Interview with Sheena Kanott Lambert, Eastern Band of Cherokee Indians (EBCI)

For the Eastern Band of Cherokee Indians, opioid prevention and harm reduction efforts flow through many areas of their public health prevention. “We started a Syringe Services Program (SSP) here in 2018, mainly because we had high rates of overdose deaths, and at the time, high rates of Hepatitis C as well. It’s controversial to start an SSP, and as public health professionals we had to persuade the Tribal Council to start one.” Over time, “we were able to hire peer support specialists teach on nasal naloxone; I think it genuinely made a huge difference in our communities over the years.”

Sheena attributed much of their success to their Tribal Health Improvement Plan (THIP), which is based on their Tribal Health Assessment (THA) conducted by Public Health and Human Services (PHHS) at EBCI every five years; one of the three core health areas in the THIP to address is substance abuse. Of the plan, “It’s been really community driven, to create a plan to save lives and reduce overdose deaths, to get people into recovery, and to reduce stigma.” One activity EBCI focused on in the past year was revamping their Cherokee Rally for Recovery, an event to promote the wellness and support of those recovering from substance abuse; “Our goal was to have 100 people and almost 500 people came. We were able to track how many people there were in active recovery, new to recovery, or supporters of those in recovery.” 

“I can’t say enough about the THIP. It’s all these pieces working together, breaking those barriers so people can get help, come forward and make lifestyle changes.”

EBCI launched their new project, public health vending machines, in October of 2023. The vending machine includes hygiene projects, safe sex supplies, nasal naloxone, fentanyl test trips, bug spray for encephalitis, and more. The items in the vending machines are fully funded by grant dollars and are set outside public buildings. The vending machines allow the public health team to access the data on when people use the supply and what time of day. To date, the vending machines have dispensed almost 19,000 products, including 300+ units of naloxone.

“We wanted to increase access, it’s all about access. The community loves them, we have not heard one negative thing about them. People don’t have to sign up for the program, they just type their [Tribal] enrollment number in the machine. Some products have limitations (for example, deodorant is limited to once per week per person), but naloxone and test strips don’t. I think it’s worked incredibly well.”

EBCI began the process of implementing the vending machines by looking up other sites in the country that were using them, then presented the idea to their community council: “we love it, we think that the community could benefit from it, but do you love it or want it?” Thankfully, the council was receptive. “They were so well received that soon we spoke with our community clubs, and they all wanted one.”

“We’re finally starting to see data from our Overdose Mapping and Application Program (ODMAP) that our overdoses are going down drastically. It’s full circle when you see that data, that our efforts are paying off; it’s very powerful and refreshing to see the progress.”

Regarding changes in the community, Sheena expressed, “I feel like there’s been a paradigm shift. Some people have tried to understand [harm reduction] better. For example, with SSP, people thought we were just giving needles out and saturating the community with needles. We had to educate that people have to return needles to get more, that was important; now, our return rate is 95%. We also have large receptacles that we painted red for people to deposit needles. We originally put those out for people who use substances, but now people with diabetes use them too. We’ve educated people on how the receptacles benefit everyone’s health.” 

“Stigma reduction has been a major part. People didn’t really understand how addiction changes the brain; you also have the flip side of families reaping the ramifications of people using substances.”

Overall, EBCI recommends to their peers in this work to “be open minded with strategies to help. Always include culture in what you’re doing, who you are as a person and who you are as a nation.”