View the report: Reducing opioid overdose deaths in Minnesota: Insights from one tribal nation


Wednesday, December 18, 2019

Gary Padtra (White Earth Nation)
Gary.Padrta [at]
218-983-3285, ext. 5903

Alyssa Dindorf (UMN Medical School, Duluth Campus)
adindorf [at]

White Earth Nation and U of M Medical School, Duluth Campus Combine
Cutting-edge Public Health Methods with Indigenous Research to Prevent
Opioid Overdose Deaths and Help Communities Heal

White Earth, Minn. – North America is struggling with an opioid overdose epidemic that cuts across all dividing lines; race, gender, age, socioeconomic status, and culture. Native Nations suffer this grief and loss along with all other American communities. Results of a unique, new program to address local contributing factors to overdose deaths in White Earth Ojibwe/Anishinaabe Nation, in northern Minnesota, have just been published in the NDEWS Minnesota HotSpot report, Reducing opioid overdose deaths in Minnesota: Insights from one tribal nation. The White Earth Nation piloted and evaluated an opioid overdose fatality review (OFR) program adapted to a tribal nation setting in partnership with the University of Minnesota Medical School, Duluth Campus. This is the first known opioid OFR involving an American Indian Native Nation.

“We want to commend the White Earth Nation and the University of Minnesota Medical School for their courage and commitment to looking deeply into preventable opioid overdose deaths,” said Minnesota Commissioner of Health Jan Malcolm. “One of the significant lessons is that cultural sensitive overdose fatality reviews can provide specific and culturally based strategies to save lives.”

The project explored White Earth Ojibwe citizen views on healing opioid-epidemic wounds. Opioid overdose death risk factors identified from five OFR cases included (1) hesitation to call for assistance, (2) lack of coordination with other substance use disorder treatment programs, (3) unaddressed medical and mental health needs, (4) movement between reservations and to urban areas, and (5) poor data accuracy and availability. Focus group-identified protective factors that prevent opioid overdose deaths included (1) innovative solutions, (2) naloxone availability, (3) community collaborations, and (4) culture. Risk factors for overdose deaths included (1) implications of historical loss, (2) historical and contemporary trauma, (3) shame and stigma, (4) effects on children, and (5) jurisdictional issues and rurality.

White Earth Nation’s Public Health/Behavioral Health Integration department, under the leadership of Clinton Alexander, MPH, an enrolled White Earth Nation member, teamed with a University of Minnesota Medical School, Duluth Campus research group headed by Dr. Brenna Greenfield, an assistant professor and clinical psychologist. Dr. Greenfield said, “As a researcher my priority is always to listen to what tribal communities would like to address and work on those topics from a strengths-based perspective. This was a unique opportunity to partner with White Earth Nation, the National Drug Early Warning System, and the Minnesota Department of Health to find ways to collaboratively address opioid overdose deaths.”

The project was funded through a sub-award from the University of Maryland at College Park’s project, the National Drug Early Warning System (NDEWS), to the University of Minnesota Medical School, Duluth Campus. NDEWS is an NIDA/NIH-funded substance use and misuse early warning system and coordinating center that supports HotSpot studies conducted by collaborating local experts and practitioners. This HotSpot study was built on a U.S. State/County review model established by the work of Erin Russell, Chief of Maryland’s Center for Harm Reduction Services. Ms. Russell served on the project as an independent consultant. An essential-and-respectful assist was graciously given by the Minnesota Department of Health epidemiological division, in accessing needed medical/epidemiological data. The project was reviewed and authorized by the White Earth Nation Research Review Board.

The White Earth Nation hosts comprehensive public health, harm reduction, behavioral health, substance use disorder treatment, human services, educational, and cultural/spiritual programs to reach and help individuals and families wounded by opioid use and overdose. Additionally, an Overdose Response Committee was established as part of the White Earth Nation’s efforts to directly address the opioid epidemic and a tribal action plan was developed in 2017 to improve methods to mitigate overdoses and enhance recovery support. Still, heartbreaking opioid-overdose deaths occur on White Earth lands. The Minnesota state American Indian and Alaska Native drug-overdose death rate in recent years is 5-6 times higher than Minnesota’s average overdose death rate.

Alexander said, “This was very hard at times; I had to step out of the circle once myself, feeling overwhelmed by personal grief.” The research team provided on-site, immediately-accessible counselors to assist review-team members as needed; also spiritual ceremony and teachings were central to each review meeting. The privacy, confidentiality, and grief-work of White Earth families and communities were respected. The team placed cultural, historical-trauma, and spiritual input at the center of their review process. 

“Facing facts and feelings over our lost loved ones is very painful; but it is also crucial to saving our Anishinaabe friends, neighbors, and family not yet lost to opioid overdose deaths. We need to find solutions that work here and now; that respectfully make use of our White Earth Anishinaabe culture and spirituality,” said Carson Gardner, M.D., chair of the White Earth Nation Research Review Board. The research project invited participating White Earth Nation community members to set their own healing research agenda; in a culturally-and-spiritually informed manner. “The richness of the White Earth team’s results is due to the infusion of the case review process with respect, dignity, and a strengths-based approach unique from any other team I have worked with,” said Erin Russell, who has supported the launch of OFR nationally and in Maryland. “The work respected the lives, stories, positive community contributions, and cultural/spiritual identities of community members lost to opioid overdose—not merely treating them as ‘fatality statistics.’”

The White Earth Ojibwe Nation and the University of Minnesota Medical School, Duluth Campus research team hope that the release of their Minnesota HotSpot report will inspire other communities—including other North American Native Nations/Tribes—to take up the challenge, in their own cultural/spiritual context, of thinking and talking about opioid fatality losses and ways to find meaningful healing wisdom and balance from and for each other.

The full Minnesota HotSpot Report can be found here.


About White Earth Nation:
The White Earth Reservation is located in Becker, Clearwater, and Mahnomen counties in north-central Minnesota. Created in 1867 by a treaty between the United States and the Mississippi Band of Chippewa Indians, it is one of seven Chippewa reservations in Minnesota.
Although the White Earth Chippewa no longer live as their ancestors did, they have kept alive their tribal heritage. Almost every aspect of their present-day life has been strongly influenced by the past.

To learn more, visit


About the University of Minnesota Medical School, Duluth Campus:
The University of Minnesota Medical School, Duluth Campus was founded in 1972 with a mission to be a leader in educating physicians dedicated to family medicine, to serve the needs of rural Minnesota and Native American communities.

  • Graduated the second largest number of American Indian physicians in the nation (Association of American Medical Colleges and the Association of American Indian Physicians).
  • #10 in primary care (U.S. News & World Report).
  • 44% of our alumni practicing in communities with populations under 25,000.

For more information, visit


About the National Drug Early Warning System (NDEWS):
The NDEWS is a NIDA-funded (U01DA038360) substance use and misuse early warning system and coordinating center that supports research by collaborating experts and practitioners to generate critical information about emerging drugs and their public health implications.
Collaborating experts, practitioners, and NDEWS staff work together to develop HotSpot studies to explore specific drug trends in specific geographic locations.

For more information about NDEWS, visit


View the report: Reducing opioid overdose deaths in Minnesota: Insights from one tribal nation

Last modified
12/18/2019 - 7:52 pm