The opioid crisis has disproportionately hit Indian Country due to structural inequities rooted in colonialism, systemic racism, and historical trauma. These inequities are contributing to higher overdose rates and barriers to accessing culturally appropriate health services. In response, Tribal Nations are creating their own legal frameworks and policies to reduce opioid-related harms and overdose deaths and to reclaim health strategies grounded in culture as medicine, self-determination, and community.

Harm reduction is aimed at reducing negative health consequences people who use drugs experience. Harm reduction is achieved through laws, policies, and programs that minimize the negative health, social, and legal impacts associated with drug use. This international movement is grounded in social justice, human rights, and reducing stigma in order to keep people alive and offer alternatives that seek to prevent drug use.

Native-centered harm reduction is crucial because the framework recognizes the impact that historical trauma and the racist war on drugs have had on Indigenous communities. By “decolonizing harm reduction” or “Indigenizing harm reduction,” Native people are getting access to more wholistic, culturally-responsive strategies for substance abuse. Integrating Indigenous cultural practices (also known as “culture as prevention”) has been effective at reducing drug use within Native communities by addressing some root causes of substance misuse, such as trauma, loss of identity, and community disconnection.

Sovereignty in Action: Tribal Harm Reduction Policy Innovation

Tribal Nations are using their sovereignty to enact laws and policies that embed cultural values, spiritual wellness, and community healing. Examples of Indigenous harm reduction policies include:

Public Health Vending Machines

Public health vending machines are like typical snack or beverage vending machines but are stocked with free harm reduction supplies such as Narcan, syringes, sharps containers, and drug test kits. Some public health vending machines also have more general hygiene items such as water, sunscreen, clean socks and underwear, dental hygiene kits, safe sex products, or menstrual products.

Naloxone (Narcan) Access

Naloxone or Narcan is an opioid antagonist, meaning it is a medicine that rapidly stops an opioid overdose by attaching to receptors in the body and reversing the effects of the opioid. These policies focus on being able to access Narcan (e.g., through a public health vending machine) and co-prescribing Narcan with opioid prescriptions.

Drug Testing Equipment

Drug testing equipment is a low-cost, high reward harm reduction strategy that can mitigate harm for people who use drugs by testing for other components such as fentanyl, benzodiazepines, and xylazine.

  • Example: Several Tribal nations in the Great Lakes area provide fentanyl test strip kits for free through a public health vending machine or another publicly accessible site, like a clinic. The Sokaogon Chippewa Community, Mole Lake Band of Lake Superior Chippewa provides an incentive first aid kit with Narcan, fentanyl test strips, and some additional harm reduction items for community members that complete a Narcan/fentanyl training. Oneida Nation provides free fentanyl and xylazine test strips and Narcan kits through Oneida Behavioral Health.

Safe Syringe Access

Safe syringe access, or syringe services programs (SSPs) (also called needle exchange programs) aim to reduce the health risks associated with intravenous drug use, such as transmission of HIV and hepatitis C, by providing clean syringe equipment to reduce dangerous needle sharing.

  • Example: Bad River needle exchange offers harm reduction services and tools for community members. The program is rooted in the seven Ojibwe teachings: respect, humility, courage, honesty, wisdom, and love. Please see the Expanding the Circle of Care guide for syringe services perspectives and knowledge from the Tribe.

Medically Assisted Treatment (MAT) 

MAT combines behavioral therapies and FDA-approved medications to treat substance-use disorder and support recovery. Medications used in MAT for opioid use disorders include Methadone, Buprenorphine, and Naltrexone. The medications can be dispensed in outpatient settings or at a licensed opioid treatment program, depending on the medication and jurisdiction. Tribal Nations are integrating MAT into culturally appropriate substance-use disorder care by incorporating traditional healing practices alongside MAT, fostering culturally grounded peer recovery programs, and offering buprenorphine at Tribal health clinics, mobile sites, or through telehealth to increase access in more rural Tribal communities.

  • Example: White Earth Nation utilizes medication management, individual and group counseling, relapse prevention strategies, family support, and education tools as part of their holistic approach to treating substance abuse disorders.
  • Lac Courte Oreilles Band of Lake Superior Ojibwe’s Health Clinic features a “MAT Clinic” with a strong cultural component rooted in the seven sacred teachings (love, courage, respect, honesty, wisdom, humility, and truth).

Good Samaritan Laws and Criminal Immunity

Good Samaritan laws generally limit liability for those who perform care and rescue in emergency situations. Good Samaritan laws are important so that people using drugs can call 911 or help each other without risking criminal or civil liability if their attempts to help go wrong.

  • Example: In 2017, the Saginaw Chippewa Indian Tribe of Michigan implemented a Good Samaritan Law into their Tribal Code, to protect both people seeking medical assistance for someone experiencing overdose, and the person experiencing the overdose.

Healing to Wellness Courts

Tribal Healing to Wellness Courts utilize a restorative justice approach designed to address substance-use disorders while centering the importance of their specific cultural values, traditional healing practices, and governance systems as opposed to relying solely on state or federal models that may not reflect the needs of their people.

  • Examples: In 2014, the Ho-Chuck Nation created the Tribal Healing to Wellness Court to serve as a form of alternative sentencing to address drug and alcohol addiction. The Wellness Court works in partnerships with other Tribes, treatment agencies, and rehabilitation services to create an effective program for participants. Throughout the admission process, a cultural assessment is completed to determine the applicant’s “cultural and/or spiritual competencies” to foster a main goal of the Wellness Court—to restore traditional values and language. Some other goals of the Wellness Court include promoting support systems and programs to aid in sobriety, along with breaking the cycle of addiction and creating accountability for program participants.

  • In 2022, Oneida Nation passed legislation to establish the Oneida Healing to Wellness Court (OHWC), a post-conviction healing court available to individuals living with a substance-use disorder as an alternative to incarceration. The program encourages healing by integrating participants in the community and centering core values. An individual must meet all eligibility requirements to qualify for OHWC, including having Tribal membership of Oneida Nation, being at least 18 years old, and having been charged with a drug or alcohol-related offense in Brown County Circuit Court. Participants in OHWC must be sentenced to complete the program by a Brown County Circuit Court Judge.

Key Policy Considerations for Native-Centered Harm Reduction:

  • Harm reduction programs and educational materials should be tailored for Native communities, including the use of Indigenous language, customs, and symbols when appropriate. This could include integrating culturally relevant traditional healing practices such as sweat lodges and talking circles.
  • Policy makers need to be aware that these policies can carry legal risk if, for example, state or federal law prohibits the possession of syringes as drug paraphernalia. Tribes and states will need to ensure the law protects users and staff from prosecution if they implement harm reduction policies. Tribes are sovereign nations, but they should consult with an attorney to discuss any potential legal risks under relevant state law.
  • Utilize harm reduction services as a connection point to refer users to other services, such as infectious disease testing; referrals to substance-use disorder treatment and to mental health and primary care; wound care; overdose prevention tools, such as Narcan; and to community education services.
  • Require staff education and training in trauma-informed care, Tribal cultural humility, and overall harm reduction strategies for emergency service workers, policy and social service workers, schools and other educational institutions, and community center staff.
  • Protect the privacy and confidentiality of those in the program, whenever possible. All programs should be compliant with Tribal law and HIPAA. Affirming informed consent and patient autonomy can help to ensure patients feel more comfortable using these services.
  • Tribal Nations may wish to coordinate with other government systems, such as federal agencies (e.g., Indian Health Service and the Bureau of Indian Affairs) or neighboring jurisdictions for program support, training, and resource delivery. Additionally, public health data systems like prescription drug monitoring programs would require cross-governmental agreements to share information that supports Tribal opioid harm reduction interventions. Check out our resource on Tribal data sovereignty.

Resources:

Looking Forward

Tribal Nations are increasingly using their inherent Tribal sovereignty to implement harm reduction laws, policies, and programs rooted in traditional healing to reduce opioid-related harms in their community. While these approaches may differ across Tribal communities, each Tribe is exercising its self-determination to prioritize critical, life-saving harm reduction interventions rooted in science and traditional Indigenous values to protect community members from opioid overdose. By centering community voices and lived experience, integrating traditional healing practices, and securing sustainable funding sources, these initiatives are not only saving lives, they are also reshaping how communities think about substance abuse by reducing stigma.

There are jurisdictional issues that Tribal Nations should be aware of, such as state laws that may conflict with Tribal laws. Under Public Law 280, certain states have broader criminal and civil jurisdiction in Indian Country. For example, Tribal Nations situated in Public Law 280 states with a state law that criminalizes syringe or drug testing strip possession under a drug paraphernalia law may require cross-jurisdictional cooperation. Tribes may wish to develop a memorandum of understanding with neighboring jurisdictions to develop programs and protect citizens from prosecution. Please reach out to an attorney licensed in your jurisdiction for legal advice.

Please reach out to the Public Health Law Center with any legal technical assistance requests or partnership around harm reduction law and policy. All Tribal laws, policies, and programs referenced are publicly available online. Look out for our incoming report, “Tribal Harm Reduction Policy and Law Scan in the Great Lakes Area” for a more in-depth analysis.

Morgan Jones Axtell, Senior Staff Attorney
February 13, 2026