Native communities are diverse, resilient, and rich in culture, history, and tradition. Hundreds of Tribal Nations each have unique strengths and experiences. At the same time, substance use and overdose have affected many Native communities. Some people may need to travel long distances for treatment or struggle to find care that feels trustworthy and culturally responsive. These challenges highlight the importance of accessible, community-informed support.

The Numbers Show the Gap:

From 2019 to 2020, overdose death rates among Native people rose by 39%. During the same time, younger Native women died from overdoses at nearly twice the rate of younger White women. Overdose deaths across the United States dropped from 2023 to 2024, which is hopeful news. But not every community saw the same progress. We need more local information to understand what is happening in Tribal and urban Native communities. We must also remember that deaths tell only part of the story. Substance use can affect a person’s health, family, job, housing, and daily life.

Policies, Systems, and Resources Shape Health:

For generations, Native people faced forced removal, boarding schools, family separation, loss of land, and efforts to suppress Native languages and cultural practices. Many Native communities also received too little funding for health care. The effects of these harms can still be felt today. Some people live far from a clinic or treatment center. Others may face staff shortages, limited transportation, or a lack of care they trust. Some people may also find it hard to trust health systems because of past harm. These unfair conditions can widen the gap in overdose deaths.

A Seat at the Table:

Native communities must have a real voice in every health and substance-use prevention decision that affects them. Programs should not be created for Native people without Native people helping to plan, lead, and review the work. Tribal leaders, elders, young people, families, health workers, and people in recovery all bring important knowledge. They know their community’s strengths, needs, and barriers. Their ideas can guide choices about funding, treatment, education, research, and access to lifesaving medications like naloxone. Communities may also choose to include Native languages, family ties, traditional healing, or ceremony. When public health partners listen, share power, and respect Tribal sovereignty, programs are more likely to earn trust, meet local needs, and last.

Change is Possible:

A better future is possible, but Native communities must help lead the way. They should have a seat at the table whenever leaders make choices about health care, substance use prevention, treatment, funding, or research. Public health groups must listen to Native voices, respect Tribal sovereignty, allow Tribal Nations to make their own decisions and build trust over time. Native communities already hold strong knowledge about family, healing, and belonging. When health systems treat them as true partners and support their ideas for the long term, programs can better meet local needs and save lives.

Sources:

1. National Institute on Drug Abuse. “NIH Launches Program to Advance Research Led by Native American Communities on Substance Use and Pain.” August 15, 2024. https://nida.nih.gov/news-events/news-releases/2024/08/nih-launches-program-to-advance-research-led-by-native-american-communities-on-substance-use-and-pain

2. Centers for Disease Control and Prevention. “Drug Overdose Deaths Rise, Disparities Widen.” July 19, 2022. https://www.cdc.gov/vitalsigns/overdose-death-disparities/

3. Kariisa, Mbabazi, et al. “Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics—25 States and the District of Columbia, 2019–2020.” Morbidity and Mortality Weekly Report 71, no. 29 (2022): 940–947. https://doi.org/10.15585/mmwr.mm7129e2

4. Garnett, Matthew F., and Arialdi M. Miniño. “Drug Overdose Deaths in the United States, 2023–2024.” NCHS Data Brief, no. 549. January 2026. https://www.cdc.gov/nchs/products/databriefs/db549.htm

5. Substance Abuse and Mental Health Services Administration. “Results from the 2023 National Survey on Drug Use and Health: Key Substance Use and Mental Health Indicators in the United States.” July 2024. Publication No. PEP24-07-021. SAMHSA report.

6. Indian Health Service. “Naloxone.” Accessed September 30, 2026. https://www.ihs.gov/opioids/harmreduction/naloxone/

7. Indian Health Service. “Medications for Opioid Use Disorder.” Accessed September 30, 2026. IHS resource.