Fighting against fentanyl: Native American communities tell GOP candidates their promises aren't enough

WASHINGTON − It was a few hours past midnight when Marla Ollinger rushed to her son Justin Littledog’s bedroom after waking to the screams of her daughter-in-law.

Littledog, a 33-year-old father of three, lay on the floor unable to breathe while Ollinger’s daughter frantically performed CPR. Hours later, Ollinger learned her eldest child was dead of a fentanyl overdose.

“For me it was the loss of a child that I shared a body with for nine months, that I shared my life with," said Ollinger, 53, who lives on the Blackfeet Nation reservation in Montana. "Grief is still deeply felt within my heart and within my family's heart."

Ollinger’s 2021 tragedy is far from uncommon on America's tribal lands. Deaths from fentanyl and other synthetic opioids have exploded among Native Americans, from 1.2 deaths per 100,000 in 2013 to 33.6 per 100,000 in 2021, according to a report from the Alberquerque Area Southwest Tribal Epidemiology Center. Opioid overdose deaths for Native Americans are well above the national average.

The fentanyl epidemic is a hot topic among Republican presidential candidates, several of whom have proposed using military force against drug cartels in Mexico or executing suspected drug smugglers as they cross the southern border.

But many Native American leaders say the opioid emergency can't be stopped only through military means.

“I think what I want the candidates to know is that it's not simply an either-or proposition," Chuck Hoskin Jr., principal chief of the Cherokee Nation, told USA TODAY. "We don't have to decide whether we're going to have strong border and law enforcement policies or whether we're going to fund, for example, very innovative drug addiction treatment programs in Indian country.”

Trump and other GOP candidates rally around border security

In the past year, U.S. Customs and Border Protection have seized more than 26,000 pounds of fentanyl coming from the southwest border. Fentanyl seizures have increased more than 800% since 2018. As more Americans overdose from exposure to the powerful narcotic, Republican candidates have focused on border enforcement as their solution.

Former President Donald Trump, the 2024 GOP front-runner, said in a campaign video that drug cartels were “waging war on America” and that "now time for America to wage war on cartels." 

"When I am president, it will be the policy of the United States to take down the cartels, just as we took down ISIS," Trump said. He isn’t alone in saber-rattling on the border.

Florida Gov. Ron DeSantis said during the third GOP debate in November that as president he would send the military to the border to shoot drug smugglers "stone-cold dead." He said he supports building a wall across the southern border − a measure the Trump administration failed to accomplish − and categorizing Mexican drug cartels as foreign terrorist organizations.

Businessman Vivek Ramaswamy also has called for a military solution in Mexico and for U.S. businesses to cease investing in China until it stops exporting fentanyl. Experts say China is a major source of fentanyl and the precursor chemicals used to manufacture it.

Former South Carolina Gov. Nikki Haley also supports deploying U.S. forces to Mexico, adding that she would cut off all U.S. trade with China, valued at more than $750 billion a year, until Beijing stops exporting fentanyl.

Native American advocates: 'It is a community fight'

Those plans mean little in America’s tribal communities.

Ryan Barnett, 32, a Cherokee citizen living in Pryor, Oklahoma, was 15 when he injured his hand and was prescribed the painkiller Oxycontin. That soon led to a “full-blown addiction” to heroin and fentanyl, he said.

Barnett, who went through several rounds of treatment for his substance use disorder, said that politicians were using the border as a "scapegoat" and that illegal drugs will continue to enter the country “no matter what.”

“We need to work in our individual communities and states to help fix the problem locally and start from there,” Barnett said. Not everyone, he noted, has health insurance or can afford a $10,000-a-day bed at a rehab facility.

The poverty rate among American Indans and Alaska Natives jumped from 24.3% in 2021 to 25% in 2022, according to Census Bureau data. The numbers are even more dire on reservations, where the poverty rate is 29.4% compared with the U.S. national average of 15.3%.

A health care shortage in Native American communities

Though agencies like the Indian Health Service provide grants to tribal communities for addiction treatment, the funding isn't enough to meet demand, said Ami Admire, executive director of For the People, a community services organization in southern California.

A 2022 federal report found funding for the Indian Health Service “addresses only an estimated 48.6% of the health care needs” of American Indians and Alaska Natives.

And the National Indian Health Board, which advises Congress, estimated last year that the Indian Health Service was underfunded to the tune of $51.42 billion.

“I can't really pretend to understand what's happening at the border, but I definitely think they should be doing something and using data to direct their objectives,” Admire said. “One of our reservations has the highest number of deaths in the county." She said policymakers should focus on "making sure that spaces that are being hardest hit are getting attention" while "coming into those communities and asking us what it is we need.”

Other factors contribute to fentanyl crisis: Mental health, homelessness

Instead of focusing on militarizing the border, Native leaders and advocates said in interviews, the presidential candidates should examine social factors driving the fentanyl crisis, including unemployment, homelessness, a lack of mental health resources and a shortage of police on tribal lands.

A 2017 estimate by the federal department of Housing and Urban Development found there were between 42,000 and 85,000 homeless Native Americans on tribal lands. American Indians face the third-highest rate of homelessness in the U.S., after Native Hawaiians/Pacific Islanders and Black Americans, according to a 2023 report from the National Alliance to End Homelessness.

Mental health − which candidates Ramaswamy and former New Jersey Gov. Chris Christie have mentioned − is another huge factor.

In 2019, nearly 18.7% of American Indians and Alaska Natives faced a mental health crisis, according to the National Alliance on Mental Health. Native and Indigenous people reported experiencing “serious psychological distress” 2.5 times more than the general population, according to the nonprofit Mental Health America.

But Indian Health Service Director Roselyn Tso testified in May before the House that the agency has a 28% provider vacancy rate − and a 40% vacancy rate for mental health professionals. An analysis by telemedicine platform GoodRx Health found high numbers of Native Americans living in rural counties with few or no mental health care providers.

Autumn Kramer, 33, a case manager at Native American Lifelines in Annapolis, Maryland, said she has seen reservations where one counselor is serving more than 100 people. 

“I love my community, and I want to help my community, but it is hard to help my community when we don't have enough funding," she said. "We don't have the space. We don't have the capacity.” 

Reservations need more police officers, wider prosecution powers

Both Marla Ollinger and Navajo Nation President Buu Nygren said their reservations are also suffering from a shortage of police to stop drug trafficking. There are about 170 police officers in Nygren's tribal lands, but 600 are needed, he said.

One legal snag hampering law enforcement on reservations: Tribal courts are barred by federal law from prosecuting non-Natives. A report by the National Tribal Opioid Summit calls for federal legislation to give tribes special criminal jurisdiction to prosecute non-Indian drug suspects.

Though Ollinger said the danger posed by drug cartels was "very real," the fentanyl crisis is a "community fight," too.

What do Native Americans want the next president to do?

Heading into 2024, tribal leaders say they want the next president to support distressed communities to better address the epidemic.

“There has to be a balance but, with so much attention paid to militarizing a solution to this problem, we will lose sight of the fact that, as chief of the Cherokee Nation, I've got a responsibility for communities in which people are really suffering,” Hoskin said.

“The focus is misguided. I think that it absolutely has to be on what's going on here ... the issues that are affecting everyday life, the everyday citizen, the communities that we all live in,” said Lance Gumbs, tribal ambassador of the Shinnecock Indian Nation in Southampton, New York, who lost his son to fentanyl.

Last week, Haley told Fox News that "we're worried about crime in our streets, fentanyl crossing the border, or a border that's out of control," well-honed talking points that avoided the complexity of the drug crisis, critics say.

“We need to have a response that brings everybody together," said Nickolaus Lewis, secretary of the National Congress of American Indians. "Because we cannot solve this issue with just a health lens or a law enforcement lens."