Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

Abstract

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2‐day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio‐recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program‐level implementation intervention using a strength‐based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.

Coming together for something good: recommendations from a scoping review for dissemination and implementation science to improve indigenous substance use disorder treatment

“…Many of the studies referenced the importance of a community engaged or CBPR approach but few defined or detailed what this meant or how the CBPR methods were applied. Several articles also mentioned having a Community Advisory Board or Research Review Board, which are key principles of CBPR, but how exactly this was developed and deployed remained unclear (for examples see 51 , 52 ). Additionally, most of the studies did not outline the use of specific frameworks, or dissemination and implementation theories and models.…”

Wiidookaage’Win: A Community-Based Qualitative Approach to Developing a Facebook Group Intervention for Native Women to Support Recovery From Opioid Use

“…Throughout the interviews, it became apparent that participants preferred content to be centered on connecting with AI/AN culture and to feature AI/ AN women and their stories, which aligns with current literature that supports recentering OUD recovery within an AI/ AN cultural framework to promote acceptability, engagement, and recovery. 61,62 Data saturation was reached despite a small number of participants, likely because we enrolled individuals with particular experiences and expertise and asked for feedback on specific aspects of intervention content. Furthermore, interview content had already been reviewed and revised for cultural congruence with our CAC, and the semi-structured guide tightened the interview's focus.…”

“…Throughout the interviews, it became apparent that participants preferred content to be centered on connecting with AI/AN culture and to feature AI/AN women and their stories, which aligns with current literature that supports recentering OUD recovery within an AI/AN cultural framework to promote acceptability, engagement, and recovery. 61,62…”

Provider perspectives on the impact of COVID-19 on treatment of substance use and opioid use disorders among American Indian and Alaska Native adults

“…Interventions that seek to embody CBPR principles must also centralize cultural perspectives and community engagement ( 26 ). A national Collaborative Board (CB) was formed in 2019 as part of a parent project, consisting of more than 25 members with a range of backgrounds from across the country ( 27 ). To inform the present research, a sub-set of the CB provided consultation on the study design, research questions, and development of the interview guide.…”