CASS LAKE -- The Indian Health Service in Cass Lake was one of five IHS facilities that received criticism from the Department of Health and Human Services in a recent report for the way the organization distributed opioids to Native Americans, a group that is disproportionately affected by the drug epidemic.

The Indian Health Service is under the purview of the federal Department of Health and Human Services. In total, it serves some 2.6 million American Indians and Native Alaskans. The department released its report in July. In addition to the Cass Lake hospital, it named facilities in North Dakota, Oklahoma, Arizona and New Mexico.

“We found that the five IHS hospitals did not always prescribe and dispense opioids in accordance with IHS policies and procedures,” the report said.

Although representatives from the Leech Lake Band of Ojibwe could not be reached for comment, officials with the Indian Health Service responded to the report, outlining a number of the changes that either will be implemented or already have been implemented.

The report referenced The Center for Disease Control and Prevention, which reported that American Indians and Native Alaskans had the largest percentage increase in deaths from 1999 to 2015 and the highest overdose death rates in 2015 “compared with other racial and ethnic groups.”

The report then noted a number of areas where the hospitals erred in their distribution of the medications. For example, it said all five hospitals dispensed opioids to some patients “in amounts that exceeded” the CDC guidelines.

The report said that medical personnel at all five hospitals prescribed “opioids and benzodiazepines at the same time.” That mixture, according to the CDC, results in a “greater risk of a potentially fatal overdose.”

While the report only recently faulted IHS for the way it distributed opioids, it merely confirmed what some members of the Native community in Cass Lake were already well aware of.

“To be that free with opiates and narcotics is really, really inappropriate.” Audrey Thayer, a former employee of the American Civil Liberties Union and an instructor at Leech Lake Tribal College, said of IHS’s former distribution practices. “Their generous use cost us more grief with people misusing the drugs, and that was a problem.”

The report also noted a few additional errors, such as the fact that some of the hospitals, including Cass Lake, fulfilled prescriptions from non-IHS providers without a “review of the patient’s medication profile, a complete drug history, or related health records.”

Not secured

The report even singled Cass Lake out at least once. A section of the report detailed situations where opioids were not physically secured. In that section, it indicated the hospital in Cass Lake would store opioids with other drugs in the pharmacy as a way to reduce theft. Patients apparently knew where the opioids were held, and because of that, they could tell which patients were receiving the medications.

“Cass Lake had issues with patients waiting in the lobby and following other patients out of the hospital to steal their opioids,” the report said. “Because the patients waiting in the lobby could tell where the opioid was being dispensed, they could easily identify which patients were picking up opioid prescriptions.”

The five hospitals named in the report included Cass Lake Hospital in Cass Lake, Fort Yates Hospital in Fort Yates, N.D., Lawton Indian Hospital in Lawton, Okla., Phoenix Indian Medical Center in Phoenix and Northern Navajo Medical Center in Shiprock, N.M.

The Leech Lake Band of Ojibwe has been battling the opioid epidemic for years. In 2017, the Leech Lake Band of Ojibwe even filed a lawsuit against a number of drug manufacturers and distributors.

“The crisis caused by the proliferation of opiates throughout our communities is the newest threat to our way of life,” Leech Lake Chairman Faron Jackson Sr. said in a press release at the time. “We hope this lawsuit will help to bring further attention to this major issue and ultimately make sure the major opioid manufacturers, who have put their corporate profit margins over the lives of our people, are held accountable for their actions.”

The report included a response from the Indian Health Service, which indicated it was working to correct the issues DHHS outlined. The agency said it was working on improved policies for issues such as accountability and the dispensing of opioids. It also said they were working on evaluating situations “where there may be increased risk for patients.”

For example, the letter from IHS said the organization initiated a “safe opioid monitoring tool” in January. In October 2018, it revised part of its requirements to make sure to lock up prescriptions waiting to be fulfilled.

Just as it was apparent to the Native community that it was formerly easy to obtain opioids from IHS, it also became apparent when IHS began to tighten its policies. However, the reactions to that change have not been the same across the board.

A number of people recently commented on the situation during a conversation that began on Facebook. Michelle Leanne Reynolds said the change has “caused more harm than good.” In situations when someone may actually may need legitimate painkillers, they may only be able to receive a shot and some milder options, such as Tylenol, she said. Reynolds was not the only one to make that sort of comment.

Thayer, however, said the change has been beneficial due to the way opioid misuse became so rampant.

“I was glad they did it this way… their crackdown, I think, was appropriate because it really was out of hand,” Thayer said.