As early as February of 2020, American Indian and Alaska Native (AI/AN) communities began to report
increased prevalence rates of COVID-19 relative to the rest of the US. Compared to non-NHWs (21%), 34%
of AI/AN adults are at greatest risk of COVID-19 related serious illness. AI/AN adults are also more likely to
suffer from underlying health conditions that further increases vulnerability to COVID-19 infection, such as
diabetes, cardiovascular disease, and cancer. These elevated risks are exacerbated by historical and political
factors, including population collapses from smallpox and the Spanish flu, low socioeconomic
status, obstacles to accessing needed care and chronic underfunding of the Indian Health Service. To
vividly illustrate COVID-19-related disparities, AI/AN people comprise ~11% of the New Mexico population, yet
account for more than 55% of COVID-19 cases in the state,10 with the Navajo Nation reporting 3,912 confirmed
cases and 140 deaths (as of 5/21/20). To address the treatment needs of people with substance use disorders,
especially opioid use disorder (OUD), during the COVID-19 emergency, federal regulations guiding addiction
services delivery have been modified, including within AI/AN communities. Changes include expansion
of telemedicine and virtual behavioral health delivery, adjusting medication dosing strategies for OUD, and
altering reimbursement and confidentiality policies and practices for addiction services. Although these policy
shifts were to promote availability and access, little is known about the adoption, implementation, and
effectiveness of these changes among programs serving AI/AN communities. Data is critically needed to inform
policy decisions following the COVID-19 emergency – that is, should policies be further developed and
expanded or, alternatively, rolled back. In order to ensure future policies decisions about addiction service
include experiences and needs of AI/AN communities, rapid research on the dissemination, adoption, and
implementation of federal addiction policies among AI/AN-serving addiction treatment programs is of vital
importance. The goal of this study is to rapidly investigate the dissemination, adoption, implementation, and
sustainment of substance use and COVID-19 related policy changes among Tribal communities.
The specific aims are to assess the dissemination, adoption, and implementation of COVID-
19 policy and regulations at Tribal, State, and Federal levels by including quantitative questions to the
CTN0096-1a National Tribal Addiction Survey (n=300) and examine the implementation and outcomes of
COVID-19 policy and regulation changes at the Tribal, State, and Federal levels through qualitative interviews
conducted among providers and consumers (n=50).