We already have all that we need: exercising the right to self-determination to safeguard tribal public health in the age of opioids.

Make no mistake about it: The fentanyl crisis is a flood of poison entering Indian Country and communities, and it is not a crisis that our tribes can face alon

– Remarks of Senator Maria Cantwell, Member of the United States Senate Committee Indian Affairs, at the Oversight Hearing titled “Fentanyl in Native Communities: Federal Perspectives on Addressing the Growing Crisis” on December 6, 2023.

The opioid crisis has devastated Native America, which experienced the highest rate of opioid overdose mortality of any racial or ethnic group in 2021. According to Evelyn Jefferson, a member of the Lummi Nation and her nation’s crisis outreach supervisor. “Fentanyl has really taken a generation from this tribe.” But will supply-side approaches work? This article seeks to challenge the presumption that investments in external solutions: more law enforcement to police Indian reservations, and tighter border security, will solve the crisis in Native America. The overemphasis on security and law enforcement obscures the impact of settler colonial power dynamics which contribute to disease in tribal communities. Indian Nations have been hobbled by the imposition of settler colonial law and policy, which stifles local action and forces top-down approaches. Instead of investing in external solutions to solve the crisis for “our tribes,” state and federal policymakers should examine how their laws and policies limit tribal sovereignty, block local solutions, and, ultimately, drive mortality and morbidity in tribal communities.

This article begins by orienting readers to the legislative and regulatory authority retained by federally recognized Indian Nations and examines how policies of the State of Wisconsin and the federal government have interfered with tribal authority to regulate healthcare, specifically concerning the critical medications naloxone and methadone. In the opioid crisis, settler colonial governments have limited the lifesaving potential of downstream and upstream strategies to solving the opioid crisis; access to naloxone and overdose reversal support to interrupt overdoses in progress, and methadone for treatment of opioid use disorder to prevent overdoses altogether. Instead of waiting for reforms to materialize at the state and federal levels, this article concludes by encouraging Indian Nations to exercise their inherent rights of self-governance to implement effective solutions.