The Opioid Epidemic in Indian Country

J Law Med Ethics. 2018 Jun;46(2):422-436. doi: 10.1177/1073110518782950.


The national opioid epidemic is severely impacting Indian Country. In this article, we draw upon data from the Centers for Disease Control and Prevention to describe the contours of this crisis among Native Americans. While these data are subject to significant limitations, we show that Native American opioid overdose mortality rates have grown substantially over the last seventeen years. We further find that this increase appears to at least parallel increases seen among non-Hispanic whites, who are often thought to be uniquely affected by this crisis. We then profile tribal medical and legal responses to the opioid epidemic, ranging from tribally-operated medication-assisted therapy to drug diversion courts rooted in traditional tribal cultures.

MeSH terms

  • Analgesics, Opioid / adverse effects
  • Drug Industry / legislation & jurisprudence
  • Drug Overdose / mortality
  • Harm Reduction
  • Health Services Accessibility
  • Humans
  • Indians, North American / statistics & numerical data*
  • Naloxone / supply & distribution
  • Narcotic Antagonists / supply & distribution
  • Opiate Substitution Treatment
  • Opioid-Related Disorders / ethnology*
  • Opioid-Related Disorders / therapy*
  • Punishment
  • Social Support
  • Substance Abuse Treatment Centers
  • United States / epidemiology
  • United States Indian Health Service


  • Analgesics, Opioid
  • Narcotic Antagonists
  • Naloxone