In 2012, the IHS National Prescription Drug Workgroup began focusing its attention on the ongoing threat posed by the opioid epidemic. The Workgroup was tasked with promoting appropriate and effective pain management, reducing prescription pain medication misuse and overdose deaths, focusing efforts on pregnant women with opioid use disorder, and improving access to culturally appropriate treatment.
From that platform, IHS established the multidisciplinary IHS National Committee on Heroin, Opioid, and Pain Efforts (HOPE Committee) in March. The committee will address 6 elements: establishing policies, training health care providers, ensuring effective pain management, increasing access to naloxone, expanding medication-assisted treatment, and reducing the inappropriate use of methadone. Among other things, that has meant updating the Indian Health Manual chapter on chronic non-cancer pain to align with the CDC Guideline for Prescribing Opioids for Chronic Pain .
The IHS also also instituted a mandatory no-cost training course, “IHS Essential Training on Pain and Addiction,” and to date has trained 96% of providers required to attend, including many tribal and urban Indian providers.
Since December 2015, when IHS signed a memorandum of agreement with the Bureau of Indian Affairs to increase access to naloxone, 284 BIA law enforcement officers have been trained and provided with emergency naloxone kits.
IHS is also “actively working” to reduce the use of methadone for pain management, which is associated with a high number of overdose deaths, compared with other opioid pain relievers. IHS policy states that methadone should not be used as a first-line pain management therapy. In an ongoing partnership with the University of New Mexico Pain Center, IHS also offers IHS, tribal, and urban Indian providers weekly real-time consultation with pain-management experts and additional web-based educational services. To help providers provide effective and optimal pain management, IHS maintains 2 websites: on Pain Management ( https://www.ihs.gov/painmanagement) and Opioid Use Disorder management ( https://www.ihs.gov/odm).