The Indian Health Service has made significant improvements to quality care for American Indians and Alaska Natives.  The IHS aims to implement and sustain an effective quality program that improves patient experience and outcomes; strengthens organizational capacity; and ensures the delivery of reliable, high quality health care. Earlier this year, the IHS released a five year (2019-2023) Strategic Plan.  This was a major step in establishing a culture of accountability and sustaining a quality program within the agency.

IHS is committed to an effective credentialing and privileging program that ensures we are hiring qualified clinicians.  Some of the recent changes we have made include establishing for the first time an agency-wide Office of Quality.   In order to provide oversight and support of credentialing and privileging across the agency, these functions are now under the new office. Other important improvements we have made to credentialing and privileging practices at the IHS include implementing an enterprise-wide deployment of an electronic credentialing software system in 2018, and for the first time hiring an IHS credentialing program manager.

At the IHS, we are taking the steps to ensure that our system is composed of robust processes that will deliver high quality care.

Comment from Gonzaga University president Thayne McCulloh:

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Here are some of the comments shared with Native America Calling in the lead up to the Standing Rock recollection show:

Katrina Silk j(Standing Rock Sioux) is an activist who said she was called to go to the camps with her children. She says it was a way to connect with what she feels is her true purpose.

Layha Spoonhunter (Northern Arapaho, Eastern Shoshone and Oglala Lakota) is a youth consultant and motivational speaker.

Jody Notah (Navajo) is a youth empowerment specialist at a homeless shelter. She said she went for a short visit at the end of October last year.

Julie Richards (Oglala Lakota), founder of Mothers Against Meth Alliance, talks about why she chose to lock herself to a piece of construction equipment.

Native America Calling reached out to the companies named in the Cherokee Nation lawsuit. None agreed to come on the show. Two sent written statements.

CVS Pharmacy:

CVS Health is committed to the highest standards of ethics and business practices, including complying with all federal and state laws governing the dispensing of controlled substance prescriptions, and is dedicated to reducing prescription drug abuse and diversion.

We also have stringent policies, procedures and tools to ensure that our pharmacists properly exercise their corresponding responsibility to determine whether a controlled substance prescription was issued for a legitimate medical purpose before filling it.

Our commitment to preventing prescription drug abuse also extends to our patient and youth education efforts, an industry-leading program to increase access to the overdose-reversal medication, naloxone, and a drug collection unit donation program to local police departments nationwide.

Cardinal Health:

Cardinal Health is committed to helping solve the opioid crisis. Our role is to help ensure consumers have access to the medications they need, while also working to prevent prescription drug diversion to the best of our ability based on our position in the complex drug supply chain. To do that, Cardinal Health operates a state-of-the-art, constantly adaptive, rigorous system to combat opioid diversion and funds prevention education programming in communities throughout the country.

Cardinal Health is confident that the facts and the law are on our side, and we intend to vigorously defend ourselves against the plaintiff’s mischaracterization of those facts and misunderstanding of the law. We believe these lawsuits do not advance the hard work needed to solve the opioid abuse crisis – an epidemic driven by addiction, demand and the diversion of medications for illegitimate use.

Cardinal Health recognizes its role alongside regulators, manufacturers, health care providers, pharmacists and patients in this serious and complex challenge. In that role, as a distributor, Cardinal Health purchases medications from pharmaceutical manufacturers and then ships those medications only to licensed pharmacies, clinics and hospitals regulated by the United States Drug Enforcement Administration and state regulators. Cardinal Health does not prescribe any medications nor does it dispense medications to members of the public.

The people of Cardinal Health understand the suffering across the county and continue to invest in and operate important initiatives to improve education and prevent diversion. We’ve developed and implemented advanced, state-of-the-art analytics, technology and on-the-ground deployment of investigators to evaluate pharmacies, scrutinize shipments and not only identify and report but also block delivery of suspicious orders. We continuously improve our processes to keep pace with those seeking to divert pain medications from appropriate uses while remaining committed to our critical role in ensuring patients get the medications they need.

Along with our education partners, we also created Generation Rx, an innovative national prescription drug initiative that includes employees as ambassadors and local pharmacists working together – for more than eight years – to prevent further opioid abuse.

We view the responsibility to continue preventing diversion and increasing knowledge and awareness as core to our business.

Indian Health Service:

IHS recognizes the opioid epidemic as one of the nation’s top public health priorities and we have a robust strategy to address this in Indian Country.

In March 2017, the IHS elevated its Prescription Drug Abuse workgroup, established in 2012, to the IHS National Committee on Heroin, Opioid, and Pain Efforts (HOPE Committee) through an official charter. The committee is tasked with promoting safe and effective pain management, reducing pain medication misuse and overdose deaths, and improving access to culturally appropriate treatment.

The HOPE Committee is comprised of multidisciplinary members with professional backgrounds in pharmacy, medicine, nursing, and behavioral health. The HOPE Committee will work from a framework based on six elements: 1) Establishing IHS policies; 2) Training Health Care Providers; 3) Ensuring Effective Pain Management; 4) Increasing Access to Naloxone; 5) Expanding access to Medication Assisted Treatment (MAT); and 6) Reducing the inappropriate use of methadone for pain management. Read more about this new committee in a recent letter sent to Tribal leaders and Urban leaders on the efforts of IHS to combat the opioid epidemic facing American Indian and Alaska Native communities.

The Indian Health Service policy on “Chronic Non-Cancer Pain” outlines prescribing guidelines for IHS prescribers. The policy is currently under revision to align with the Centers for Disease Control and Prevention’s “Guideline for Prescribing Opioids for Chronic Pain.”

IHS requires healthcare providers working in IHS federal-government-operated facilities, including doctors, pharmacists, nurse practitioners and other providers who prescribe opioids, to check state Prescription Drug Monitoring Program (PDMP) databases prior to prescribing and dispensing opioids for pain treatment longer than seven days and periodically throughout chronic pain treatment —one of the first such actions by any federal agency involved in direct medical care.

Checking a PDMP before prescribing helps to improve appropriate pain management care, identify patients who may have an opioid abuse problem and prevent diversion of drugs. PDMPs are state-based, electronic databases that collect data on controlled medications dispensed by registered pharmacies operating within the state.

These two policies formalize the IHS practice of ensuring safe and appropriate opioid prescribing practices for more than 1,200 IHS prescribers.

‎IHS also focuses its efforts to combat prescription drug misuse in American Indian and Alaska Native communities by requiring prescribers to take mandatory training on proper opioid prescribing to provide quality care to American Indian and Alaska Native patients. To date, IHS has trained 96% of its workforce. Prescribers are required to take refresher training every three years.

Another component of our opioid work is increasing access to naloxone, an opioid overdose reversal drug, through co-prescribing and ensuring first responders have the life-saving medication. An announcement in December 2015, took the first step for IHS to train and equip hundreds of BIA law enforcement officers with naloxone. Co-prescribing ensures those at greater risk for opioid overdose have access to naloxone.

These actions will build on the National Pain Strategy and the five specific strategies HHS has prioritized to combat the ongoing opioid crisis: strengthening public health surveillance, advancing the practice of pain management, improving access to treatment and recovery services, targeting availability and distribution of overdose-reversing drugs, and supporting cutting-edge research.

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Jim Northrup (Photo: Ivy Vainio)