Kenaitze Indian Tribe (Kenaitze) is a federally recognized Tribal Government reorganized in 1971 under the statutes of the Indian Reorganization Act of 1934, as amended for Alaska in 1936. Kenaitze serves 1,670 Tribal members and approximately 4,410 Alaska Native/American Indian (AN/AI) residents. The Tribe’s service area spreads across more than 15,000 square miles of rural Alaska, where heroin use in particular has reached epidemic proportions in recent years. Kenaitze’s health programs do not currently offer medication-assisted treatment (MAT) for opioid use disorder (OUD), so patients who would benefit from such approaches must be referred to other local/regional providers outside the Tribal health system. The population of focus is limited to Kenaitze Tribal and other AN/AI adult (18 years and older) community members who are diagnosed with OUD because Primary Care services are available only to IHS beneficiaries, which include the prescription of FDA-approved MAT; non-IHS beneficiary patients who are encountered by this program will continue to be referred to outside providers to receive MAT. This proposal is intended to achieve the following goal and objectives:
Goal: Improve the availability of evidence-based treatment options for Tribal/AN/AI un’ina within the Kenaitze service area.
Objective 1: By the end of program year 1, provide MAT to at least fifteen (15) Tribal/AN/AI patients diagnosed with OUD as measured by program enrollments.
Objective 2: By the end of program year 2, provide MAT to at least thirty (30) Tribal/AN/AI patients diagnosed with OUD as measured by program enrollments.
Grant-funded services will be provided at Kenaitze’s Dena’ina Wellness Center (DWC), a state-of-the-art health facility. Participants’ MAT will be provided in this clinical practice setting as a collaboration between the Primary Care and Behavioral Health Departments, ensuring that OUD-diagnosed patients receive FDA-approved MAT from a licensed prescribing physician and are linked to psychosocial services via a Chemical Dependency Counselor (CDC) that are intended to support sustained recovery; those admitted to the program will be administered Suboxone (buprenorphine) in weekly treatment increments in conjunction with required individual and group counseling sessions conducted by the CDC, utilizing Motivational Interviewing (MI), the Matrix Model, and Cognitive Behavioral Therapy (CBT) as evidence-based practices that demonstrate effectiveness with the population of focus. To ensure accountability, the CDC will also perform weekly “dipstick” urinalysis testing that can be used in-office to determine whether patients are using substances other than that prescribed. Used Suboxone strips will be collected to ensure the patient is using the MAT as it has been prescribed. The CDC will also be responsible for conducting face-to-face interviews with all patients who are accepted into the MAT program at initial intake, at the 3- and 6-month marks of service delivery, and at discharge.