For many living on the Passamaquoddy Pleasant Point Reservation, Maine’s opioid epidemic has been especially unrelenting. It has torn apart families and added yet another layer of trauma for members of the Wabanaki community.
“You talk about an epidemic. You can take an epidemic times ten and that’s the reservation, because we are so small and so close and so affected by it,” Denise Altvater, director of the American Friends Service Committee’s Wabanaki Program and a tribal council member, recently told Beacon.
The reservation is located on the northern coast of Washington County, just south of the Canadian border, where it reaches into the Passamaquoddy Bay as one of the easternmost points of the U.S. With roughly 700 people living there, the community is extremely tight-knit and also isolated from the rest of the state — and with limited and often underfunded health care options, the community’s health is deeply interwoven and dependent on the decisions of a few providers.
“Here in our community, it’s really small,” Altvater said. “Most people, none of them have health insurance, and they have nowhere to go but the health center. They don’t have the freedom of searching for doctors the way other people do.”
Twenty years ago, when oxycontin first came out, Altvater said, the clinic dispensed it regularly to whoever had pain, leading to widespread substance use and addiction. This included her daughter, who was 15 when she “was given oxycontin for a sprain in her neck,” leading her to develop a lifetime opioid use disorder.
“We had a lot of people who we shockingly saw become addicted and it didn’t make any sense,” Altvater said. “Some of these people were spiritual leaders and elders… many people have died.”
From bad to worse
A few years ago, a nurse practitioner working at the clinic decided to “cut our people off of pain medication cold turkey,” according to Altvater, which caused many to go into dangerous withdrawal and forced others to “go to the streets” because “they couldn’t deal with the pain without pain medication.”
“After they cut everybody off of [oxycontin] or hydrocodone, all the heroin started showing up in the community,” she said. “A lot of people were dying because of the heroin — not because of opioids — because they got cut off.”
In just three months, she said, there were three overdoses and one suicide. “It’s been the most horrible, horrible thing to have to watch.”
Last October, Altvater won a position on the tribal government, which she was motivated to join because of what she saw as its failure to address the crisis or introduce medically-assisted treatment to the reservation.
“For us, we have no services. We have no treatment. We have no place to go or to send people to withdraw,” she said.
Layers of trauma
The Wabanaki people are no strangers to hardship. The trauma foisted onto tribal communities has been “layered, generation after generation,” explained Maria Girouard, the current executive director of Maine Wabanaki-REACH, who also serves as the organization’s coordinator of Health, Wellness and Self-Determination.
Girouard, 53, who is Penobscot and spent most of her life on Indian Island Reservation, said there is a through-line that connects the brutal history of colonization, the forced removal of native children from their community, and local racism to the high levels of alcoholism and substance use seen today.
“The trauma has never ceased, it’s never let up,” she explained. “The colonizers brought this trauma with them across the ocean and Wabanaki people have had to deal with an exorbitant amount of trauma throughout their existence.”
This “intergenerational trauma,” she said, “generates responses such as depression, low self esteem, and shame because of the racism that is projected at the tribe. It causes a lot of anger and the way to cope with these feelings unfortunately, oftentimes, is through the use of substances.”
The organization she leads, Maine Wabanaki-REACH, focuses on building resilience within the community, which includes acknowledging this legacy of trauma and finding solutions within the culture, like restorative circles, to promote healing.
“I don’t know anybody who wouldn’t have a story to tell about feeling the racism, feeling the shame, and kind of retreating, isolating, finding a way to feel better,” Girouard said.
“To understand how to move forward, we must first talk about what happened and so I think that’s a very important starting point.”
Children once again taken away
Native children being forced into government boarding schools and non-Native foster homes is one of the more devastating episodes in Wabanaki history. Now, tribal members say they are seeing a reoccurrence of children being taken away as a result of the opioid crisis.
“More families are having children removed from the community than ever before,” said Altvater.
According to the Maine Department of Health and Human Services, there were 450 Native American children placed in foster care between 2000 and 2012, amounting to four percent of all relocated children in the state. According to U.S. Census data from 2018, people identifying as American Indian or Alaskan Native made up 0.7 percent of Maine’s population.
At 59, Altvater spent her entire life at Pleasant Point, except for four years during her childhood when she and her five sisters were taken from her parents by state workers. Forced to live in a foster home in Old Town, she said she suffered “horrendous trauma,” including being starved and sexually abused.
Because of her experience, Altvater is one of the leaders behind the landmark Maine Wabanaki-State Child Welfare Truth and Reconciliation Commission, which found that in the years between 2002 and 2015, when the commission’s report was released, Native children were over five times more likely to be put into foster care than other children.
“Everyone thinks they know what’s best for the child, but there’s so much more we can do for families,” she said. “But they don’t focus on that. We need to change the way we deal with families and we need to stop taking children away. We need to help them.”
Kenney Miller, executive director of the Maine Health Equity Alliance, said that “our culture has conflated substance use with abuse and neglect to the point where we’re seeing more and more children being removed from their households,” which he added is “not reflective of the reality of substance use.”
Removing children from their homes can have numerous and serious adverse effects. For the parents who are using substances, the threat of having their children taken away can even prevent them from seeking treatment, according to Miller.
If a child is taken away, he said, the state is “taking away one of the big reasons [the parents] have to recover for. They spiral into hopelessness. If you are feeling already that life is beating you down, this is just one more reason and one more stresser to try to escape from.”
Miller also points to the impact of Adverse Childhood Experiences, or ACEs, which research has found to be a significant risk factor for future substance use disorder.
“If we are saying that being seperated from family, being in foster care, is more conducive to a child using drugs in the long term, then we are really compounding the problem,” Miller explained.
A lifeline in Washington County
Washington County, which is home to both Pleasant Point and Indian Township reservations, in 2016 had the highest rate of overdose deaths in the state – though that number has declined in recent years.
Unlike the reservation, Washington County has treatment options. However, a lack of information, transportation, and other barriers are preventing people from accessing help.
“We have a number of treatment modalities going from Danforth to Harrington,” explained Rep. Anne Perry (D-Calais), who said the region has several health centers providing suboxone, a methadone clinic, and an abstinence clinic. But, “nobody knows where they are, nobody has any resources,” she said, pointing out that it can take more than three hours to get from one end of the rural region to the other.
“This is not going to work,” she said. “You gotta bring people to treatment.”
To do so, Perry, who is also a nurse practitioner, has introduced legislation, LD 1005, which would create a pilot project to provide residents with treatment and support at the moment they need it. This includes a 24-hour hotline with qualified staff who can provide the initial ”soft touch” if someone calls looking for help, recovery coaches who will work with the person until the can access treatment, and flexible “recovery funding” to help with barriers, like transportation or housing.
This program and its resources, she said, would be available to everyone, including those living on the reservations.
Altvater and some others tried a similar approach last year. They posted their phone numbers to Facebook and encouraged people in crisis to call night or day.
In her experience, many on the reservation are wary of calling first responders because police often come to a home and seize children or search for drugs. If this program is going to be successful, Altvater said, “it needs to treat people with respect and love.”
“I truly believe that if we start a movement – where we start from the top and we say that we care about you, that we love you, that we want to help you, that we don’t want to hurt you, we don’t want to stop you from getting a job, from getting a place to live – then maybe we can start to make a difference,” Altvater said, “and these people don’t have to hide underground like they are lepers.”
Girouard agrees that the solution to the crisis “is not only going to be something we find in our heads, but in our hearts.”
“We need to be compassionate in understanding other people and the plight of their lives,” she said. “It’s going to take a whole bunch of people working together and a whole lot of understanding.”
(Top Photo: Denise Altvater outside her home on Passamaquoddy Pleasant Point Reservation by Andrew Clark for Beacon)
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