Research Project 3

PROJECT SUMMARY American Indians (AIs) have the highest rate of prescription opioid misuse of any sociodemographic group in the United States (US). Increasing rates of opioid misuse have led to increased prevalence of injection drug use (IDU) and concomitant overdose and infectious disease morbidity and mortality. Infectious disease burdens are driven in part by inadequate access to sterile injection equipment. IDU-associated harms are one of many drivers of AIs having the lowest life expectancy in the US. Few Federally recognized Tribes in the US have implemented syringe services programs (SSPs). This scarcity is driven in part by the fact that SSPs – which reflect harm reduction and, often, allopathic approaches to health and well-being – must be integrated with traditional AI approaches for healing. While these approaches are not incompatible, their integration can be challenging. Understanding factors that facilitated the successful implementation of AI-centered SSPs that integrate harm reduction, allopathic, and traditional AI approaches warrants exploration since these programs are essential for mitigating IDU-associated harms. We will conduct community-based participatory research with AI communities that successfully implemented SSPs that integrate multiple approaches to health and well-being. Through this Project, we will identify the roles of community contexts and policy during the implementation of SSPs that integrate multiple approaches (i.e., harm reduction, allopathic, and traditional AI) to health and well-being in three AI communities through key informant interviews with persons who played a role during implementation (Aim 1). We will also determine the contexts and mechanisms by which social and structural factors affect attitudes and beliefs about the utilization of SSPs that integrate multiple approaches among AI SSP and non-SSP clients (Aim 2). Finally, we will examine how patterns of knowledge and attitudes about multiple approaches to health and well-being and SSPs that integrate them are associated with sociodemographic factors through audience segmentation research among AI-serving members of the public health and healthcare workforce (Aim 3). The results of this Project will culminate in a robust evidence base for reversing and eliminating substance use harms in AI communities.