In summer 2020, as the pandemic was setting in, Justin Lee Littledog called his mom to tell her he was moving from Texas back home to the Blackfeet Indian Reservation in Montana. And he was taking his girlfriend, stepson and son.
They moved in with his mom, Marla Ollinger, who lived on a 300-acre ranch on the rolling prairie outside Browning — and had what Ollinger says was the best summer of her life. "That was the first time I've gotten to meet Arlin, my first grandson," Ollinger says. Another grandson was born in the spring of 2021 — and Littledog, 33, found maintenance work at the casino in Browning to support his growing family.
But things began to unravel over the next year and a half. Friends and relatives saw Littledog's 6-year-old stepson walking around town alone. Then last fall, Ollinger received a call from another one of her adult sons. He was frightened because he was briefly unable to wake Littledog's girlfriend. Ollinger says she could hear one of Littledog's children crying in the background.
After that incident, Ollinger asked Littledog whether he and his girlfriend were using drugs. She says Littledog denied it. He explained to his mom that people on the reservation were using a drug she had never heard about: fentanyl, a synthetic opioid that is up to 100 times as potent as morphine. He said he would never use something so dangerous and reassured his mom everything was fine. Ollinger backed off, fearing that any more confrontation would push her son away.
Then in March, Ollinger woke up to screams. She left her grandchildren, who were sleeping in her bed, and went into the next room. "My son was lying on the floor," she says. Littledog wasn't breathing.
After calling 911, she drove behind the ambulance into Browning. He was pronounced dead shortly after the ambulance arrived at the local hospital.
Littledog was one of four people who died from a fentanyl overdose on the reservation on the second week of March, according to Blackfeet health officials. An additional 13 people on the reservation survived overdoses that week, making a startling total for an Indigenous population of about 10,000 people.
Falling prey to fentanyl
During the pandemic, fentanyl took root in Montana and communities across the Mountain West region, says Keith Humphreys of the Stanford-Lancet Commission on the North American Opioid Crisis. Previously, the drug was prevalent east of the Mississippi River.
Montana law enforcement officials have intercepted record numbers of pale blue pills made to look like prescription opioids such as OxyContin. In the first three months of 2022, the Montana Highway Patrol seized over 12,000 fentanyl pills, more than three times the number from 2021.
Nationwide, at least 103,000 people have died from drug overdoses in 2021, a 45% increase from 2019, according to data from the Centers for Disease Control and Prevention. About 7 of every 10 of those deaths were from synthetic opioids, primarily fentanyl.
Overdose deaths disproportionately affect Native Americans. The overdose death rate among Indigenous people was the highest of all racial groups in the first year of the pandemic — and was about 30% higher than the rate among white people, according to a March study published in JAMA Psychiatry, co-authored by Joe Friedman, a researcher at the University of California, Los Angeles.
In Montana, the opioid overdose death rate for Indigenous people was twice that of white people from 2019 to 2021, according to the state's Department of Public Health and Human Services.
Part of the reason why this is happening is that Native Americans have relatively less access to health care resources, Friedman says. "With the drug supply becoming so dangerous and toxic, it requires resources and knowledge and skills and funds [for people] to stay safe," he says. "It requires access to harm reduction, health care, medications."
The Indian Health Service, which is responsible for providing health care to many Indigenous people, has been chronically underfunded. According to a 2018 report from the U.S. Commission on Civil Rights, IHS per patient expenditures are significantly less than those of other federal health programs.
"What we're seeing now is deep-seated disparities and social determinants of health kind of bearing out," Friedman says, referring to the disproportionate overdose deaths among Native Americans.
Blackfeet Tribal Business Council member Stacey Keller says she has experienced the lack of resources firsthand while trying to get a family member into treatment. She says just finding a facility for detoxing was difficult, let alone finding one for treatment.
"Our treatment facility here, they're not equipped to deal with opioid addiction, so [people] are usually referred" to facilities outside of the reservation, she says. "Some of the struggles we've seen throughout the state and even the western part of the United States is that a lot of the treatment centers are at capacity."
The local treatment center doesn't have the medical expertise to supervise someone going through opioid withdrawal. Only two detox beds are available at the local IHS hospital, Keller says, and they are often occupied. The health care system on the reservation also doesn't offer drugs used to treat opioid addictions. The nearest locations to get buprenorphine or methadone, for example, are 30 to 100 miles away. That can be a burden to patients who are required by federal rules to take those meds to manage their treatment on a daily or weekly basis.
Finding treatment for Indigenous communities
Keller says tribal leaders have requested assistance from IHS to build treatment centers and procure other substance use resources, like detox beds and medication, in the community — with no results.
IHS Alcohol and Substance Abuse Program consultant JB Kinlacheeny says the agency has largely shifted to appropriating funds directly to tribes to run their own health care programs.
The Rocky Mountain Tribal Leaders Council, a consortium of Montana and Wyoming tribes, is working with the Montana Healthcare Foundation on a feasibility study for a residential treatment center operated by tribes, specifically for tribal members. Tribes across both states, including the Blackfeet, have passed resolutions supporting the effort.
On March 14, Blackfeet political leaders declared a state of emergency after the fentanyl overdoses. Two weeks later, some of the children of Timothy Davis, the tribal council chairman, were arrested on suspicion of selling fentanyl out of Davis' home. The council removed Davis from his position in early April.
The tribe has created a task force to identify both the short- and long-term needs to respond to the opioid crisis. Blackfeet tribal police investigator Misty LaPlant is helping to lead that effort.
Driving around Browning, LaPlant says she plans to train more people on the reservation to administer naloxone, a medication that reverses opioid overdoses. She also wants the tribe to host more needle exchanges. There's also hope, she says, that a reorganization of the tribal health department will result in a one-stop shop for Blackfeet Nation residents to find drug addiction resources on and off the reservation.
However, she says, it's crucial to resolve some of the underlying issues — such as poverty, housing and food insecurity — that make communities like the Blackfeet Nation vulnerable to the ongoing fentanyl crisis. These problems can spur people to use drugs — and under-resourced communities are generally easier targets for drug traffickers, she says. Solving that problem is a massive undertaking that won't be completed anytime soon, she says.
Meanwhile, Ollinger is feeling optimistic that momentum is building to fight opioid and fentanyl addiction in the wake of her son's death and others. She hopes sharing her story will help advocate for more resources so no one else has to live through her experience.
"It's heartbreaking to watch your children die unnecessarily," she says.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Copyright 2022 Montana Public Radio.