SAULT STE. MARIE, Mich. (CIRCA) — Of Aaron Payment's 16 siblings, almost all have battled addiction.
“I have a sister right now that's in jail. She's in her early 40s. She's been in jail 70 percent of her adult life because of her addiction," Payment said.
"My other brother is living on the street right now, and my brother died in January, and so it goes.”
Payment is chairperson of the Sault Ste. Marie Tribe of Chippewa Indians. He said addiction issues in Indian Country have always been a problem, but as the substance of choice has evolved, the problem is getting worse.
“We have not seen anything like this. We’ve dealt with alcohol addiction since alcohol was introduced to us," Payment said. “This is that times 1,000 times.”
The rate of fatal drug overdoses in the Native American community increased by more than 500 percent between 1999 and 2015, the highest increase rate of any demographic during that time, according to the Centers for Disease Control.
Experts have long discussed whether the reason for this persistent problem is more genetic or environmental, but what it seems to come down to for Native Americans is the historical trauma of being forced out of their culture and identity for years.
For example, many aspects of Native American religions were banned in the United States until 1978 when the American Indian Religious Freedom Act was passed.
“One of the root causes of suffering for our people is that we didn't have the ability to know or engage in our culture and our ceremonies that we had historically lived on," said Nichole Causley, the Sault's Tribal Action Plan Coordinator.
When Causley was younger, her parents battled alcoholism, and she was removed from her home and placed in foster care for three years.
"When we talk about alcoholism, we're talking about small-family and community dysfunction. Now, moving forward to today, the opioid addiction, that, it just kills people," Causley said.
As for who is responsible for the deadly shift, Payment said he largely blames the pharmaceutical companies for the rise in the number of opioids in the community.
“The physician practices coupled with the pharmaceuticals preying on that have promoted the use of prescription drugs that then became common in people's households," Payment said.
So he said the Sault have joined a growing list of tribes exploring filing suit against the opioid manufacturers.
But in order to move the community into a phase of recovery, it is going to take resources, something for which the Native American community is already fighting.
The United States government is legally obligated to provide health services to all members of federally recognized tribes. These health services are provided by the Indian Health Service (IHS), a division of the U.S. Health Department.
“We don't receive what we receive because of reparations. We receive the funding we get and judicial precedence because of the treaties, and the treaties were signed consistent with the United States Constitution, so they're legal tender," Payment said. "The federal government is fulfilling that obligation, but they're only scratching the surface.”
The Sault Tribe has four health centers serving 16,000 members, but the director of the tribe's health division said they receive only about 40 percent of the funding that is needed.
The underfunding experienced locally by the Sault represents a national and systemic problem throughout Indian Country.
A report published in 1928 found a lack of funding resulted in inadequate health services for Native Americans. The number of doctors and other medical professionals working with the community was also insufficient.
The health of Native Americans was designated as "bad" compared to the rest of the country at the time.
Since then, report after report has been published by the Government Accountability Office and the Health Department's Office of Inspector General and generally finds the same issues within IHS: underfunding, underemployment, limited services and outdated equipment.
Some reports even found issues with policies, or no policies, regarding opioid prescribing and pain management.
“It's not surprising to me that there's an overdose, overuse rather, of painkillers on Indian reservations because that the quality of medical care that's offered is so far below what is necessary and needed. And part of what should have been good medical care is often pawned off by saying here's some pain killers," said former Senator Byron Dorgan, D-N.D.
Dorgan also published a report about IHS in 2010 when he was chairman of the Committee on Indian Affairs.
"The Indian Health Service seems impervious to improvement. We did an investigation on my watch of part of the Indian Health Service, and it showed a massive amount of difficulty. It showed some theft. It showed favoritism, hiring of relatives. It showed sexual assaults. It showed the stealing of some pharmaceuticals at IHS hospitals," Dorgan said.
But the Native American community does have hope that things could change.
“The Native American voice as a whole is better today than it was when we first got up here, and it’s because Indian Country as a whole is investing in it," said Rep. Markwayne Mullin, R-Okla.
Mullin is one of very few Native Americans in Congress. Last year, he became the co-chair of the Indian Health Service Task Force.
“We decided we would focus on three things, and the first one obviously being funding, and a second one being standard operating procedures, and the third one bringing up the technology," Mullin said.
To help solve IHS' underemployment issue, Mullin said he thinks recruiting should start early on reservations, with representatives going into middle and high schools to talk to students.
"Kind of like the (U.S. Department of Veterans Affairs) is growing their own, we have to grow our own," he said.
Congress has also appropriated more than $50 million to specifically address the drug crisis in Indian Country, and Payment said more is expected in the next budget, though it is still not enough.
In the meantime, the Sault Tribe is going to do what it can to fight the epidemic on its own, and one way it is doing that is through the Tribal Action Plan.
The plan attempts to battle the crisis on several fronts, including prevention methods and the court system, but also treatment.
"If we're going to heal people, then we can't wait for federal dollars for treatment services, so we're in the planning stages of building our own treatment facility," Payment said.
Also part of the plan: a focus on tradition.
“The solutions to our challenges is to bring our culture back, and to pray for that direction, and to listen to our ancestors, and to fulfill our duty and responsibility for our future generations," Payment said.