The Tanana Chiefs Conference (TCC) is the traditional tribal consortium of the 42 tribes of Interior Alaska. Our region spans three Census areas (Southeast Fairbanks Census Area; Yukon Koyukuk Census Area; and the Fairbanks North Star Borough) and covers almost one-fourth the entire state of Alaska. The TCC region is divided into six sub-regions and the Fairbanks North Star Borough. Our service area for the Tribal Opioid Response Grant (TOR) project will be four of the rural sub-regions: Upper Tanana, Yukon Flats, Yukon Tanana, and Yukon Koyukuk. We will implement MAT in the regional hubs of Fairbanks, Galena, and Tok. Within these four sub-regions there are 30 villages with populations ranging from 20 in Alatna and 1,246 in Tok. TCC serves 16,797 Indian Health Service beneficiaries each year. While we do not have an exact estimate of the number of individuals with opioid use disorder in the TCC region, several indicators suggest that around two percent of our population currently has an opioid use disorder; most are polysubstance users.
Our goals are to 1) increase awareness about the risks of opioid use (prescription opioids and heroin) among youth and adults in the TCC region; and 2) increase the number of individuals with OUD who receive evidence-based MAT.
TCC will implement three activities incorporating culturally appropriate and traditional practices: 1) complete a comprehensive strategic plan to address the gaps in prevention, treatment and recovery identified by our tribes; 2) develop and implement effective prevention strategies, including elder education, outreach and engagement of youth, and promotion of drug disposal; 3) Implement service delivery models that enable the full spectrum of treatment and recovery support services that facilitate positive treatment outcomes and long-term recovery. Primary care or other clinical practice settings where MAT is provided and linkages to psycho-social services and recovery services in support of patient needs related to the provision of comprehensive treatment of OUD may also qualify as evidence-based programs/practices.
In implementing these activities we will use several evidence-based programs. For prevention efforts, TCC will integrate opioid misuse prevention in its Talk. They Hear You. framework which is currently being used in our broader substance abuse prevention efforts. The approach was selected due to its positive and inter-generational focus, a cultural value, as well as the flexibility to adapt it to TCC’s expanded conversations, and easily adaptable with images and language. TCC will follow the Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction and Incorporating Alcohol Pharmacotherapies into Medical Practices to develop its evidence-based medically assisted treatment program using naltrexone and buprenorphine. TCC will use the evidence-based Matrix Model of Intensive Outpatient Treatment to provide individual and group counseling to patients with opioid use disorder. The Matrix Model is a multi-element package of therapeutic strategies that complement each other and combine to produce an integrated outpatient treatment experience.
As a result of these activities we will reach at least 3,000 youth and adults with prevention information and 1,000 adults and particularly elders with information to safely dispose of or store prescription opioids; distribute at least 1,000 lockboxes and opioid disposal bags; train TCC physicians and behavioral health staff to implement policies and procedures to use MAT and provide linkages to psycho-social services and recovery services; and treat at least 34 individuals with MAT.