Translating Mixed-Methods Research in Addiction & Overdose to Policy & Practice in Indigenous Communities throughout the United States

For the past half-century, American Indians (AI) have endured the largest inequities in drug addiction and overdose deaths of any race in the US. The opioid crisis adds fuel to the crippling physical, social, emotional, and economic effects of drug use on AI communities.

This research will avail a novel mixed-methods research model to address the opioid epidemic in two AI tribes. The design reflects expert knowledge of past barriers that obscured advancement in drug prevention science, and opportunities for change that are unique to AI populations and contexts. Past barriers include inequitable relationships between researchers and tribal communities; stigmatizing epidemiological studies lacking AI community input and interpretation; inadequate AI-specific drug use prevalence data; failure to engage AI stakeholders in culturally congruent, evidence-informed intervention and policy creation; and a focus on risk reduction rather than strengths-based solutions. Current opportunities for change include emerging Indigenous research leaders in the drug prevention field with capacity to authentically engage tribal stakeholders; increasing sophistication in applying mixed-methods models to address complex factors underpinning drug abuse; and understanding of how tribes can exercise sovereignty to mount evidence-driven public health response.

We will conduct mixed-methods Community-Based Participatory Research (CBPR) in two diverse tribes: the Bois Forte Band of Ojibwe in Minnesota and the Cherokee Nation of Oklahoma. Our overarching goal is to identify complex drivers of injection drug use health inequities and mobilize public health intervention and policy levers for change via these objectives: 1: Quantify the size and characteristics of the population of people who inject drugs (PWID), 2: Explore how diverse community contextual factors (cultures, policies, health systems) interact with individual (e.g. injection drug of choice, gender) and community (stigma, access to treatment, cultural resources) factors to identify levers for change, and, 3: Develop a tribal toolkit to translate findings to policy and practice.

Primary Investigators

• Melissa Walls, PhD
  International Health,
  Johns Hopkins Bloomberg School of Public Health
• Sean Allen, DrPh
  Health, Behavior, Society,
  Johns Hopkins Bloomberg School of Public Health

Co-Investigators & Partners

• Allison Barlow
  International Health,
  Johns Hopkins Bloomberg School of Public Health
• Mary Cwik
  International Health,
  Johns Hopkins Bloomberg School of Public Health
• Brady Garrett
  Cherokee Nation
• Pam Hughes
  Bois Forte Chemical Dependency Team