Claradina Soto, PhD, testifies on growing fentanyl crisis in Native American communities

On November 8, 2023, Claradina Soto, PhD, MPH, associate professor of clinical population and public health sciences at the Keck School of Medicine of USC, testified during a hearing, held by the United States Senate Committee on Indian Affairs, on the growing crisis of fentanyl in Native American communities. Soto, who identifies as Navajo and Jemez Pueblo, is a behavioral health scientist with over 20 years of experience partnering with American Indian and Alaska Native (AIAN) populations in public health. During this time, she has collaborated with urban and Tribal communities in California to reduce and address health disparities across several areas including mental health, cancer, commercial tobacco use, and substance use and opioid use disorders.

During her oral testimony, Soto described the unique challenges and vulnerabilities that have contributed to the opioid crisis among AIAN populations. According to the Centers for Disease Control and Prevention (CDC), in 2021, AIAN adolescents experienced the highest overdose deaths from fentanyl due to an increased availability of illicit fentanyl. “Our community has high overdose rates, high fentanyl use, and high overdose from fentanyl — so this was a really important time to be a part of this conversation,” Soto shares.

Soto proposed four recommendations on how to address this epidemic, starting with an increase in accessibility, quality, and sustainability of opioid use recovery treatment services for tribal and urban Indian populations. These facilities provide continued treatment and recovery support to people with substance use disorders. She also suggested residential treatment programs in counties and tribal communities with high opioid use and overdose deaths.

Her second recommendation highlighted the integration of cultural and traditional modalities into recovery treatment programs. She explained that “healing begins with culture and with practices that are grounded in AIAN traditions and way of life.” Additionally, studies that found AIAN community members strongly favor traditional healing over strict medication use, revealing the importance of familiar and preferred approaches with effective treatment.

Her third was to focus on Native youth in urban and rural areas with community-based and culturally relevant opioid use prevention and treatment services. Soto explained a need for youth rehabilitation programs and mental health services to treat and reduce opioid and substance use disorders. “It is crucial we provide family cohesion, cultural and traditional practices, and culturally based youth programs as protective factors against our youth engaging in opioid or substance use,” she affirmed.

Her final recommendation confronted the challenges of collecting reliable data from this demographic. “All too often, we are racially misclassified, especially in urban areas where we are assumed to belong to another ethnicity based on appearance,” she assessed. “We must improve our data collection methods, collaborate with tribal governments and organizations to advocate for policies that provide data collection and representation of AIAN populations.”

Soto continues to work with community stakeholders to address the fentanyl crisis and has found the need for harm reduction education and greater access to naloxone and culturally specific services for mental health and substance use among AIAN. “This work is so important because it is impacting the lives of our Native communities. As a Native researcher addressing the opioid epidemic, our statewide community needs assessment has been essential to reach and support individuals, and to understand the needs of this community by talking and working with them,” she concludes.