by Jeena Kar, DO
The COVID-19 pandemic has severely impacted substance use disorder patients, as nearly all of the resources they normally rely on have become limited. Patients are being asked to stay home, which directly impacts their ability to attend AA meetings, go to methadone clinics, or visit their regular healthcare providers. Although there are certain adjustments being made to help extend prescriptions or provide tele-health meetings, COVID-19 has created unprecedented hurdles and has limited the access to traditional help for patients1. Notably, one group that will be particularly impacted by the pandemic is the Native American Youth (NAY). The Navajo Nation actually has the highest coronavirus infections per capita in the United States, ahead of even New York and New Jersey2. Furthermore, their numbers are considered grossly underestimated due to misclassification of Native Americans under the category “Other” category on coronavirus census reporting3. Beyond the statistics on the Navajo Nation, officials are unsure how rampant and severe coronavirus cases actually are in Native American reservations across our country.
Even before the coronavirus pandemic, the NAY group has had consistently higher rates of addiction. A study by Colorado State University found lifetime drug use among NAY to be higher than the general sample at every grade level for all illicit substance use, with the exception of tranquilizers and amphetamines. At the same time, 30-day rates of substance use were higher in NAY for nearly all substances4.
There are several theories as to why NAY have continuously grappled with higher-than-average rates of substance use in their communities. These high addiction rates can be attributed to combined factors of social isolation, lack of healthcare services, negative cultural stereotypes/racial discrimination, and poverty in their respective reservations5.
In consideration of these factors– specifically focused on “social isolation” and “lack of healthcare services”, the situation with regards to NAY becomes very worrisome given our current health crisis. Both social isolation and lack of health outreach will become more severe as the Native American communities continue to battle the pandemic.
It is important for mental healthcare providers to advocate for this often-overlooked minority. A great place to start is to look into getting involved with SAMHSA’s Tribal Technical Advisory Committee (TTAC). This forum allows tribal leaders and healthcare workers to have an open exchange about public health issues6.
Additionally, the ACGME requires trainees to get involved in scholarly activity7, so this could be a great subgroup to choose for research poster presentations or workshop ideas. Native American Youth are understudied, so trainees can make a huge difference by participating in and implementing research initiatives that are centered on this population. The more awareness grows about this minority group and the unique issues that affect them, the more advocacy there can be for their resource allocation.
There are several initiatives in AAAP that trainees can endorse and take advantage of as well. The AAAP has a five-year grant to help minority physicians get involved in Addiction Psychiatry, which would greatly help Native American populations. This is called “The Recognizing and Eliminating disparities in Addiction through Culturally-informed Healthcare (REACH)” training program, and applications are currently open for anyone interested in working with underserved populations8. AAAP also has travel grants available to attend the College on the Problems of Drug Dependence (CPDD), which focuses on minority populations and how to best serve them9. These are great avenues for trainees to get involved with.
To conclude- mental health professionals must take special care and consideration for vulnerable populations, especially with ongoing COVID-19 in our midst. By working through avenues such as SAMHSA and AAAP, providers can begin to address mental health disparities in Native American Youth and other minorities. Mental health professionals can have a voice in this public health issue and can make a significant contribution.
- Grinspoon P. A tale of two epidemics: When COVID-19 and opioid addiction collide. Harvard Health Blog. https://www.health.harvard.edu/blog/a-tale-of-two-epidemics-when-covid-19-and-opioid-addiction-collide-2020042019569. Published May 20, 2020. Accessed May 25, 2020.
- Sternlicht A. Navajo Nation Has Most Coronavirus Infections Per Capita In U.S., Beating New York, New Jersey. Forbes. https://www.forbes.com/sites/alexandrasternlicht/2020/05/19/navajo-nation-has-most-coronavirus-infections-per-capita-in-us-beating-new-york-new-jersey/#52851a158b10. Published May 19, 2020. Accessed May 27, 2020.
- Nagle R. Native Americans being left out of US coronavirus data and labelled as ‘other’. The Guardian. https://www.theguardian.com/us-news/2020/apr/24/us-native-americans-left-out-coronavirus-data. Published April 24, 2020. Accessed May 27, 2020.
- Swaim RC, Stanley LR. Substance Use Among American Indian Youths on Reservations Compared With a National Sample of US Adolescents. JAMA Network Open. 2018;1(1):e180382. doi:10.1001/jamanetworkopen.2018.0382
- Addiction Among Native Americans: Drug Use & Alcoholism. Sunrise House. https://sunrisehouse.com/addiction-demographics/native-americans/. Published February 26, 2020. Accessed May 18, 2020.
- Tribal Technical Advisory Committee (TTAC). SAMHSA.gov. https://www.samhsa.gov/about-us/advisory-councils/tribal-technical-advisory-committee-ttac. Published April 14, 2020. Accessed May 23, 2020.
- Specialty-specific References for DIOs: Resident/Fellow Scholarly Activity. ACGME.org. https://www.acgme.org/Portals/0/PDFs/Specialty-specific Requirement Topics/DIO-Scholarly_Activity_Resident-Fellow.pdf. Published July 2019. Accessed May 23, 2020.
- Souza S. New Initiative to Address Shortage of Minority Physicians Treating Substance Use Disorders – AAAP. American Academy of Addiction Psychiatry. https://www.aaap.org/new-samhsa-grant-to-address-shortage-of-physicians-treating-substance-use-disorders-and-to-increase-minority-clinicians-in-addiction-field/. Published January 30, 2019. Accessed May 24, 2020.
- Souza S. CPDD Primm-Singleton Minority Travel Awards Program – AAAP. American Academy of Addiction Psychiatry. https://www.aaap.org/cpdd-primm-singleton-minority-travel-awards-program. Published November 7, 2019. Accessed May 24, 2020.