Project Summary
American Indian communities have been greatly affected by the opioid epidemic with many Tribes being
overwhelmed by opioid use and overdose. Among all racial/ethnic groups in the U.S., American Indians and
Alaska Natives have the highest rate of overdose fatalities from all opioids. Within Southern California, areas
encompassing American Indian Tribes have experienced some of the highest age-adjusted rates of opioid
overdose deaths. In March 2023, the Harm Reduction Coalition of San Diego (HRCSD) formed strategic
partnerships with Southern California Tribes to install overdose prevention vending machines (ODPVM) that
freely dispense naloxone, with the goal of reducing opioid-related overdose deaths on tribal reservations. To
our knowledge, these are the first ODPVM to be established on Tribal Sovereign Land in the U.S. With the
current or soon-to-be placement of ODPVMs on several tribal reservations, our research team, led by two
American Indian Principal Investigators, is in a unique position to conduct timely applied research that is
responsive to tribal leadership's call for community-based prevention activities aimed at reducing overdose
deaths. Through a collaborative community-based and participatory research (CBPR) approach we will
conduct a bi-phasic, milestone-driven R61/R33 study over a 3-year period. Our study will focus on the
implementation process of ODPVM on tribal lands using the RE-AIM framework (Reach, Effectiveness,
Adoption, Implementation and Maintenance), with a focus on health equity. During year 1, the exploratory R61
phase, the study will be guided by the following specific aims: 1. develop the CBPR infrastructure by identifying
and working with tribal and community representatives who will aid in the development of a culturally
appropriate study design to examine the implementation of ODPVM on tribal lands and 2. identify the initial
reach of ODPVM during the first year of vending machine placement. During years 2-3, the developmental R33
Phase, our specific aims will address the following: 3. describe the implementation process and identify
implementation strategies to increase utilization of ODPVMs within tribal reservations and 4. compare the
impact of ODPVMs by examining the statistical and spatial distribution of fatal overdose rates on tribal
reservations vs San Diego County, California. Opportunities to evaluate harm reduction strategies on tribal
lands are rare but urgently needed for American Indians. Timely research to evaluate the implementation of
ODPVM in real-time will allow key questions to be addressed about approaches, activities, and processes that
lead to ODPVM uptake. The knowledge gained from this work will provide crucial preliminary hypothesis-
generating data on facilitators to ODPVM uptake and inform a larger scale study to test implementation
strategies for effectively implementing ODPVMs within Tribal Sovereign Nations.