How the Bad River Tribe flipped the script on the Native American opioid crisis

BAD RIVER RESERVATION, Wis. — Sunlight is streaming through holes in the walls of a disused, corrugated metal shack, revealing its modest insides: Dirt floors, stacks of two-by-fours, and a pile of Little Caesars pizza boxes under attack by a work crew on lunch break.

This building is clearly not ready to be a home. But in the next 24 hours, it must become one. At this time of year, sleeping outdoors is deadly. And barely 100 yards away, on the historic pow-wow grounds of the Bad River Tribe, stands a small tent city still thawing out from yesterday’s first snow. Its inhabitants, left homeless by addiction to fentanyl and methamphetamine, have nowhere else to go.

The building’s conversion into a habitable shelter is, logistically, a minor project: Tasks include installing a few cold-weather tents, wood stoves, and a porta-potty. Spiritually, though, it is an emblem of this community’s aggressive approach to a drug crisis that, in 2023, has already killed roughly a dozen people on a reservation of fewer than 2,000. To stave off further deaths, the tribe has pivoted to harm reduction — a strategy that leaves behind “just say no” in favor of radical compassion and hands-on public health interventions for people who use drugs, even if they’re not ready to stop.

“We take care of our people,” said Lisa Whitebird, a coordinator of a specialized harm reduction team the Bad River Band of Lake Superior Chippewa has rapidly scaled up in the past year, as she surveyed the tent city on a recent afternoon, watching a colleague dispose of a used needle he found lying on the road. “It’s not like they woke up one day and decided to be homeless, and a drug addict, and live in tents on the pow-wow grounds.”

So instead of pushing an approach that insists on immediate abstinence or coerces drug users into low-quality treatment, Bad River’s harm reduction workers offer sterile syringes and pipes. Team members distribute naloxone, the overdose-reversal medication, and encourage their clients to use test strips that can detect fentanyl or xylazine, also known as “tranq.” When community members overdose, they chaperone them through emergency room visits, ensuring they receive effective care. Their aim is not to convince their clients to immediately quit, or even to seek treatment. For the moment, they have only one goal: To keep their neighbors alive.

Early numbers show that the approach is working. Bad River community members now report reversing hundreds of overdoses in 2023, including 30 in September alone, that would have been fatal if nobody had intervened. Harm reduction workers believe that naloxone they’ve distributed has been used to reverse hundreds more. And since the tribe’s needle exchange program opened nearly a decade ago, harm reduction workers have collected thousands of pounds of used syringes that could otherwise have been shared, risking HIV or hepatitis C transmission.

Bad River’s story was once a case study in all that has gone wrong throughout the U.S. opioid crisis. It began with a wave of addiction to OxyContin, which soon became heroin, then fentanyl. And as is the case across rural America, the drug epidemic here has played out against the backdrop of a remote community with little economic opportunity, high incarceration rates, and limited access to high-quality treatment. This community must contend, also, with centuries of trauma inflicted on Indigenous people and the discrimination Native Americans still face today.

Today, though, Bad River’s story has become a case study in all that is going right in the fight against drug deaths. Here, local community leaders and outside public health experts see the basis of a model for preventing drug-related harms on Native American land, and in rural communities more generally, from coast to coast.

Already, the Bad River Band has been asked to consult with other Wisconsin tribes. And after receiving a nearly $1 million grant last year from Vital Strategies, a New York-based public health nonprofit, its program is increasingly cited as a potential path forward for other communities.

“I would hope every community wants to do it, and I would hope we get invited to every community to model it,” Whitebird said. “Not that we want to be the face of it. But we want to save people — without the judgment.”

Eliminating judgment here is no small task. In Bad River, as in the rest of the U.S., people who use fentanyl or meth are often viewed with little sympathy. Many tribal elders see the tent city on the sacred pow-wow grounds as an affront and the harm reduction team’s efforts as enabling.

For years, Whitebird, 41, agreed wholeheartedly. She objected, in particular, to the strategy of supplying sterile glass pipes to people using meth or fentanyl, meant to prevent them from injecting the drugs instead, which could lead to infectious diseases or infections like endocarditis.

“I couldn’t understand: How are we giving them crack pipes? I couldn’t wrap my head around it,” she said. “But that was judgment on my part. Now, I understand that it’s preventing them from taking that next step of using a needle. That, to me, is harm reduction.”

Whitebird’s ideological shift is representative of the broader drug-policy rethink that has taken place in Bad River. The tribe now holds candlelight vigils for victims of drug overdose, and Whitebird and colleagues are invited to conduct demonstrations of how to use naloxone at community meetings. While the overall message still warns against drug use, it now also recognizes that countless community members will use drugs anyway — and will need help staying alive.

In effect, it is an acknowledgment that past strategies simply haven’t worked. The overdose epidemic is claiming over 110,000 American lives each year, and Native people in Wisconsin die of overdose at a rate nearly three times higher than the general population.

“I don’t think there’s a family in Bad River that hasn’t had a relative survive an overdose,” said Philomena Kebec, an attorney and tribe member who launched the Bad River Band’s harm reduction efforts nearly a decade ago. “And it’s because of this program.”

Those personal ties are often the only way of changing minds. Whitebird, who is in recovery and was once revived from an overdose herself, says she would never have come around to the concept of harm reduction if it wasn’t for her own family’s story.

In 2014, both Whitebird and her father were in pain: She from a car crash that left her with a slipped T7 vertebra, he from an injury sustained while working on Enbridge’s Line 5, an oil pipeline that bisects the Bad River Reservation.

Both were prescribed copious amounts of OxyContin, the blockbuster opioid now blamed for fueling a surge in addiction and overdose in the early 2000s and 2010s. But the timing was cruel: They became dependent on the drug just as blowback began against its manufacturer, Purdue Pharma, and their prescriptions were abruptly cut off.

Father and daughter went into withdrawal. Whitebird was able to treat her discomfort using buprenorphine, a common addiction medication that quashes cravings and withdrawal symptoms. Her father took a different route: heroin.

Whitebird despised the idea of enabling her father’s drug use. But she felt she had no choice: She could either help, or sit back and watch his injection drug use lead to infection or death. So she brought him sterile syringes. She fed him. Several times, she encountered him overdosing and used naloxone to save his life.

“I wasn’t OK with it,” Whitebird said. “But I was grateful to help my dad, because the ultimate goal was to get him sober. The ultimate goal was to keep him from getting HIV and hepatitis.”

On July 4, 2019, she found him alone, in bed, dead from an overdose. He had naloxone on his nightstand.

In the years since her father’s death, however, Whitebird has saved nine other tribe members, including several people whose overdoses she has reversed more than once.

Though she is not a doctor, or a paramedic, or a police officer, or a first responder of any kind, in Bad River, Whitebird is sometimes all there is. In the last year, she has operated as something of a one-woman ambulance service, fielding calls about overdoses in progress and driving frantically to the scene — most recently, she says, she revived a 17-year-old girl she found passed out in her car.

Not once, in the dozen times she’s been called, has the person overdosing died on her watch. And now, when she hands out naloxone, she admonishes anyone who will listen to never use alone.

“The ones who you lose — they’re the ones who had Narcan in their pocket and used alone,” she said.

Whitebird’s firsthand experience on both sides of overdosing is, in one sense, a bleak commentary on the state of drug use in Bad River. But in another, it is precisely what has allowed Bad River’s harm reduction program to gain acceptance and grow.

To sell community leaders on harm reduction, the program must put its lifesaving results on display. And in many cases, the people doing the harm reduction work are the same people who once needed harm reduction services, and lived to tell the tale — using naloxone and clean needles and test strips as a springboard to treatment, and then to recovery.

“A lot of our participants end up in our treatment programs,” Kebec said. “They’re the ones who can validate what’s going on. I don’t do a lot of P.R. in the community — but the people who’ve survived an overdose are the ones who can talk us up and defend us when people get crazy.”

The small building now being used as a shelter for homeless drug users in Bad River sits in the shadow of a Catholic church. Decades ago, the same church ran a boarding school where nuns would punish children for speaking Ojibwe — the language and culture that white settlers called “Chippewa” — by washing out their mouths with lye soap.

The school closed in 1969. But the legacy of trauma imparted by the church, the federal government, heavy industry, and European colonists’ attempts to expel or exterminate Native people centuries ago still remains.

Much of that legacy is more recent. In the 1970s and 1980s, the Bad River Band was caught up in the so-called “Walleye War” — a push from tribal sovereignty activists to regain many of the fishing and harvesting rights afforded to the Ojibwe people in 19th-century treaties. But exercising their right to fish generated massive protests from non-Native, predominantly white sportsmen who threw rocks at tribal officials and displayed signs with unabashedly racist slogans.

Today, having won back its fishing and hunting rights, the Bad River Band is fighting a different kind of battle: A years-long legal fight with Enbridge, a multinational oil and gas company. Enbridge’s Line 5, known to have spilled more than 1 million gallons of oil in the past half-century, runs through the reservation and through the Bad River — so named by French settlers because of how difficult it is to navigate — itself. For years, severe erosion near the pipe’s crossing point has left the community fearful of another major spill.

Given the constant struggles, many Ojibwe members see the harm reduction effort as not just a fight to save lives, but a fight for their people’s existence. Native Americans experienced 56.6 overdose deaths per 100,000 people in 2021, according to the Centers for Disease Control and Prevention — a higher rate than any other racial or ethnic group. In Wisconsin, the Native death rate is even higher: 63.8 per 100,000, according to the state health department.

“We’re in a crisis where we’re seeing more people die than are being born in our communities,” said Kebec. “Our future leadership is at risk of not being there to learn the ropes and engage in tribal sovereignty. Harm reduction is as essential for our communities as water and sewers and electrification and roads.”

At the Bad River Band’s harm reduction office, a faded yellow trailer with a dirt parking lot in the back, the day often starts with the Native American ritual of “smudging” — burning a highly aromatic sage thought to cleanse the room’s energy.

Soon after, Eli Corbine gets to work. His desk sits next to shelves of naloxone vials, fentanyl and xylazine test strips, syringes, cooking foils, glass pipes, and more. In the last year, Bad River has expanded its harm reduction offerings beyond the five counties immediately adjacent to the reservation. Now, anyone in Wisconsin can request mail-order naloxone, and much of the medication is being sent all across the state — not just to Native American communities, but to cities like Madison and Milwaukee, too.

In the last year, the grant from Vital Strategies has allowed Bad River to scale up the ambitious new mail-order program, much of the responsibility has fallen to Corbine, a Bad River Native who is also in recovery.

Future plans include a free naloxone vending machine and, building on the progress of the temporary shelter, a 40-unit apartment building to be used in part for transitional housing for people with addiction.

So far, the aggressive public health strategies seem to be working. The team has received nearly 100 returned batches of used syringes so far this year. In a recent 12-month stretch, Kebec said, the harm reduction team distributed over 8,000 doses of naloxone, distributed 100,000 syringes, collected 300 pounds of syringe waste, sent out 1,400 mail-order harm-reduction kits, and made over 2,000 face-to-face contacts with people who use drugs and other community members.

While the results are remarkable, the process is not always smooth. On Halloween, a day before construction began in earnest at the Quonset hut that will become temporary housing, Whitebird attended a meeting of the tribe’s drug policy task force dressed as a red Teletubby. But her costume did not match her tone. Why, she demanded to know, was the project still incomplete even as temperatures plunged toward zero?

The outburst worked: The next day, the tribe’s chairman, Mike Wiggins, stood inside the Quonset hut and surveyed the progress workers had made in the past few hours alone.

Building four tents and sheltering community members from the elements wasn’t much, he acknowledged. But he likened the project to a Mt. Everest base camp: A brief, stabilizing stop before the long start of the long, upward journey toward recovery.

Today, Bad River’s harm reduction team is saving lives in Wisconsin. One day soon, though, it may help save lives in Indigenous communities across the country.

Corbine and Whitebird now travel regularly to other tribes’ pow-wows across the state, handing out literature, advertising their mail-order naloxone service, and handing out the medication on site.

Recently, they presented their strategy to the St. Croix Band of Lake Superior Chippewa, another Ojibwe tribe.

Far from the reservation, outside public health experts have come to view the Bad River program as a success story that other tribes might replicate.

“Not only is it a model for other Indigenous communities, but it’s an education point for all of us to understand how harm reduction works,” said Adrienne Hurst, a senior technical adviser for the overdose prevention program at Vital Strategies.

Part of the model, Hurst said, involves outside funding, but little outside interference. While Bad River has relied on Vital Strategies for some technical support and an $855,000 grant, the program’s labor, policies, and strategy decisions all come from the reservation itself. The tribe also receives state support for buying and distributing naloxone, and another New York-based nonprofit, Next Distro, has partnered with Bad River to bolster its naloxone stockpile even more.

Those efforts may soon expand: Kebec said she recently submitted a grant application to the National Institute on Drug Abuse that, if approved, would give the tribe funding to hire even more harm reduction workers and peer recovery specialists and research the benefits of steady employment for people in recovery.

The program has also allowed its workers career growth they never imagined. Corbine, in particular, views himself as a success story: His first job after he was incarcerated and once he stopped using drugs was at Domino’s. Now, he’s traveling to Puerto Rico for harm reduction conferences and earns a comfortable living helping people whose situation he understands all too well.

Allowing harm reduction workers a chance at career growth, Hurst said, is a central element of Vital Strategies’ approach.

“In Bad River, we’re supporting their longstanding dedication to reducing overdose deaths, while ensuring that staff are financially compensated for the work and expertise and as well as advancing career pathways in this space,” she said. “It is critical that our harm reductionists who have worked for love can also work for pay.”

But more important than career advancement, Corbine said, is the opportunity to help people who have nowhere else to turn — and to do so having traveled the same path through trauma, addiction, and recovery.

“These also are people that I grew up with and who I love that I’m helping,” Corbine said. “That aspect helps a lot.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.