Administration Seeks to Invest $250 Million in Indian Country To Combat the Opioid Crisis, Part of Broader Federal Effort to Address the Crisis

On February 1, 2024, the Indian Health Service (IHS) hosted a virtual consultation to solicit Tribal input on the potential implementation of $250 million included in the Biden Administration’s recent supplemental request. The funds would address fentanyl and opioid abuse, prevention, treatment, recovery services, and harm reduction interventions in Tribal communities, according to the Dear Tribal Leader Letter dated January 12, 2024.

The Opioid Crisis in Indian Country

Representatives from across IHS, including Director Tso, attended the consultation, highlighting the seriousness with which the agency is approaching the crisis. IHS representatives began by framing how harmful the opioid crisis has been in Indian Country, citing that overdose mortality among the AI/AN population increased 33% between 2019 and 2022. This increase in overdose mortality underscores the urgent need for effective and continual intervention. The Centers for Disease Control and Prevention (CDC) reported in 2022 that AI/ANs had the highest drug overdose death rate in 2020 and 2021, with rates of 42.5 and 56.6 deaths per 1,0000 people, respectively.

Discussion with Tribal Leaders

Tribal leaders began the discussion by expressing the importance that any additional federal funds targeted at the opioid crisis must serve the dual role of also protecting Tribal sovereignty. Tribal leaders clarified that the competitive grant process hinders access to federal funds, virtually prohibiting many Tribal communities from creating and implementing successful programs and services to combat the opioid crisis. Tribal leaders shared that they are hopeful that IHS will lead the federal government in efforts to provide direct funding to Tribes, which is much more conducive to accessing funds and to program success in Indian Country. IHS representatives shared that every effort is being made to ensure funds that are made available to Tribal communities can be distributed via direct funding. Tribal leaders urged that IHS distribute any supplementing funding in one lump sum, as opposed to annual distributions. IHS representatives explained that funding would be provided on a one-lump-sum basis because the opioid crisis is an emergency, and Tribes need the inherent flexibility that lump-sum funding offers to address the crisis.

Another issue pertaining to funding mechanisms that Tribal leaders wanted to discuss was the amount of time Tribes must wait to receive federal funds from the time that the funds are made available. IHS representatives explained that they are reviewing every administrative hurdle to streamline the process. Next, Tribal leaders inquired as to how much of the $250 million IHS would retain for its own expenses, but IHS representatives were unable to speculate on a figure at the time. In response, Tribal leaders urged IHS representatives not to withhold a substantial amount of funding as this crisis requires as many resources as possible to be made available to Indian Country.

Tribal leaders also inquired as to the likelihood that President Biden’s supplemental request would be successful, and while the IHS representatives had no insight to offer, they explained that Tribal input during this consultation will be utilized to determine what to do with future federal dollars targeted at combating the opioid crisis in Indian Country, regardless of whether the supplemental request is successful. Some Tribal officials explained that IHS should review how it distributes funds via direct funding to more accurately reflect that Urban Indians come from outside service areas to receive care but are not counted in the IHS user population.

Some Tribal leaders pointed to the need for funds targeted at infrastructure instead of programs, adding that while program funding allows for the creation of services and the ability to hire staff, Tribes also need to build out infrastructure to house programs and staff. Other Tribal leaders added that flexibility in how to spend the funds is imperative to upholding Tribal sovereignty.

Ongoing IHS Efforts to Address the Opioid Crisis

IHS representatives also discussed ongoing projects targeted at intervention, prevention, and treatment. The Community Opioid Intervention Pilot Project, which currently funds 35 grantees, is designed to promote culturally informed and family-oriented opioid education, prevention, and treatment for Tribal communities. The program expires in March of this year (read the IHS evaluation of the pilot program here). However, in December of 2023, IHS announced $9.5 million in grant funding for the Community Opioid Intervention Prevention Program (COIPP), which will focus on the same goals as the pilot project. The closing date for applications is February 7, 2024 (view application information here). Last year, IHS also initiated a fentanyl test strip pilot program, released a new Essential Training on Pain and Addition, and announced a new Naloxone Safety Net Program.

Other Federal Efforts to Combat Crisis

Congress has also targeted efforts at combating the opioid crisis. In December of last year, the Senate Committee on Health, Education, Labor & Pensions (HELP) held a markup on the SUPPORT Act and the Modernizing Opioid Treatment Access Act. The SUPPORT ACT reauthorizes programs and grants that support prevention, treatment, and recovery from opioid use. The Modernizing Opioid Treatment Access Act expands access to methadone, a medication used to treat Opioid Use Disorder. Both pieces of legislation saw bipartisan support and were referred to the full Senate for consideration. The House of Representatives has also passed a version of the SUPPORT Act, H.R. 4531. The House passed the bill 386-37, as amended, and then referred it to the Senate. H.R. 4531 was introduced on the Senate floor and referred to the HELP Committee on December 13, 2023.

Next Steps

It is promising to hear that IHS is responding to Tribal requests that the agency utilizes direct funding to distribute federal dollars. However, it is through consistently voicing these thoughts at consultation, as well as submitting written comments, that Indian Country communicates such requests. IHS is accepting written comments on the issue of the Supplemental Request until Monday, March 4, 2024. Comments can be e-mailed to [email protected], with the subject line: Supplemental Request for Fentanyl and Opioid Abuse Funding.