People with substance use disorders face enormous internal and external challenges on the journey to recovery. Harm reductions services aim to keep people safe while using drugs as well as helping them eventually reach recovery. Cultural and community background plays an important, but often overlooked, role in these services.
“It's an ugly beast that causes not only physical harm, emotional harm, mental harm,” said Michelle Chapoose, a coordinator for the Tribal Opioid Resource Center. “And most people, if you ask them, do they want to find sobriety or do they want to keep on using, most people will say they don't want to keep on using, but substance use is so misunderstood.”
Chapoose works to provide information and services to tribal members dealing with opioid use. That includes educating communities on opioids and harm reduction, as well as providing Naloxone and Narcan kits.
“When you start to reduce the harm of somebody's behavior, you're not condoning it,” Chapoose said. “You're not perpetuating it. You're making sure that that person is safe or when the time comes, that when they are ready to get the help that they need, they are able to get that help.”
Harm reduction isn’t one size fits all, it’s about meeting someone where they’re at, Chapoose said. That also means understanding and working with cultural identity and background.
“I think a lot of the barriers that we're looking at when we look at harm reduction is the connection. Cultures have to connect to that information ‘cause usually when there's an ad or a presentation, you know, there's a cookie cutter type visual identity of whoever they're putting into that,” Chapoose said. “And I know sometimes when an individual culturally can't connect with, ‘Oh, yeah, this is something that's for me, this is something that's for my area,’ then there's a level of disengagement that occurs.”
So if someone is taking on the enormous challenge of getting help related to their substance use, it can be discouraging if a provider doesn’t understand or validate their culture.
“I think those are some key challenges that our tribal communities have at this point," Chapoose said. "It's like how do I explain that I smudge or pray in the morning to somebody who doesn't know what that's like? How do I explain that we participate in things like the bear dance and why this is such an important cultural event to somebody who doesn't know that?”
Lizette Villegas is a local activist within the Logan Latino community, and she said that cultural disconnect can lead to greater distrust of healthcare providers.
“It’s really hard for the Latino community to find an agency that they trust to be able to help them walk them through the process. Um, I’ve seen that a lot of the agencies don't have information in Spanish,” Villegas said. “There’s not a lot of bicultural employees and with the Latino community, you really need that. You really need that bicultural experience because it's a world of difference.”
Villegas has also observed that there’s a lot of stigma around substance use in the Latino community. She said that creates an even greater barrier for people to get help. That means that providers need to know how to reach out and help educate their patients sensitively.
“Unfortunately, that's where most of the problems that occur [are] because with opioid overdoses and addiction, it's really hard to do it by yourself," Villegas said. "You really need those resources to help you walk through the process.”
Narciso Delgadillo was prescribed Klonopin to manage his intense anxiety thirteen years ago. He’s had bilingual providers before and isn’t sure it made a difference, but he is frustrated by his doctor’s lack of support as he struggles with substance use. His doctor didn’t offer any education or suggestions on harm reduction services that could help him. When he asked his doctor for alternatives, especially a medicine his doctor in Mexico recommended, his doctor told him it wasn’t an option.
“He believes that some doctors don't care about the health of the patients,” said Narciso’s wife, Claudia, translating for him. “They just care about what they do, only the profit that they can make from them. And they don't take the time to make sure that everything is going well. They just want the money.”
Villegas said providers need to be in the communities they are serving and really invest in making harm reduction services accessible to everyone. Otherwise families like the Delgadillos struggle alone without support.
“Make it easy, simple, and make it cultural, make it relatable,” Villegas said. “Without visibility, it's all swept under the rug. Education, education education is going to be the key with our Latino community.”