Tribal nations in the United States provide publicly funded opioid treatment to those who need it most

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Brent Simcosky, director of health services for the Jamestown S’Klallam Tribe, looks on from the Jamestown Healing Clinic on Washington state’s Olympic Peninsula May 24.Nathan Vanderklippe/The Globe and Mail

A man-made stream trickles a tinkling chatter past the banks of freshly embellished plants to the exposed beams and huge glass windows that make up the Jamestown Healing Clinic.

It could be a resort, set in a sunny lot on the outskirts of town, its soaring lobby decorated with open-air scenes of Washington state’s rugged Olympic Peninsula and artwork by the local Jamestown SKlallam tribe. Instead, it is an opioid treatment center, built in a county that has seen more overdose deaths per capita than any other in the state.

In recent months, the Healing Clinic has offered an answer, providing methadone treatment, mental health counseling, dentistry, transportation, and even childcare for those seeking assistance.

People say, God, it’s like a spa. It doesn’t have to be this fantasy, said Brent Simcosky, the tribe’s director of health services. Several other opioid clinics, he said, appear to be in the sheds.

Throughout Washington state, however, the architecturally sculpted outlines of the tribally run nursing clinic are becoming more common.

Seven of Washington state’s 37 opioid treatment programs are now run by tribal nations, with two more exploring the idea. Nearly a third of those opened since 2017 are tribally owned or managed. By next year, half of the state’s mobile methadone units will be run by tribes.

It’s a remarkable response to the story. Despite federal treaty obligations to provide health care to Native Americans, the country’s Indigenous people have some of the worst health outcomes. Indigenous Americans are second only to black Americans in the incidence of opioid-related deaths.

But through the entrepreneurial moxie of several small groups in Washington state and a U.S. regulatory breakthrough, tribal nations are embarking on a new effort to be a balm for an opioid epidemic that the fentanyl outbreak has made much worse. . Clallam County recorded 15.7 overdose deaths per 100,000 people from 2013 to 2017. By 2021, it had more than tripled.

Answering it isn’t rocket science, Simcosky said. But it takes money and resources.

Tribes have discovered a unique ability to access both.

A non-tribal provider may be able to bill Medicaid, the US publicly funded health care program, $30 per opioid patient per day, to provide methadone. For tribes, the reimbursement rate is much higher, as high as $600 per patient per service, rates created in response to underfunding of Indigenous health care, which often has to be provided in remote settings. Such services may include substance use disorder treatment, dentistry, daily dosing, and mental health.

Basically, tribes can access higher rates for non-tribal citizens as well. Approximately 85% of the Jamestown Clinic’s patients are non-Indigenous. This means that the tribes have discovered a way to provide a variety of publicly funded services to those most in need.

It is setting the gold standard for recovery, said Jeremy (JJ) Wilbur, vice chairman of the Swinomish Tribal Senate. And it’s from Indian country, added Leon John, director of outreach for told him Health Club, (pronounced act-gwah-leech), Swinomish’s opioid clinic.

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The Swinomish, who are located near Anacortes, Washington, are the progenitors of the pattern. They started with a small wellness facility that provided treatment for tribe members, only to find it inadequate. Someone living with non-tribal members might go home to others whose addictions were ineligible for treatment.

They were only treating half the house, Mr John said. He championed a much bigger clinic that could treat everyone. No one could stop drug trafficking on the reservation. But it might be possible, he argued, to reduce demand in the surrounding community, and we’ll never know how many lives we save this way.

It was no small task. Building a comprehensive opioid treatment program required going through eight different regulatory processes, many with uncertain outcomes and high costs. For Jamestown, the Drug Enforcement Agency mandated a secure room for pharmaceutical storage, with earthquake alarms, steel-clad walls, and a huge safe.

It was $30,000 just for the safe to store the methadone, Mr. Simcosky said. Which, by the way, is delivered in a FedEx truck.

But the didgli clinic was fully booked soon after it opened in 2017 and has expanded several times since then. Tribes across the United States have taken note, with delegations from Alaska, Colorado, North Carolina, Oklahoma and Oregon studying what the Swinomish have built.

Providing health services, they found, can drive broader change. By law, any excess profit can only be spent on health, education or social services. As a result, the Swinomish Opioid Center now funds more than $1 million annually in full-price scholarships for tribal members. The transport network of 13 buses created to take people to treatment has also been used to build a local transport service.

Jamestown, meanwhile, operates a primary care clinic that serves about 18,000 patients, most of them non-Native. The tribe’s health care department is its biggest revenue generator, eclipsing its casino.

The Jamestown opioid center, which opened last year, is expected to pay off its construction costs in 5 to 10 years. The tribe has already begun plans for a 16-bed mental evaluation and treatment hospital after receiving $26 million in funding from the state.

This model suggests that healthcare could become a major business for US tribal nations.

For now, however, opioid treatment has been more rapidly being embraced.

As an employee and as a client at these clinics, I don’t think you can get any better, said Dawn Lee, a substance use disorder practitioner who runs a small consultancy. I have a couple of non-tribal clinics right now and their reimbursement rate is really low. So it’s really hard to keep suppliers and keep staff.

Not so with the tribes, who kept adding services. A new tribal clinic provides kennels for dogs. Security personnel are trained to know each patient by name. Providing multiple services under one roof means patients don’t wait around for treatment and don’t get lost between appointments in different locations.

Hurdles remain, particularly in securing regulatory approvals. The Jamestown project was built only after a costly court battle against local opponents who argued the opioid center would bring a surge of drug addicts into their community.

But tribal healing centers tend to be located away from major population centers, which has been a boon for the state. Our biggest drive right now is finding ways to reach more rural communities, said Misty Challinor, president of Washington State Opioid Treatment Providers, an industry group.

What isn’t clear is how well those tribe-run treatment centers work. Most are too new to generate reliable statistics, and fentanyl’s ubiquity has created a worsening scenario. Last year, Washington state measured a 17 percent increase in opioid-related deaths.

The didgli clinic, however, has counted only one overdose client in the past two years, and members of the Swinomish tribe say the difference is tangible.

Compared to the past, we attend nearly as many funerals for opioid overdoses, Wilbur said.

It’s almost rare now, Mr. John added.

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