Project Stories The Strong People

Recovering in Indian Country: One Family’s Journey

By Alena Prcela

SEQUIM, Wash. — When Joshua Carver hurt his back as a middle linebacker for the freshman football team, his doctor prescribed a round of pain pills. When his pills ran out, he found more at parties. When his money ran out, he found cheap heroin on the streets for $5 a bag.

Carver dropped out of high school in 2008, stole money from his family and spent many nights in the county jail, high and barely able to recall what had put him there.

Fourteen years after that first prescription, 28-year-old Carver is among hundreds of Native Americans in the Pacific Northwest working to overcome opioid addiction in a region flooded by prescription painkillers and black tar heroin, a crude, sticky substance shipped in by drug cartels.

“You always think you can stop,” said Carver, a citizen of Jamestown S’Klallam, a 543-person tribe on Washington’s Olympic Peninsula. “Then you go to stop and you get sick and you realize that you can’t.”

Jamestown S’Klallam, with ancestral ties to the land dating back more than 10,000 years, sits in the northeast corner of Washington’s Clallam County. In 2017, according to the Centers for Disease Control and Prevention, doctors wrote nearly 102 opioid prescriptions per 100 residents in the county — higher than the number of prescriptions in some areas of Appalachia, seen by many as the epicenter of the epidemic.

No other county in Washington saw more heroin-related deaths in 2016 than Clallam, according to the Washington State Department of Health.

In a region dependent on logging and manual labor, experts said pain pills were widely prescribed for on-the-job injuries. The county’s proximity to the Pacific Coast also made it easier for drug cartels to ship in heroin, particularly a form of heroin found primarily west of the Mississippi.

“They’re selling it for $5,” said Brent Simcosky, director of health services for the Jamestown S’Klallam tribe. “A six-pack of beer is more expensive than heroin. There are networks where you can call and they deliver it like a… pizza.”

Jamestown S’Klallam plans to open a healing campus, where medication-assisted treatment would be supplemented by native storytelling, singing, drumming and crafting. Much like a longhouse– a traditional home for coastal Native American families– faces the water, the center would face southwest toward the headwaters of the Dungeness River.

In late 2017, the Swinomish Indian tribal community, about 60 miles northeast of Sequim, opened a similar recovery center.

For generations, tribal communities struggled to deal with alcohol addiction. The influx of prescription pills and illicit opioids created new treatment challenges, said R. Dale Walker, a Cherokee professor emeritus at Oregon Health & Science University.

Many Native American tribes are in rural areas, often plagued by high unemployment rates and limited access to education, housing and health care, said Walker, who has consulted for more than 250 tribes.

“You can just imagine that a lot of people feeling the pain want to make the pain go away,” he said.

For Carver and his family, healing centers and other services are a critical lifeline.

“Whatever it takes, it’s better than finding one of your children dead,” said Carver’s mother, Shawna Priest, a medical assistant for Jamestown S’Klallam’s family health clinic.

The current clinic provides primary care and limited addiction treatment. The tribe wants to expand existing services with the new healing campus.

The Jamestown S’Klallam tribe is paying for Carver’s college classes. He hopes to earn an associate’s degree in construction management. Soon, Carver plans to enroll his son in the tribe’s daycare program. (Daniel Konstantino/MEDILL)

On a recent afternoon, Priest sat with her children in a house near the edge of Sequim. The walls were decorated with family photos and a tiny dog named Brutus, clad in a T-shirt that read “Problem Child,” darted around the living room.

For years, 49-year-old Priest said, she would often look into her son’s bedroom when he was sleeping to be sure his chest was still moving.

“It terrified me every time I went in there,” she said. “I thought… one of these times I’m going to go in there and it’s not going to be going up and down.”

Priest’s younger daughter, 26-year-old Hannah, also struggled with opioid addiction, at times using painkillers with her brother at local parties. Later, the siblings drove together to Seattle to pick up larger, cheaper quantities of heroin.

“It’s like shopping at Costco — just horribly,” Carver said.

Carver and his sister went to inpatient treatment, outpatient care and court-mandated youth programs. Eventually, they turned to medication-assisted treatment that blocks the euphoric effects of opioids.

Carver, who has been in recovery for two-and-a-half years, is now a construction worker for the tribe and the father of Jameson, born last July. The tribe is paying around $5,000 this year to finance his construction management and business degrees. Hannah has a steady job at the tribal casino and was recently promoted.

In Priest’s living room, Carver cuddled with Jameson, who was dressed in tan corduroy overalls and dark gray lace-up sneakers. Soon, Carver would leave his mother’s house for a day at work renovating an old house into new tribal offices.

He glanced at his son. These days, Carver said, he spends most of his time worrying about Jameson, school and work, rather than the possibility of relapse.

“It’s not even a thought in my mind.”

Project Stories The Strong People

Despair, Hope and Healing in Washington’s Indian Country: A Photo Essay

By Daniel Konstantino

In Sequim, Washington, Jamestown S’Klallam tribal member Joshua Carver, 28, was prescribed pain pills for a football injury in high school and soon became addicted. He spent months in recovery and is now working full time as a construction manager and raising his infant son, Jameson, with his girlfriend (middle). His sister (left) also struggled with addiction. In 2017, according to the Centers for Disease Control and Prevention, doctors wrote nearly 102 opioid prescriptions per 100 residents in Clallam County—higher than the number of prescriptions in some areas of Appalachia.

Carver’s younger sister, Hannah Barclay, said she also battled opioid addiction and successfully worked through a recovery program. Now 27, she works at the tribe’s casino. “It’s hard because when you’re chemically imbalanced… I didn’t care about anything at that point other than getting high,” she said.

With a combination of tribal resources and state funds, Jamestown S’Klallam is pushing to open an innovative healing center for people struggling with addiction. The center in Sequim would combine medication-assisted treatment with behavioral healthcare and traditional Native American methods. The Priest family supports the center. Here, Joshua Carver smiles at his son, Jameson, in the family home a few miles from the proposed center.

Jamestown S’Klallam tribal descendant Vicki Wallner, whose family has lived in Sequim for five generations, said she watched her son grow addicted to prescription painkillers after he injured his back in high school while working in a supermarket. Over time, she said, she began to prepare for the possibility that her son would suffer a fatal overdose. He went on to work toward recovery.

“You feel like you did everything right, and there’s a point in time where you look at this person and you see a stranger,” said Wallner, whose son has been in recovery for four years. “I think that’s the hardest part, seeing a stranger and not being able to do anything about it.”

Opioid abuse has also struck the Swinomish reservation, about 120 miles north of Sequim. There, tribal leaders have established a healing and recovery center that is generating widespread interest from other tribes and health experts, including the Jamestown S’Klallam tribe. Rita Boome-Revey lives in a recovery house operated by the Swinomish tribe. She said five of her children are in various states of addiction and recovery.
Boome-Revey, recovering from opioid abuse, said she wanted to set a good example for her children.
Boome-Revey, a mother of five, lost her youngest daughter to foster care. Boome-Revey said she wanted her daughter to live in a stable home.
In his 14 years as Clallam County sheriff, Bill Benedict said he has watched opioid abuse touch the lives of hundreds of people.

"There is the sickness, misery and even death by overdose of those afflicted, coupled with the sorrow and loss felt by families and friends. The economic costs are huge— lost wages, lost opportunities and the costs associated with many opioid-related crimes, such as burglary, theft and shoplifting. Illegal sales of heroin in Clallam County probably exceed $15 million a year. Property losses due to burglaries and thefts exceed $5 million a year. This is a lot of grief, sorrow and misery for a rural county with a population of 75,000."

Project Stories The Strong People

Undercounted and Underserved: Experts Say Opioid Deaths Overlooked Among Native Americans

By Ally Mauch

As tribes and urban Indian populations scramble to tackle the opioid crisis, inaccurate data about overdose deaths has stymied health officials and frustrated tribal leaders struggling to get the help they need.

Nationwide, nearly 2,000 Native Americans died of prescription opioid overdoses from 2008 to 2017 — the highest rate of any racial or ethnic group. Experts fear the true death count is far higher.

Graphic: Worth Chollar

In Washington state, home to 29 federally recognized tribes, researchers in a first-of-its-kind study found that opioid overdose deaths among Native Americans were underreported by about 30 percent from 2013 to 2015. That same disparity was not found among the state’s white population.

The corrected death count showed that Native Americans were 2.7 times more likely to die from opioid-related overdoses than white people.

Graphic: Worth Chollar

“When you look at health data, a lot of times you just don’t see American Indians represented at all,” said Sujata Joshi, an epidemiologist who wrote the 2018 study for the Northwest Tribal Epidemiology Center in Portland.

The problem, experts say, can be linked to death certificates. On the documents used by local, state and federal health officials, Native Americans are sometimes misclassified as “mixed race” or “other.”

The problem extends to all causes of death among Native Americans, according to the Centers for Disease Control and Prevention. In a 2016 study, CDC researchers found that 40 percent of death certificates for American Indians and Alaska Natives were misclassified. The data remained “highly accurate” for other races.

Improper data  — or a lack of data — can limit grant funding and other state and federal support as tribes work to battle addiction, said research scientist Linda Stanley, with the Tri-Ethnic Center for Prevention Research at Colorado State University.

“Tribes won’t get what they deserve to have because the problems are not as well- documented,” said Stanley, who has spent much of her career studying substance abuse within Native American communities.

Some tribal organizations are collecting their own data on opioid-related deaths. The United South and Eastern Tribes, made up of those in the North and Southeastern regions, has collected opioid death data for more than a decade.

The group is one of 448 tribal organizations involved in the ongoing consolidated lawsuit in Cleveland against opioid manufacturers and distributors. Like many other tribes, the group  noted that correcting death-data gaps for Native Americans is essential.

“Comprehensively addressing the opioid epidemic is a major priority… including addressing the lack of resources, inadequate data, historical trauma, and other issues,” the group wrote in a court brief.

The chronic underreporting of death data has helped to marginalize Native Americans, said epidemiologist Samantha Lucas-Pipkorn of the Great Lakes Inter-Tribal Epidemiology Center in Minneapolis. The center is one of 12 granted federal funding  to improve the reporting process.

“One of the ways that you can erase a population is by them not even appearing in state and federal data sets,” Lucas-Pipkorn said. “If an entire population doesn’t appear…[the government] can say that they’re not here — they don’t really exist.”

Without accurate numbers, tribal leaders say, funders will be less inclined to treat the epidemic.

Mary LaGarde, the director at the Minneapolis American Indian Center and a member of the White Earth Nation, said she fears the lack of death data has had a dramatic impact in her community. In 2016, Native Americans in Minnesota were nearly six times more likely to die of an opioid-related overdose than whites in the state.

LaGarde has been applying for grants to repave, clean and fence in a neighborhood playground littered with needles used by addicts. So far, she said, no funding has come through for the $135,000 project.

“Honestly, we don’t know where that funding is going to come from,” she said.

Lucas-Pipkorn, the epidemiologist, said the issue comes down to accurate reporting.

“Without data, there’s no way that you can advocate for your community,” Lucas-Pipkorn said. “Absolutely no way.”

Project Stories The Strong People

In Washington, Some Tribes Turn to Cannabis to Support Health and Healing

By Syd Stone

SEQUIM, WASH. — The Cedar Greens Cannabis shop sits just off of Highway 101, across from the serene waters of the Sequim Bay along Washington’s North Olympic coastline.

The store’s walls and floors are lined with cedar planks, and water flows under an indoor bridge that sits just beyond the entryway. In the center of the shop, customers in search of cannabis find high-concentration resins and dried buds, neatly displayed in well-lit display cases under 17-foot-high ceilings.

The Jamestown S’Klallam Tribe opened the store in October, and Tribal Chairman Ron Allen said he expects sales to quickly become a “big piece” of the tribe’s revenue stream.

“We know from our sister tribes how well they perform,” he said. “Ours happens to be probably the most elegant. We took from everybody else’s structure and design and took the best of each, so we’re very confident that we designed it nicely.”

The Jamestown S’Klallam Tribe is among a growing number of tribes in Washington that have turned to cannabis as a significant revenue source. In Sequim, the tribe for generations relied on enterprises ranging from shellfish companies to a casino to a family health clinic.

Revenue from the new cannabis shop will be used in part to cover addiction treatment programs, including a planned 16,000-square-foot healing center for opioid dependency.

Clallam County saw 101.8 opioid prescriptions per 100 people in 2017, far higher than the national average of 58.7, according to the CDC.

Cannabis sales pose a unique business opportunity for tribes in Washington.

Tribes on sovereign land do not need state approval to sell cannabis. The Jamestown S’Klallam Tribe in September 2018 struck an agreement with the state that allows sales tax accrued from cannabis-related businesses to remain within the tribe for community improvement.

The compact is modeled after similar agreements with the state that regulate the sale of liquor, gasoline and cigarettes on tribal land, said Mike Smith, manager of Cedar Greens. The shop charges taxes equivalent to the state’s cannabis taxes — a 37 percent excise tax and 8.5 percent sales tax for recreational purchases, which, Smith said, has been vital to the tribe’s economy even in the short time the store has been open.

“Tribes are traditionally underfunded, their people are underserved,” he said, “So tribes rely on their own ingenuity to come up with and create different enterprises to help support and sustain their people.”

Allen said it was critical for the tribe to diversify its economic interests.

“A lot of folks think that your casino is the big dog on the block,” he said. “For many, many years, from the ‘90s into the early 21st century, it was, but now, it’s not anymore.”

More and more tribes in Washington are entering the cannabis industry in recent years because tribes continue to look for business opportunities which will make them competitive in the surrounding economies, said Eric Trevan, a professor at The Evergreen State College in Olympia and an expert in Tribal economies.

“I’ve seen how it can truly help, not just generate revenue for the tribes, but how it builds the economy,” said Trevan, who is a Tribal citizen of the Match-E-Be-Nash-She-Wish Band of Pottawatomi Indians, Gun Lake Tribe.

When tribal governments decide to enter into the cannabis business, they affirm their sovereignty as independent nations which are looking for ways to support their citizens, he said.

Just 80 miles south of Cedar Greens, the Squaxin Island Tribe has been operating Elevation, a cannabis shop, since 2015.

Mike Ogden, a Squaxin Island tribal member and manager of the shop, said profits go toward critical services in healthcare, education and employment.

“It’s definitely important that we can generate this revenue and help our community, and our people, in that way,” Ogden said.

The store was so successful by its third year that the tribe opened the first tribal marijuana grow site in Washington — Native Sun Grown. The commercial operation spans more than 5 acres and provides cannabis products to Washington’s recreational market. Washington became the first state to legalize marijuana in 2012.

In Sequim, Smith said he’s looking forward to the first summer season. Thousands of tourists will pass the shop along Highway 101, headed to Olympia National Park or farther into Sequim for its annual lavender festival in July.

“We’re on the edge of our seats to see what we can do,” he said.

Project Stories The Strong People

Opioids Escalate Battle to Keep Native Children in Tribes

By Heena Srivastava

SEQUIM, Wash. – Indian child welfare caseworker Tanya Pankowski spends 30 minutes driving home along Washington’s Highway 101, crossing the Dungeness River and weaving through the mountains of Olympic National Park. Before she reaches her six dogs and cats and the stroganoff her husband often prepares for dinner, she tries to clear her mind of the work she left behind.

Pankowski’s days are unpredictable.

She scrambles to help working parents find money for childcare. She visits schools to make sure troubled children are behaving. She launches investigations for children who are reported to be hungry, abused or in homes with no heat. On her worst days, she’s forced to take them away.

The younger ones, she said, have trouble understanding why they have to go.

“Little children love their parents no matter what,” Pankowski said. “It’s really traumatic on the children. ‘No, you can’t see mom.’”

American Indian children are four times more likely to be placed in foster care than their white counterparts, according to the National Indian Child Welfare Association. Caseworkers such as Pankowski say the nation’s opioid epidemic has escalated the crisis.

Pankowski, who has spent 15 years working for the Jamestown S’Klallam tribe in northwest Washington, estimates that 95 percent of her child welfare cases are now opioid-related.

“It’s not too often that we have children come into the system because of physical abuse. It’s more because of neglect,” she said. “It’s a really long process for some parents to be able to get healthy. And so children stay in care longer than what we would like.”

In 2015, 41 in 100,000 American Indians in Washington died of drug overdoses, compared to a rate of 15 for whites, according to the Centers for Disease Control and Prevention. The epidemic has taken a toll on child welfare workers, parents and children.

Tribal leaders said they fear children removed from homes will be sent to nonnative communities, diminishing the tribal population. In 1978, Congress passed the Indian Child Welfare Act to ensure that displaced Native American children were placed within native communities. At the time, as many as 35 percent of all native children were being removed from their homes. The vast majority were placed outside of tribes.

The 41-year-old law is now being challenged in court by a Texas couple who successfully adopted a child with Cherokee and Navajo ties and are looking to adopt his sister. The adoption was contested by the Navajo Nation. In a widely watched lawsuit, Chad and Jennifer Brackeen, two other non-native couples and the states of Texas, Louisiana, and Indiana are challenging the constitutionality of the law.

In 2018, a federal judge in Texas backed the parents. This past August, a three-judge panel on the Fifth Circuit Court of Appeals overturned the ruling and granted a rehearing, which has not yet taken place.

In the state of Washington, officials are acting to ensure American Indian children stay in their communities.

Though caseloads are high, Pankowski said, only about 5 percent of Jamestown S’Klallam children are placed in foster care with non-native families. She said state Child Protective Services quickly determines whether a tribe should be notified about a displaced child.

“Is there any native ancestry?” Pankowski said. “Find out right away, so that process can start right away.”

Washington State’s Department of Children, Youth & Families also hosts case reviews every three months to make sure tribes are complying with the law.

“They pull up three cases to go over to see if everything was done properly, if there are any red flags or areas that need to be addressed,” said Michelle Claplanhoo, a caseworker with the Makah Tribe, 100 miles west of Jamestown S’Klallam. “If we are not getting reports or we are not getting what we need from the state, that is where we address it.”

Some tribal members have voluntarily placed their children outside the community.

Across the Puget Sound from Jamestown S’Klallam, Rita Boome-Revey has struggled for years to kick an addiction to opioids. She said her youngest daughter was placed with a non-native family. Though they stay connected through Facebook, Boome-Revey said they rarely see each other.

“It was one of the hardest things I did, but I did it so she could have a better life,” she said.

A member of the Upper Skagit tribe, Boome-Revey lives in an addiction recovery house in Swinomish nation. On a recent afternoon, she prepared to attend a funeral for her 41-year-old niece, who overdosed on opioids. She left behind three children.

Panskowski said she is all too familiar with the devastation. Day after day, she said she pushes aside her personal connections to local families to focus on the children.

“In tribal cultures,” she said, “our children are our future.”

Project Stories The Strong People

‘Coming Home to Themselves’: Native American Nations Turn to Tradition to Treat Addiction

By Mia Mamone, Jonah Dylan and Alena Prcela

June O’Brien isn’t too worried about ghosts. She said she believes that counselors working to treat drug and alcohol dependency at the Northwest Indian Treatment Center in western Washington see tribal ancestors standing behind patients.

That’s fine by her. The center sits on two and a half acres of ancestral land in rural Elma, Washington, where members of several Pacific Northwest tribes would once gather in the summer. Here, in this remote town of 3,000 about 40 miles east of the Pacific Ocean, spirituality is just as important as mainstream medicine.

Across the country, hard-hit indigenous communities are turning to tradition to battle the growing threat of substance abuse.

From Washington to Wisconsin and beyond, tribes are using cultural activities and nature-based medicines — some dating back thousands of years — to reach and treat members struggling with addiction.

Experts say many tribal members have traditionally distrusted Western medicine and that an integrated, holistic approach to drug treatment and recovery is crucial.

“Treatment of special populations has to reflect the identity of that population,” said O’Brien, the director of the treatment center run by the Squaxin Island Tribe, whose members for generations have lived along the seven southernmost inlets of Puget Sound. “We say that they are coming home to themselves.”

In Phoenix, the Patina Wellness Center has integrated talking circles and sweat lodges with more mainstream drug treatment The center is one of 18 sites run by the nonprofit Native American Connections.

“We believe that these traditional ways are what provide us with the guidance to understand our place in nature, in the family, to understand ourselves as individuals,” said cultural counselor Dwight Francisco. “Our goal is to reconnect them to those value systems that will help them to heal.”

The focus on tradition and culture is so integral in Arizona that the state’s Inter Tribal Council, which represents 21 tribes, has urged state officials to use Medicaid funding to reimburse hospitals and clinics that employee traditional healers as regular workers or consultants.

“I’ve seen firsthand how traditional healing alleviates the stress of the situation,” said Alida Montiel, health and human services director of the Inter Tribal Council of Arizona. “Hopefully, it helps you find out the root of the illness, helps you with the next step.”

At addiction-focused ceremonies in South Dakota, Native American Church members gather from dusk to dawn to call on spirit helpers and to commune with peyote, a small cactus with psychoactive properties used by tribal members for thousands of years. Peyote, which grows in southern Texas and northern Mexico, can minimize withdrawal symptoms, tribal members say.

Though peyote is classified as a Schedule 1 drug, the American Indian Religious Freedom Act Amendments of 1994 allows Native Americans to use the cactus for religious purposes.

“The peyote way of life is a healing way of life,” said Sandor Iron Rope, an Oglala Sioux Lakota from the Pine Ridge Reservation and the president of the Native American Church of South Dakota.

A poster highlights traditional foods and medicines at the Didgwalic Wellness Center, an opioid treatment center in Anacortes, Wash., run by the Swinomish Nation. Counselors say Native American culture and tradition are essential to the healing process for patients recovering from addiction. (Syd Stone/MEDILL)

Peyote is more commonly used to treat alcohol addiction and other ailments. In Michigan, Native Americans are fighting the opioid epidemic with other natural medicine.

Fawn YoungBear-Tibbetts, a White Earth Ojibwe traditional practitioner, uses sage to help ease the symptoms of opioid withdrawal, including nausea.

In western Washington, the Squaxin Island Tribe, known as “The People of the Water,” used federal money to open its widely touted, 28-bed treatment center in 1994.

The tribe has long combined mainstream medicine with cedar-weaving, drumming and beading. Residents have access to an on-site sweat lodge for purification ceremonies and a healing garden with traditional medicine and food, such as nettles, violets and dandelion leaves.

O’Brien, the director of the center, said the oppression shouldered by generations of Indian people created cycles of poverty, trauma and substance abuse. Traditional healing, she said, is an integral part of the recovery process.

“Everything here is cultural,” she said.