your land taken, when you haven’t had your children stolen from you and placed into an educational system that will not allow them to be native. And as we have seen very tragically with some of the recent reporting and ongoing reporting, as we investigate boarding school experiences, many of our children were never returned. They did not survive. They died. And that’s harsh to say that, it’s harsh to say that word, but how do you soften that? You know, this is a part where I think euphemisms are not necessary. Euphemisms don’t work. We need to to be able to safely and carefully say that together, that these are experiences of trauma that are well-established. My own grandfather, Albert, was a boarding school survivor, and he was sent to boarding school in Oklahoma where he was not allowed to speak Choctaw. He was not allowed to dress traditionally. The entire goal was for him to assimilate, for him to learn Western ways, for him to learn, to be able to dress a specific way, speak English, and ignore everything about his identity that was native.

[00:07:21] Narrator Charlene Bingham is a social worker from the Oneida Nation just outside of London, Ontario, Canada. Canada has a similar system of boarding schools called residential schools, where children often experienced abuse at the hands of the school leaders. The last residential school in Canada closed in 1996.

[00:07:41] Charlene Bingham Where I came from, because my mother was in residential school, I was in day school and so was my brothers. So residential school impacted our family by, one of them was the drinking. My mom, in order to forget to drink because the pain she saw and felt the drinking helped her forget that moment. She told me one time that she saw a little boy about seven years old, jumped from a two storey building because he couldn’t take it. When she was in there, she had to scrub the floors. She had to clean. For their meals, they had to eat maggots. Sometimes not even eat sometimes if they if they were being disciplined. It was a real hard thing for my mom to overcome.

[00:08:41] Narrator Generational trauma and mistrust in the medical system are some of the effects that this history has on communities. Nickolaus Lewis is a council member from Lummi Nation in Washington State. He is also the vice chair of the NIHB, the vice chair on tribunal self-governance, the recording secretary of the National Congress of American Indians and the chairman of the Northwest Portland area. He, like many others, believes that this history and the present are inextricably intertwined.

[00:09:11] Nickolaus Lewis You look at the whole history of this country, everything that this country has was on the backs, our ancestors and our tribe tribes across the country have tribute, they have agreements with federal government. And those are often broken still today. And when you look at our health care system, which is a treaty right. And you see how it’s chronically underfunded, helps fuel that distrust. Can you say that this is important, but then you don’t honor your commitments. But what we’ve seen is a lot of that distrust in using our people for studies, guinea pigs and things like that. Go back to the trauma when the government gave up blankets and smallpox and things like those. A lot of those things still a trickle down. You look at the boarding schools that and where our people were ripped away from their communities and beaten for speaking their language. There’s always been a level of distrust and we have to work harder at that and make sure that when we’re delivering our our health care, it is by us first and foremost. And that’s why I think it’s worked really is that culture on trying to let people know that we’re not here to cause harm or we’re trying to do the right thing. I hope by doing that over time, it’ll change the data that we see.

[00:10:38] Narrator Judith, whose voice you heard at the top of the episode, has firsthand experience with the devastating effects that the opioid epidemic and subsequent introduction of fentanyl has had on Native communities and families.

[00:10:51] Judith My husband had been a really hard working logger his whole life. He was a Yurok tribal member from the next reservation, and he had been a very hard working logger on the ground, driving three hours a day to work and back in, and he got an accident on the job and so he hurt his back and torso muscles in his back. And I remember at the time the doctors coming in because he couldn’t hardly walk and go to work. And they said, we have this new drug and it’s going to really help you. It’s long lasting and it’s not going to be addictive. And honestly, that was the beginning of the end. My husband, like most native people here, had had a lot of trauma in his life. He had grown up with a lot of trauma. What they started is maybe 120 milligram OxyContin went to 40 to 60 to 80 to 240 a day. And it just was a fast upward spiral of addiction. He was very discreet and I didn’t even know that. And then all of a sudden, you know, there was this harsh stop on the medication and all of a sudden people started realizing that these are drugs are addicting and they’re bad and they’re hurting people. So people weren’t weaned down. They were just cut off like, nope, you can’t have it anymore. And so they’re a large group of people, including my husband, went on to find other things. They were never going to handle that come down and not the cold turkey, I guess. There wasn’t much information or knowledge about (MAT) medication assisted treatment. So he quickly then at that point went on to heroin. And I actually did not know that for years until he got to more the end of his life. He handled it well and just very functioning. And that’s what a lot of people don’t understand, that people can be addicted but be very functioning. He helped take care of our grandkids. He was just like, you would never notice anything different. And then a few years ago, my oldest granddaughter, who me and my husband had raised a lot in along co-parenting with her mother, she started having a fentanyl issue, and she overdosed several times. We started looking for treatment for her. And for native kids to get into treatment, I mean, I don’t know about other kids, but here getting a child into treatment that young was almost impossible. It took like five months to find somewhere that would take her and she had to go five states away. And it was very traumatic. And we were cut off of her all of a sudden for months. And I’m happy to say that she is home now. She is in recovery. She’s clean. She’s happy. She’s now a thriving 15 year old. And so I’m grateful that she made it out of this mess at this point. And that’s just the personal people. That doesn’t count the money, the possessions, the you know, pretty much when you have people who are this into addiction, you’d basically lose everything and you lose people because people turn away from you also. You know, Judith must like it. She stays. Judith must like it. She doesn’t keep her kids out. Judith must, you know, there’s no support for the families. And that’s what I’m trying to build into my program that I run is support for families who are struggling with family members and addiction.

[00:15:00] Narrator Judith works at the K’ima:w Tribal Health Clinic and is also a writer. She has published a book called Reservation High that is informed by her experiences.

[00:15:10] Judith I didn’t really know where I was going with it, but I knew I wanted it to be from the person’s perspective who was struggling with addiction. I had a lot of friends who basically kind of turned away from me and would say things like, Well, I wish I was an addict so I didn’t have to work or be responsible or I wish I could take that easy way out. And I just thought, if you think that’s the easy way out, then you don’t know what you’re talking about because it’s the hardest life, right know. So I wanted to give people, I wanted them to like this character so that they could feel empathy. I wanted empathy. I wanted people to realize that nobody wants this. Nobody chooses this. And so that was my goal, to make these characters that people really would like, but then have her struggling. And a lot of people have gotten on to me because in there I do have a relapse. And they were like, How could you do that? That relapse is real. Let’s face it, people relapse. And so it is part of, you know, recovery. It happens. And all we can do is get up and move on forward. And so I wanted to show that that could be done and that it does happen to people. And it’s not some big mark against you because it happened. So while I was writing the book, I got about halfway through and my son Roger, who was struggling, and his significant other, Ethel, I had gotten to a writer’s block and basically I got about halfway through and I just didn’t know where I was going with it. And I was really frustrated. It had been sitting for like a month. I didn’t know how I was going to get it moved on where I was going, so I had set it aside and on March 21st I got the worst phone call of my life and it was that my son had been shot in the head, in the chest, along with two other men. And so we ran up to the scene. It’s about five miles from my house, and I pull up and nobody’s there. I just see my car he had used in a little trailer, little tiny travel trailer. And so I’m thinking maybe it’s a mistake, you know. And I run in and my son had was laying there with another man shot and we had to wait hour and 40 minutes for any kind of help. There was no ambulance. Everybody was staging. They were waiting for help to come from Eureka. I’m calling 911 every second, freaking out. In the end, my son was flown out to Redding and so we got in the car and we drove three hours to Redding and I took everything with me that I thought I would need. But the one thing I grabbed was my computer. Like, I wasn’t in my right mind. I grabbed clothes that didn’t even make sense together and stuff that, summer stuff, you know, just stuff that didn’t make sense. But the one thing I grabbed was my computer. And while we were at the hospital for the next week, I just kept working on the book because I felt like if I relaxed or slept or anything, that something was going to happen to my son. So I just didn’t sleep. And I stayed up and I kept working on the book and it just kind of took a life of its own. And so finally, my son is fine now. He did not have any debilitating things. You know, it was a hard trauma, wise and healing wise. It was a long couple months, but I just sulked myself into the book. And one month after he was shot, I had taken my mom to a doctor appointment in San Francisco. And while I was there, I got the next worst call of my life, and that was that. My only daughter and my youngest, my baby of my family had been stabbed three times by a DV incident. And at that point, I truly lost it. Like I cried for 18 hours straight trying to drive home from San Francisco. And I’m happy to say she, too, is all right. She didn’t die in that sense. But at that point I thought, I am going to finish this book if it’s the last thing I do. That just became my mission. That was April 28th, and I finished the book on June 25th. So whether I ever did anything with the book, I feel like it saved my life at a time when I needed something to sink myself into. So that’s what the book means to me. And I have had a few people read it and say that they went to recovery after they read it. They felt like it was something they could do. And they did go and they did stay. And so, you know, whether it was only one person in the world, I feel like it did its job at that point.

[00:20:27] Narrator All of the interviewees emphasized the importance of culturally centered treatment to combat the opioid crisis and help those seeking recovery.

[00:20:36] Nickolaus Lewis One of the things that we really do strive to do the best that we can, is making sure that our services go up to them, go out to the community. I think when you look in Western lens, we say come to the providers. In our lens and it goes back to the cultural component. We will take our services to the people. One example, we have a crisis outreach team that consists of people in our behavioral health department, that consists of people in our MAT program, but they will go up into, for example, homeless encampments where people are struggling and bring them medication or feed and just talk to them, let them know that they matter. We’re trying to encourage them to come into services where we’re putting that extra step in there and trying to get people connected. And I think that’s something that we have to do a lot more of is meeting people where they are seeing the struggles. When you’re you’re trying to talk to people that are struggling with addiction, you have to earn a lot of trust because they’ve had their doors shut from everybody in their life. And it’s a feeling of hopelessness is what it really feels like at times. And remembering that the root cause of this is trauma. And so having somebody come there that’s genuine with the best intentions. It takes time, but it really makes the most of the difference.

[00:22:11] Charlene Bingham My grandmother taught me some things to remember. She told me I’m an Indian first. She taught me my foundation, where I come from, who I am. And don’t forget it. So they use the medicines a lot in treatment. They bring in elders. Elders talk to them from their experience because they went through all the residential school peers and drinking, drugging and whatnot. So they walk with that person to get to a good place.

[00:22:51] Judith I noticed that when we got funding and we could actually start putting cultural classes, cultural identity stuff into our program, our success and the interest went way up. And so right now we’re working to bring up Hupa Language, and they are going to start working at the first of the year. But we do things like have cultural classes of basket weaving and carving for the men, beading, jewelry making. We’re going to do a mink hair tie, so if we can bring in the classes. And then we also, like, have people who do sweats and they go to different ceremonial things, but it builds in a resiliency. I think it’s right now the best gauge we have to keeping people from relapsing or to coming right back to it. In Hoopa, we weren’t like discovered, as they say, until the later 1850s, 1860. So we were here and didn’t have contact with non-Indians for a long time and a lot later than other tribes. So we have a lot of culture. But when people start becoming struggling with addiction, a lot of times they turn away from their culture. So we know that if we can bring them back and connect them, their success rates of staying abstinent goes way up.

[00:24:31] Nathan Billy We know in tribal communities that our culture is our strength. Just for example, in May of 2023, when we had our National Tribal Health Conference in Anchorage, Alaska, at the National Indian Health Board, our theme was culture heals, culture knows, culture leads. And that wasn’t chosen just because that has a beautiful ring to it, that all of that is absolutely true. Our culture is our strength. It is the path of healing. It is the center of our knowledge. It is the way to lead forward through healing. And I think what’s really important, we talk so much about risk factors. You know, what are the risk factors that we have in terms of opioid use that deficit based understanding of ourselves. But there are protective factors in our culture. There are protective factors of strength. There is so much to celebrate in that attempt to what was attempted to be taken away from us in some of these policies. There’s so much there that when we are allowed to or when we are encouraged or equipped to reclaim that, to revitalize that, to focus on that, that becomes our protection and that becomes a positive experience in the work that we do, for example, in HIV with adverse childhood experiences. One of the things we want to make clear is while it is so important, yes, absolutely, to talk about adversity and what those adverse experiences are. What about the protective experiences? What about the positive experiences that we can really encourage and what is positive within our tribes that keep us safe and that keep us healthy? That is what we need. And that is that is the the root of that healing. I think it’s important, since we talked about some of those experiences earlier, the federal Indian boarding school. My own tribe now operates a boarding school. But far from the boarding school of the past, which was externally operated with attempts to erase identity. We’re talking about identity, encouragement, cultural encouragement, where the school is purposefully engaging in youth stickball leagues. So for culturally specific stickball as a prevention effort to create that connection with youth so they can be a part of something that is culturally relevant to them, that is specific to our background and gives us that sense of reconnection with our communities. So what happened to us should never be confused with who we are. That is not our identity. That is something external that happened to us. It is not who we are. And yes, what has happened to us has resulted in some very real deficits. It has resulted in very real health disparities. It has resulted in some very specific concerns and issues and problems that we are having within this opioid epidemic. But the way through is that reconnection and that protection. So we talk about intergenerational trauma. Yes, there is intergenerational trauma, but there’s also intergenerational strength and intergenerational knowledge and brilliance. There are native ways of knowing that are the foundation for the help and the foundation for the healing. And so that’s where we see that that cultural reconnection being that way through that is the path for us.

[00:27:39] Narrator The NIHB is the voice of tribal communities at the national level. Currently, a priority is advocating to have the fentanyl crisis declared a national emergency.

[00:27:50] Nickolaus Lewis Coming out of the national trouble yet some that we had this past year, we did finalize a lot of our reports, our recommendations. There is some legislation that’s coming out from that. It’s not all health care. But I think when we talk about this in a crisis, we have to understand that it’s not just health care. We can’t treat our way out of this. You have to look at housing and look at jurisdiction, community safety, health care. It really touches on everything. And one of the best things that the federal government can do, and this is something we’re here working on, is highlighting these recommendations. These are things that we need. These are improvements I’m going to be working on advocating to have a national no opioid crisis in the country. I’m going to be meeting with the White House to talk about things like that. And those things, I think when we do those kind of things, it doesn’t just benefit tribal members, it benefits everybody. And I think that’s the beauty of our leadership that we have in Indian country is that when we’re doing this work, this benefits everybody. That would be a short answer. Is having the federal government really take the time to read our recommendations but themselves in our place? One thing I often asked people is how many funerals  have you gone to this past year? And I really ask him to think about that. Because in our communities, it’s not uncommon to go to the funeral a week. And when you are seeing somebody that you grew up with, somebody that was a family member or close friend died from something like an overdose at a young age, that causes trauma, that is unfortunately normalizing what our people are experiencing. And that’s not who we are. We shouldn’t be going to more funerals than we do birthday parties. That’s our reality today and we’re working hard to change that or being that voice knocking on every door we can to talk to them and make sure that they hear us. It feel like what we’re doing, we’re really uniting Indian country, was the common voice on saying this is an emergency. You know, when you look at the data, our people are dying three times the rate of anybody else especially in our area. We’re going to funerals far more often than birthday parties. But even uniting Indian country in uniting everybody that has a story of grief here, it’s not going to be enough to get this country to shift. What we’re talking about is working with our governors for the states and getting them to also call us. We’re trying to unite people. It doesn’t matter if you’re Republican or Democrat or religious belief, this doesn’t know the color of your skin. Once it gets a hold of you, it’s going to devastate all of us. And what we’ve seen is working with everybody to try to amplify this in a work was our county council. They’re getting ready to declare emergency, not crisis. And also call in President Biden to declare a working with our governor who’s funded to tribal state summits now in Washington state, working with them, trying to get President Biden. So I’m just encouraged to try to reach out to others as well. Is this, this is for all of us, this word. And we can’t do it alone.

[00:31:39] Narrator Native American peoples and tribes are not a monolith, and each have their own unique culture, history and priorities. However, culturally centered care grounded in community, traditional healing and understanding are vital parts of reconciling with the past and finding a way forward. If you’d like to read Judith’s book or a recent piece in The New York Times or learn more about the NIHB in their recent report, please visit the links in the show notes. Thank you to all of today’s guests for sharing their stories and insights. Thank you for listening to this episode of Countermeasures. To learn more about what Emergent is doing to address public health threats like the opioid crisis, visit EmergentBiosolutions.com. If this episode resonated with you, consider rating and reviewing Countermeasures on your preferred podcast platform.