Considerations for Tribal Communities When Implementing MOUD Programs

Tribal communities are generally found in rural areas and include American Indian and Alaska Native (AI/AN) populations. These populations may experience unique barriers to medication for opioid use disorder. In particular, AI/AN populations may prefer traditional healing approaches over the Western medical approaches typically used to treat opioid use disorder (OUD). AI/AN populations may desire holistic treatment and avoidance of medication during treatment. Rural programs serving AI/AN populations should aim to integrate traditional healing approaches and adapt programs to make them culturally appropriate.

Tribal communities may also experience systemic barriers to MOUD. Some systemic barriers are unique to tribal communities, including institutional discrimination towards AI/AN populations, incompatibility of Western medicine with AI/AN traditional healing approaches, and distrust of federal health services within tribal communities.

Other systemic barriers within tribal communities are similar to those experienced in other rural communities, including provider shortages, limited number of MOUD prescribers, distance to access services, and transportation.

To be successful in tribal communities, MOUD programs should consider the following implementation factors:

• Offer specific medication types – It may be favorable for programs to use specific medications for OUD for AI/AN populations, including buprenorphine and naltrexone, because these medications are commonly offered in the primary care setting, which are close to or within tribal communities, and because naltrexone does not cause euphoric effects and cannot be diverted.
• Deliver educational interventions – Programs can provide information to patients, families, communities, and practitioners to explain OUD and appropriate treatment, with the goal of reducing stigma.
• Ensure coordinated care – Programs should provide MOUD in conjunction with other treatment needs addressing medical, psychological, and social issues. This can help improve quality of life.
• Provide psychosocial supports – Programs can provide culturally-appropriate counseling in conjunction with medication, which supports the AI/AN holistic approach to treatment.

One rural medication-assisted treatment (MAT) program serving a tribal community noted specific strategies their program has used to ensure success. The program has engaged a physician, social worker, outreach specialist, and nurse — all of whom are Native American. These program staff are trusted by and work closely with the population served to encourage recovery treatment. The program has also developed literature and resources specifically for recovery, MOUD, and Native American populations.