Rates of opioid use and overdose in the United States increased during the COVID-19 pandemic, while opioid use disorder (OUD) treatment facilities faced disruptions to services during this time. American Indian and Alaska Native (AI/AN) communities were amongst those most affected by the pandemic, while also experiencing some of the highest rates of opioid-related overdose deaths. As such, this study aimed to investigate the ways in which AI/AN-servicing OUD treatment centers and their communities were impacted by the pandemic. Semi-structured interviews were conducted with ten service providers working at AI/AN-servicing OUD treatment centers between January and April 2021. Treatment centers were located in the Pacific Northwest, the North Midwest, and the South Atlantic regions, and all provided medications for OUD. Using thematic content analysis, three broad domains were identified: (1) impacts to the AI/AN communities; (2) impacts to family and social life; and (3) impacts to OUD treatment services. Our findings indicate that AI/AN clientele and communities were negatively impacted by the suspension of AI/AN traditional practices. The importance of family and community support within treatment was emphasized and how this was impacted during the pandemic, while positive changes to services brought about by the pandemic were also reported.