June 11, 2019

The Indian Health Service (IHS) has demonstrated a commitment to increase access to culturally appropriate prevention, treatment, and recovery support services for Opioid Use Disorder (OUD). Key components of these approaches include enhanced screening and early identification of Opioid Use Disorders; improved care coordination and patient referral for treatment; and workforce development strategies to increase education and resources surrounding the use of medications in the support of recovery.

The purpose of this Special General Memorandum (SGM) is to announce that:

1. All IHS federal facilities will identify local Opioid Treatment Programs or Office-Based Opioid Treatment models, in their responsible Area, in order to improve access to Medication Assisted Treatment (MAT) for patients with an OUD diagnosis; and
2. All IHS federal facilities will create an action plan to identify local MAT resources and to provide and/or coordinate patient access to these services when indicated.

Opioid Use Disorder is a chronic disease and evidence demonstrates that treatment is effective and that recovery is possible. American Indians and Alaska Natives are disproportionately impacted by the opioid epidemic. The Centers for Disease Control and Prevention (CDC) data indicates that American Indians and Alaska Natives had the highest drug overdose death rates in 2015 (metropolitan: 22.1; nonmetropolitan: 19.8) and the largest percentage change increase in the number of deaths from 1995-2015 (nonmetropolitan: 519%) among racial/ethnic groups in the United States. The MAT is a comprehensive evidence-based approach to recovery that combines pharmacological interventions with substance abuse counseling, social support, and culture. Increasing provider training, education and support surrounding OUD and MAT may create an accepting patient-care environment to improve access and decrease stigma.

I am relying on the full support of all IHS Area Directors and all Area Chief Medical Officers to ensure that all facilities improve access to culturally appropriate treatment for patients with OUD. Each federal facility will create an action plan to provide and/or identify local or telemedicine MAT resources, and will create a plan to coordinate access to these services for all beneficiaries, regardless of a patient’s eligibility for Purchased/Referred Care (PRC) or alternate resources, within six months of the issuance of this SGM. Patient eligibility for PRC services is defined by the Indian Health Manual, Part 2, Chapter 3, Purchased/Referred Care. Action plans shall be in compliance with 42 CFR § 2 and shall implement broad screening protocols that utilize validated tools to assist with the early identification and referral to treatment for OUD, increase the training and capacity of providers to encourage, manage and support patient long-term recovery efforts, increase staff proficiency in managing acute opioid withdrawal, and improve access to naloxone for patients at risk for overdose.

Thank you for your continued support and cooperation in raising the physical, mental, social and spiritual health of American Indians and Alaska Natives to the highest level.

Effective Date

This SGM becomes effective on the date signed.

/Michael D. Weahkee/
RADM Michael D. Weahkee, MBA, MHSA
Assistant Surgeon General, U.S. Public Health Service
Principal Deputy Director
Indian Health Service