‘We hold you sacred’: how a mobile drug unit is fighting the opioid crisis in the Cherokee Nation
Twice a week, Coleman Cox drives a white sprinter vanfull of life-saving supplies along winding rural Oklahoma roads from Tahlequah, the capital of the Cherokee Nation, to Vinita, a town of 5,000 about 70 miles (113km) north. It’s a hot spot for drug use in the northern part of the reservation.
Cox, who’s 38, is the director of the Cherokee Nation harm reduction program, an evidence-based public health strategy designed to mitigate the adverse effects of drug use, such as infectious diseases, overdose and death. The mobile unit was launched in September 2023 to bring harm-reduction supplies to remote areas of the reservation. Vinita is its first distribution site.
It’s an unseasonably hot day for November in Oklahoma. Cox, an enrolled member of the Cherokee Nation, parks the van in the alleyway behind the Vinita Potters Guild, as he does every Tuesday and Thursday. Then hesets up a folding table with black bins of naloxone, a drug to reverse opioid overdoses, along with testing strips,clean syringes and woundcare supplies. The mobile unit typically sees 16 regulars from the community, he says. Some days, no one comes. It all depends on the patterns of drug use and the current drug supply.
“It’s feast or famine,” Cox said. “That’s why it’s important to know how people use.”
He goes on to describe how typically someone using intravenous methamphetamine uses up to 10 syringes a day, an intravenous heroin user up to four and fentanyl users up to 30. Knowing what the local drug supply looks like and how many syringes someone needs can help Cox keep people from reusing or sharing needles – and spreading infectious disease – or going into withdrawal in an unsupervised environment.
Cox looks like an average American dad: he wears a baseball hat and a flannel shirt, and he has a warm smile. He is possessed by the energy of a parent with a young, busy family, whose days are filled with after-school activities and sports practices.
Cox picks up a packaged syringe and explains that he carries several sizes, as different intravenous drugs have various levels of viscosity. Using the wrong size can lead an injection site to become infected. So far, the mobile unit has distributed more than 600 clean syringes. He hopes he can start providing intravenous naloxone, which is cheaper than the common nasal spray variety.
A stack of shiny folders that Cox sets out contains information on how to administer naloxone to someone who is overdosing, and how to angle a syringe to reduce skin tearing and infection. Prominently featured is a message the Cherokee Nation wants to send to its members who use drugs:
“We hold you sacred and wish to give you the respect you deserve.”
It’s a sentiment the Cherokee Nation is weaving through its $100m (£79m) strategy to reduce opioid overdoses on the reservation, funded in part by the tribe’s landmark 2017 lawsuit against opioid manufacturers and distributors.
The van is just one part of the tribe’s investment in harm reduction and addiction healthcare centered on Cherokee culture.
More than twice as likely to die of overdose
Like the rest of Indian country, the Cherokee Nation is on the frontlines of the current opioid epidemic. Addiction experts say it is in its fourth wave in the past 25 years, beginning with prescription opioids in the late 1990s, a resurgence of heroin around 2010 and, in the last 10 years, heroin being mixed with fentanyl, a highly lethal synthetic opioid that is as much as 50 times as strong as heroin. Now fentanyl is increasingly found in non-opioid drugs such as cocaine and methamphetamine, which is driving up overdoses among users of those drugs.
More than 103,000 Americans died in opioid-related incidents in 2022. According to the federal Centers for Disease Control and Prevention, opioid-related overdoses have tripled since 2000. According to data compiled from the CDC, the Indian Health Service, the National Institute on Drug Abuse and various state health departments, Native Americans are 2.6 times more likely to die of an overdose than white Americans.
The wounds inflicted by colonialism, the violent removal of tribes