Responding to a Community's Voice: Using Culturally Appropriate Methods to Gather Drug Use Data with American Indians

Background:Non-medical use of prescription drugs is endemic on American Indian (AI) reservations. However, this population is difficult to reach through traditional research methodologies resulting in a gap in knowledge of drug use in AI communities. This study was designed to contribute to our understanding of drug use among American Indians on a Midwest reservation.

Methods:The PI gained tribal elder and tribal council approval and access to conduct this study on this sensitive subject because of a seven-year history of conducting research, qualitative and quantitative, in a culturally appropriate manner. A self-report questionnaire on substance use was completed by tribal community members on a reservation. The study methodology was informed by conversations with tribal elders and community members who requested that this data on substance use be collected. A stratified random sample of households and individuals was planned but elders indicated that knocking on doors was intrusive and culturally inappropriate.  They requested a convenience sampling methodology. Thus, several tables with chairs were set up in several venues on the reservation.  Within a period of three days, almost one-quarter of the reservation’s population was surveyed (N=400). Data were analyzed with descriptive and inferential statistics using Stata 13.

Results: Participants were 18 to 85 years old (M= 41). Most (85.5%) were tribally affiliated, 51% were female, 39% were single, 36% married or cohabitating, 17% were widowed, divorced or separated.  About 50% were employed and 37.6% unemployed.  Prevalence of lifetime use is 30% for OxyContin^®, 31.5% for Vicodin^®, 42.6% for any OPR, and 78.68% for Marijuana. Among lifetime OxyContin^® users, there are high rates of comorbidity with Vicodin^®(78.3%) and Marijuana (81.2%). increased perception of the seriousness of illicit and non-prescription drug use problems were positively associated with observing more transactions and actual use of illicit drugs (r=0.38, <0.0001 ) and non-prescription medications (r=0.52, <0.0001) in the tribal community. Interestingly, no association was found between frequency and quantity of drug use and perceptions of a community problem, that is both, non-users, infrequent, moderate, and heavy users all shared a similar understanding of the extent of the drug problem in the community.

Implications:Collecting data on AI reservations requires time and learning from the community about culturally acceptable and appropriate methods. The resulting study demonstrates that prescription and illicit drug use are a serious problem, one that is recognized by the community regardless of the users’ status. For prescription drugs the household composition may play a role in the exposure to the sale and use of prescription drugs, as the data suggest heavier OPR users are more likely to report having a household member with a prescription drug problem. It is implied that the sale and use of drugs is impacting most community members if they personally use drugs or not. More culturally appropriate research and treatment methodologies that are acceptable to tribal communities need to be designed.

Funded by the University of Michigan’s Substance Abuse Research Center and the Curtis Center. Thanks (Miigwetch) to participants and to the Research Associate, Isabelle Kappeler.