Melissa Harris-Perry: You're listening to The Takeaway, I'm Melissa Harris-Perry and it's good to have you with us. In recent years, the opioid epidemic has devastated communities across the country, but the effect of the crisis has been unequal. From 2006 to 2014, Native Americans were about 50% more likely to die from opioid overdoses than non-natives and that's according to data analyzed by The Washington Post. In 2018, the Senate Committee on Indian affairs held a hearing on the opioid crisis in Indian country.

Samuel Moose: My name is Samuel Moose, I am the Human Services Director for the Fond du Lac Band of Lake Superior Chippewa and an enrolled member of the Mille Lacs Band of Ojibwe.

Melissa Harris-Perry: Members of Congress had testimony highlighting the extent of damage from opioids within multiple tribes.

Samuel Moose: Historic and intergenerational trauma along with current trauma that spans a lifetime for American Indians and a lack of funding for IHS and a failure to include tribes at state level prevention and public health programs all contribute to this crisis in tribal communities. In Minnesota, pregnant American Indian women were 8.7 times more likely to be diagnosed with maternal opiate dependence. American Indian infants were 7.4 times more likely to be born with neonatal abstinence syndrome.

Melissa Harris-Perry: Those alarming facts were echoed by Jolene George, the Behavioral Health Director for the Port Gamble S'Klallam Tribe.

Jolene George: As this committee knows, we are disproportionately impacted by opioids. The statistics you hear reflect our heartbreaking reality as we struggle to confront the drug epidemic caused by opioids flooding our community. Every family on our reservation has been impacted by this epidemic. Many are grieving the loss of loved ones because of it.

Melissa Harris-Perry: Jolene George went on to outline the ways in which the opioid crisis was depleting her tribe of already scarce healthcare funds.

Jolene George: At a government level, these impacts cut across all departments, complicating funding priorities and creating competition for already scarce resources. At least 75% of our substance abuse patients are opioid dependent. These complex patients often utilize behavioral health resources at a higher rate than other patients. In our health clinic, pain management patients overwhelm the schedule. Our family medicine physician has become a pain management specialist.

Melissa Harris-Perry: The failure by officials to provide proper resources and a tendency to exclude tribes from conversations on how to handle the issue are problems that extend far beyond this particular crisis. This week, a tentative settlement was reached that could bring much needed resources to hundreds of tribes over the next six and a half years. Opioid manufacturer Johnson & Johnson along with several opioid distributors have agreed to pay around $590 million to the tribes.

This comes in addition to a $75 million settlement that the distributors reached with the Cherokee Nation last September. The companies still continue to deny actual wrongdoing in the crisis and whether these funds will be enough to address the deep wounds inflicted by the epidemic within Indian country remains a concern. Joining me now is Chief Chuck Hoskin, Jr. Principal Chief of the Cherokee Nation. Thanks so much for being here, Chief Hoskin.

Chief Hoskin: Hello, Melissa. How are you?

Melissa: I'm great. It's wonderful to talk with you. We heard some from the testimony there, but I'd also love to hear from you a bit about what the effect of opioids has been within Cherokee Nation.

Chief Hoskin: All of that rings true what was in the intro. The impact has been significant. You can see it anecdotally in families that you visit with and you see a generation of very productive, happy members of the family and you see a generation coming up just gripped by opioid addiction. Then you get a little more broad in our population. Talk to people like our language director who says we're trying to save the Cherokee language.

We're counting on a generation coming up to be able to do that. The opioid epidemic has hit some of the communities where our language is spoken more harshly than other communities and where our culture and our lifeways are still held. Those communities have been hit hard and so you see the damage in lots of different ways. You think of a generation ahead that that ought to be moving the tribe forward and they're not reaching their potential in large measure because of this epidemic.

Melissa Harris-Perry: How might the settlement help? In what ways will these resources be deployed to try to address the harm that's been done?

Chief Hoskin: Well, it'll help us do what we need to do in Indian country for generations, which is to take control of our own healthcare destiny. You could do an entire show on Indian country healthcare and the Indian country healthcare for generations was delivered directly top down by the federal government. The resources inadequate, which is some of the reasons we're where we are in terms of the opioid epidemic. The ability of tribes to determine how to deliver healthcare is important. Having the resources to do it of course is indispensable.

For tribes, I think across the country, including the Cherokee Nation we can focus more on our behavioral health programs. We have to think about this, which is that treating opioid addiction meant the scarce dollars we had went to that effort and maybe didn't go to other efforts. There's other efforts we need to focus on underlying behavioral health issues that can lead to or exacerbate overuse of these substances and then of course the direct damage done by opioid abuse causes its own problems in terms of emotional well-being.

We're going to be able to literally build facilities in an accelerated rate in terms of brick and mortar transitional living facilities, detox centers, things of that nature. Other tribes are in different spaces of development on their healthcare system. I'm excited that some tribes that maybe haven't got as far along as they would like because of lack of resources will maybe for the first time be able to create some of these programs that can really help people dealing with addiction. This is going to help in very real ways, it's going to help treat people who are suffering.

Melissa Harris-Perry: I'm going to return to the point that you were making about autonomy decision-making capacity to govern and to address primary issues addressing Cherokee Nation and for other tribes as well. I guess part of what I'm wondering is how much you've seen either state or federal authorities over the course of this long epidemic actually partnering in egalitarian ways with the nations in order to address this even as it was occurring?

Chief Hoskin: Well, I think like a lot of the country as this was occurring and it's occurring all around us and it's occurring slowly and so we're all reacting. Whether it was our federal partners or our tribe itself trying to make sense of this growing problem, it's one of those that like you're in the pot and slowly the water starts boiling and then before long it's really a crisis. I think in hindsight we all could have done better. I think one of the problems though is the nature of the Indian healthcare system being inadequate.

Not enough resources flowing into Indian country to address some issues that ended up resulting in people perhaps self-medicating or perhaps some underlying physical health issues that could have been addressed through prevention end up manifesting themselves in a lot of real physical pain that has to be treated and what was the treatment of the day? Well, it was opioids. I think it's a complicated set of reasons why Indian country was hit harder and I think in hindsight we could have all done better.

I think the government of the United States though needs to recognize that its failure to meet its obligation in Indian country healthcare for generations. In fact, I always say the next time the federal government meets its healthcare obligation will be the first time it's done it. That happening over generations has consequences and it's going to continue to have consequences. What it's had in the last decade has been the opioid crisis has hit us harder for a variety of reasons, I think, rooted in inadequate healthcare.

Melissa Harris-Perry: Which maybe leads me to this point that you've been trying to get a congressional delegate from Cherokee Nation seated in Congress for several years and I'm wondering if there's been any progress on that front.

Chief Hoskin: We made some progress and I'm hopeful that we can get it done this year. It feels like that this is a Congress we can get it done in, and so here's where we are before COVID hit. The worst public health crisis in living memory that's gripped all of us, but before it hit we had met with Speaker Pelosi and other members of her leadership and also on the Republican side. We're hitting our stride and answering a lot of good questions they had about how you implement a 180-year old treaty promise.

That what's at the heart of this effort to see Kim Teehee our delegate at the Congress. COVID certainly took us off track a bit as it did the whole world, but we've been reengaging with bipartisan leaders a few months ago. We went to Capitol Hill and we're going to return so we are, I think, getting close. We're down to some very mundane questions about how this works to the parliamentarian's office. Is it a house rule? A lot of things that get bogged down in the weeds but are very important. I think we're close but I think when you start to think about these big policy issues and funding Indian country, showing respect to Indian country by providing the resources that have been promised, I think it underscores why we need champions in Congress.

That champion can be Kim Teehee our delegate at the Congress, but it can also be a lot of members in Congress now who ought to be looking at this settlement. Looking into statistics, looking at the fact that in 2015 we had 107 opioid pills for every adult on the Cherokee Nation reservation, [unintelligible 00:10:42] reservations. I think they ought to be jarred by that. I think they ought to realize that everyone has a role in helping Indian country because this is America's problem and America ought to find a solution for it.

Melissa Harris-Perry: For the last minute here, I know that Cherokee Nation still has a lawsuit pending, with CVS and some other pharmacies. I'm wondering, again, also about progress on that and also how it compares to the existing settlements that have now been settled.

Chief Hoskin: Just to recap, we settled $75 million against a couple of other distributors, and we'll get around 18 million out of this latest settlement, $590 million. I couldn't tell you the price tag on the potential settlement against the distributors that pharmacies rather-- that's a number that that is in flux and it's all about negotiations, but I think it'll be a significant settlement because I think there's several points and that's what I think people in the country need to understand. There's several points at which this opioid crisis could have been mitigated, prevented much lower and there's a lot of responsibility, not just the manufacturers, but also the distributors, the pharmacies, and so there's a lot of justice to be served. We've got a measure of justice so far, I think we'll get another measure of justice when it comes to holding these pharmacies accountable.

Melissa Harris-Perry: Chief Chuck Hoskin Jr Is the Principal Chief of the Cherokee Nation. Thanks so much for your time, Chief Hoskin, and I know a storm is expected in your area today, so please stay safe. Thank you so much for your time, Chief Hoskin.

Chief Hoskin: Thank you, Melissa.

[00:12:24] [END OF AUDIO]

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