Harold Plaster had been awake for nine days when he noticed his face in the mirror. It was January 2017, and he was on his latest heroin binge inside a red house on the Lummi Reservation in north-western Washington state. The windows were covered in garbage bags and there were rats scurrying around.
As he looked at himself, dangerously thin, he said he began thinking about his six children, all either adults or in foster care, and about his mother, whom he had promised his late father he would look after.
“I seen myself in the mirror, and I was like, ‘What the fuck are you doing Harold?’” he told the Guardian.
He called Rosalie Scott, the director of Lummi Chemical Addiction Recovery and Education (Care), the outpatient drug and alcohol treatment and education program leading the way on addiction response on the reservation.
“I don’t want to die,” he told her.
Plaster had already attempted treatment more than a dozen times, but Scott didn’t hesitate. She directed him to stay put, Plaster recalled, and then added: “I’ve been praying and waiting for you to come here, Harold.”
Five minutes later, another member of the Care team was outside the house. Plaster quickly collected his only belongings – backpack, blanket and clothes – and was driven to a nearby detox center.
This past January, the 52-year-old ushered in five years of sobriety alongside his two youngest children, ages 12 and 15, and his new wife, in the house he grew up in, and with his mother in a nearby rest home.
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The Lummi Nation, a community of more than 5,500 people located on a small slice of land on the US west coast extending into the Salish Sea, has faced addiction issues on the reservation for decades. It has affected everything from crime to housing, families and foster care. And for over half a century, tribal leaders have been working to rid the reservation of drug abuse, explained Deanna Point, Scott’s interim director at Care.
“We just start getting our hands on one [drug], and then right after that, once we think we’re just finally getting our hands and getting some kind of relief from this drug that’s in our community, a new one comes,” she said.
In the last several years the situation has become particularly acute, due to the prevalence of highly addictive methamphetamine and then, most recently, lethal pure fentanyl, or some combination of the two.
The estimated number of drug overdose deaths in the US during a 12-month period ending in April 2021 rose by 28.5% compared with the same period the year before, according to the Centers for Disease Control and Prevention. Overdose deaths caused by opioids, as well as synthetic opioids – primarily fentanyl – and psychostimulants including methamphetamine, drove the increase.
While methamphetamine is highly addictive and can cause strokes and psychotic episodes, fentanyl can be lethal at just 2mg.
In recent years, there has been an increase in seizures of both drugs across the country’s southern border, while at the same time they have become more widely available and cheaper, according to Dr Nora Volkow, director of the National Institute on Drug Abuse.
On the Lummi reservation, Point described fentanyl as “the worst one that we’ve seen yet” due to how deadly it is. When it is combined with methamphetamine the risk of an overdose can be even greater.
She explained that the tribe initially struggled to identify what was causing community members to appear intoxicated because fentanyl wasn’t showing up on the drug test they were using.
“After we kind of put two and two together, we started testing for fentanyl. And everybody just started testing positive left and right,” she said.
At the same time, the Covid-19 pandemic has heightened stress and anxiety for tribal members as they’ve been cut off from their support networks and their cultural and sporting events are put on hold. The result for the Lummi Nation has been one of the highest number of drug relapses, according to Lummi Nation chairman William Jones Jr.
As of February, Care had 342 active clients, but 39 of those in its medication-assisted treatment program hadn’t been in for more than 14 days, a sign that they may have relapsed, according to Rene Ramirez, a program sponsor for the opiate treatment program.
Drug abuse is of course not distinct to this community. A study published in September in the journal Jama Psychiatry found that between 2015 and 2019, the number of overdose deaths associated with methamphetamine in the US increased by 180% to 15,489. When broken down by ethnicity, the report found that Native Americans and Alaska Natives had the highest rate of methamphetamine use disorder.
These high numbers within the Indigenous community can be linked to historical trauma in the form of community massacres, forceful relocation and boarding schools, explained Dr Tommy K Begay, research assistant professor at the University of Arizona’s department of psychiatry and a member of the Navajo Nation. The trauma, he explained, resulted in maladaptive coping behaviors that sometimes include drug use, which were passed on to new generations.
“This is not just unique to Native people,” said Begay. “You put any human being through circumstances that some individuals were placed under, we would see the same relationships.”
Yet the problem of drug abuse among Native people has been neglected, said Volkow.
She explained that treatment and prevention needs to be prioritized and that the response should involve culturally appropriate treatment, as well as prevention that looks to the systemic issues at play.
“Prevention will require that we actually provide support, social, economical and educational, so that you give them quality services,” she said. “The same thing pertains to healthcare, that you have to provide quality services that will help buffer and overcome the years of disparities.”
Today, the Lummi Nation uses a combination of culturally based healing and western-based substance abuse treatment approaches, all centered on love and compassion.
The outpatient treatment program, Care, is housed in a small, one-story cream building. It offers group sessions that range from one hour a week to nine, medication-assisted treatment plans, and specialized programs for those who are pregnant or have children.
Group sessions typically include clients sharing a meal together, an important component of the Lummi Nation’s cultural identity, explained Point. There is also a culture room inside the facility, where clients often spend hours beading, cedar weaving and carving.
“What makes our program unique is we focus a lot on our tradition and cultural values. And some people come in, they might have roots to their cultural identity, but most of them aren’t going to have roots to who they are,” she said.
The tribe also connects those suffering from addiction to a wide array of programs throughout the reservation and beyond, allowing them to seamlessly access such things as detox centers, housing, parenting classes and employment training.
But when the main treatment approaches don’t take, the tribe turns to measures such as banishment and withholding fishing licenses when someone doesn’t produce a clean drug test.
Jones explained that recently, the tribe made the decision to allow homes of repeat offenders to be turned over to the Lummi Tribe until the person goes through treatment.
It’s “just a new tool that we’re trying to use in Lummi here to help combat the drug use and the drug dealers from moving into our community”, he said. “They find someplace, they come and they move in. And they really take over a family or a home.”
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One house on the reservation has seen decades of tribal members work their way to recovery. Known as the Raven Home, it was a donation from a doctor in Bellingham and in the 1990s was transformed into a temporary home for those healing from chemical addiction, explained Scott.
With three bedrooms, community members who may not qualify for US Housing and Urban Development housing, which comes with a lot of requirements, have been able to make use of this safe and extremely affordable space.
“For our homes, that’s what we’re trying to do is to knock out all that red tape because everybody deserves a second chance,” said Point.
Point knows better than most just how vital Raven Home can be. In 2010, while healing from drug addiction, she lived there with her four children.
“The Raven Home was where I learned how to be independent and to be a mom,” she said. “The support that I got from Lummi counseling here really inspired me into this field today.”
The tribe is now working to add a second house, called the Salmon Home, as well as a detox center, so they no longer always have to refer community members to treatment centers off reservation, which are often full.
Tribal leaders have also instituted programs to try to deter drug and alcohol abuse, including canoe clubs. Groups of young people are taken through physical training as well as cultural teachings as part of the clubs, and devote hours every week preparing for races.
Akesha Martin, 30, who started paddling at one such club when she was 10 years old, said the feeling of belonging stuck with her.
“I think just being able to be a part of that, and being able to be a part of that family, is what really kept me grounded and able to just continue on with my life. And not ever have to experience drugs or the alcohol addiction that my family had to experience,” she said.
For Plaster, whose recovery process extended far past group sessions and into parenting classes, anger management and even his driver’s license tickets being paid off, the tribe’s programs completely changed his life.
“They really wanted to help me. They really wanted me to stay clean. They wanted me to be a better person,” he said. “And that’s how they made me feel.”
