KINGSTON, R.I. — November 25, 2019 —American Indian adolescents are more likely to misuse heroin and other opioids, and are five times more likely to die from the misuse than non-American Indians, necessitating new forms of interventions to help prevent opioid misuse among the American Indian population.
These alarming statistics were the motivation for the University of Rhode Island Psychology Department’s PATHS Lab to examine risk and protective factors related to this use. A manuscript summarizing these findings has been selected for publication in a prestigious national substance abuse journal.
University of Rhode Island clinical psychology doctoral students Tessa Nalven and Melissa Schick, along with Assistant Professor Nichea Spillane, analyzed data collected from nearly 3,500 American Indian adolescents across the country. They found that 2.8 percent of adolescents in the sample, with an average age younger than 15, reported misusing heroin at some point in their lives, compared to just 0.3 percent of their non-American Indian peers, making them about seven times more likely to have misused heroin. About 14.7 percent of American Indian adolescents reported misusing another opioid, compared to 8-11 percent among non-American Indians.
“Among AI communities, opioid use disparities are reported at alarming rates,” the team writes, noting they also found large disparities in misuse over the past month. “American Indian youth have disproportionately high prevalence rates of opioid misuse and consequences compared to their non-AI peers. For example, one study found AI youth have over a 500 percent higher mortality rate due to opioid use. Despite these alarming statistics, there is a dearth of studies investigating risk and protective factors for heroin use and opioid misuse in American Indian youth.”
The team, whose paper is scheduled to be published in the journal “Drug and Alcohol Dependence,” examined the contributing factors to the higher rates of misuse among American Indian adolescents. Their full manuscript can be read here: https://cutt.ly/eeCxzWQ.
The paper reports peer substance use was a strong predictor for opioid misuse; that family disapproval of substance use was related to less opioid use; and that better school performance was also related to less use. The family dynamic is particularly important in formulating interventions into opioid use among native populations, the team said.
“The study confirms what was already known — that opioid misuse rates can be high in American Indian adolescents,” Nalven said. “It shows that intervention methods need to be adapted to the American Indian population. For example, if parents are encouraged to specifically say their thoughts on substance use, and let the children know what they think, that might be an effective way to target prevention. If families are communicating to their youth that substances are bad, you shouldn’t do them, then they were less likely to use.”
While the exact causes of high opioid rates among American Indians is difficult to specify, the historic challenges these populations have faced, particularly racism and discrimination, have been shown to be contributing factors in opioid misuse.
“It is really important to think about the context,” Schick said. “Think about the historical trauma on American Indian communities and the effect that colonization has had on all these areas — the discrimination they’ve faced, the impacts on the ability to practice traditional care. All these factors have impacted them in different ways, and I think substance abuse is one of the largest ways it has impacted.”
One of the main conclusions of the report, the researchers said, is the need to target prevention and intervention programs specifically for American Indian adolescents. Prevention and treatment programs should include family, peer and school interventions, and should include context specific to American Indians, including the historical trauma that may contribute to high rates of misuse, the increased role of family, and the intersection of family and peer groups in small communities, such as those on American Indian reservations.
The study, using data originally collected by researchers at Colorado State University, is among the most comprehensive looks at the American Indian population regarding heroin and opioid misuse. The inclusion of nearly 3,500 American Indian adolescents from six distinct geographic regions gives a more complete look at the issue than previous studies that included fewer American Indian people or limited geographic diversity, which ignores the significant cultural differences across geographic regions.
“The big benefit of using this data set is that it is nationally representative of American Indian adolescents, which is a very hard-to-reach population,” Spillane said. “With the ongoing opioid epidemic, it’s really important to focus on this unique population that experiences a lot of health disparities. It provides us with an opportunity to see what is going on with rates of usage, but just as importantly, what might be some really important intervention targets that hopefully address the problem within the community.”