By Megan Thielking

Dr. Anna Miller sits with her legs pulled up, boots kicked off, in an exam chair at Cherokee Nation W.W. Hastings Hospital. She’s waiting for her first Suboxone patient of the day.

She knows the odds are stacked against these patients struggling to get off opioids. She’s seen firsthand how crooked the path to recovery can be. She also knows she has a few singular advantages, unique to Indian Country, in tackling the crisis.

But those advantages are double-edged — and all too swiftly can turn into obstacles.

There is, for instance, the fact that health care is free to members of Cherokee Nation, as it is for most Native Americans under longstanding treaties with the US government.

“The great advantage is that I basically have socialized medicine,” Miller said, though she’s quick to point out the care didn’t come without a cost: “Free is not the right word to use. It’s something that was earned by their ancestors in a treaty.”

Those treaties ensure that patients don’t have copays or deductibles to worry about when they receive medication or behavioral therapy to help wean them off opioids. That lifts a huge financial burden: The Suboxone alone can run hundreds of dollars a month.

At the same time, providers said, because there’s no cost, it can be hard to get patients to fully commit to sticking with the long process of recovery. They don’t lose a lot of money if they decide to drop out.

But the strong connections binding the community can also drag down individuals trying to overcome addiction. It’s hard to break habits when you’re surrounded by so many friends with the same cravings for opioids.

The rate of drug-related deaths among American Indian and Alaska Native people has almost quadrupled since 1999, according to the Indian Health Service. It’s now double the rate in the US as a whole. Oklahoma — home to the 120,000 citizens of Cherokee Nation — leads the country in prescription painkiller abuse.

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