The National Indian Health Board (NIHB) is committed to advocating on behalf of all Tribal Governments and American Indian/Alaska Natives while: promoting healthy practices; preventing diseases and injuries; providing basic resources and infrastructure to Tribes; and researching and developing Tribal, local, state, and national health policy. To view all our public health resources, please visit www.nihb.org/public_health/public_health.php. | |
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FDA Approves Over-the-Counter Naloxone to Help Reduce Opioid Overdose Deaths
On March 29, 2023, the U.S. Food and Drug Administration (FDA) approved the first naloxone product for over-the-counter (OTC), non-prescription use: Narcan, 4mg nasal spray. Naloxone is used to reverse opioid overdose and prevent opioid overdose deaths. It is important to note that only Narcan has been approved so far for OTC use; other formulations of naloxone will still require a prescription.
American Indians and Alaska Natives have the highest, age-adjusted drug overdose rates of any population. Opioid overdose deaths, particularly due to fentanyl and fentanyl-laced drugs, have taken destructive tolls on our Tribal communities. Expanding access to products such as Narcan is a welcome addition to Tribal harm reduction and opioid overdose prevention efforts that hold the potential to save Native lives.
To read more about the life-saving potential of Narcan and the FDA’s decision, check out the FDA News Release on Narcan.
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COVID-19 Public Health Emergency to End on May 11, 2023
The U.S. Department of Health and Human Services (HHS) has extended the COVID-19 public health emergency (PHE) for 90 days to May 11, 2023; this is expected to be the final renewal. HHS based this decision on the most recent COVID-19 trends.
What will not be affected:
- Access to COVID-19 vaccines and treatments, such as Paxlovid and Lagevrio.
- Medicaid will continue to cover COVID-19 vaccinations without a co-pay or cost-sharing through September 30, 2024. After that, coverage will vary by state.
- Medicare telehealth flexibilities will not be affected. This is a win for Tribal communities in rural areas or those who struggle to access care.
What will be affected:
- Medicaid Continuous Enrollment Provision. People no longer eligible for Medicaid may lose coverage as early as April.
- Medicare and Medicaid waivers and flexibilities for healthcare providers will end.
- Medicare beneficiaries enrolled in Part B will lose access to free over-the-counter (OTC) COVID-19 tests.
Although HHS is expected to announce the end of the PHE classification for COVID-19 on May 11, COVID-19 infections will not disappear overnight. We must work together to prevent the spread of COVID-19 in our communities and support interventions to keep our people healthy. Consider getting a booster to protect yourself and your loved ones against Omicron variants and to reduce your risk of severe illness, hospitalization, and death.
The National Indian Health Board will continue to monitor the status of major health policies when the public health emergency ends. As new information is provided, we will provide updates.
You can read more about the HHS plan for ending the COVID-19 Public Health Emergency here.
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SAMHSA 2021 National Survey of Drug Use and Health (NSDUH)—Key Findings for Indian Country
The Substance Abuse and Mental Health Services Administration (SAMHSA) has released its 2021 National Survey of Drug Use and Health (NSUDH). NSDUH is an annual survey that provides self-reported, nationally representative data on substance use, treatment, and mental health issues and services among those aged 12 or older.
In 2021, American Indians and Alaska Natives reported the highest use of tobacco products, nicotine vaping, and marijuana. They were more likely to have used illicit drugs in the past year than any other group. They were also more likely to have a diagnosed substance use disorder and mental illness and to need substance use treatment.
Rates of opioid misuse and suicidal thoughts and behaviors were comparable, with no statistically significant differences compared to other groups.
As Tribal communities continue to gather data to provide effective behavioral health services, it is essential to note that the 2021 NSDUH survey results apply only to 2021 and cannot be compared to earlier years.
Click here to read more about the survey’s findings, limitations, and potential implications for Tribal communities.
Click here to read more about NIHB’s ongoing work in substance use and suicide prevention.
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FDA Issues Refuse to Accept Letter for Applications for Approximately 17 million E-Liquid Products
To date, the U.S. Food and Drug Administration (FDA) has made determinations on more than 99% of the nearly 26 million deemed products for which applications were submitted, including authorizing 23 new e-cigarette products and devices, and issuing refuse to accept (RTA) letters, refuse to file letters or marketing denial orders for millions of products. This includes determination on applications for nearly 6.7 million products received by the Sept. 9, 2020, deadline, more than 18 million products received after the Sept. 9 deadline, and applications for almost 1 million non-tobacco nicotine products submitted by May 14, 2022, by the new federal law passed in April 2022. Under a federal court order, manufacturers of new tobacco products on the market as of the deeming rule’s effective date (Aug. 8, 2016) were required to submit premarket review applications by Sept. 9, 2020.
On Feb. 21, 2023, FDA issued an RTA letter to one applicant notifying a company that their Premarket Tobacco Product Applications (PMTAs), associated with approximately 17 million individual tobacco products, do not meet the acceptance requirements outlined in FDA’s regulations. The applications were for a grouped submission of e-liquids in varying sizes, nicotine strengths, and flavor combinations. Each was treated as a product application according to existing premarket review processes.
During the acceptance phase of application review, FDA reviews applications to ensure they meet a minimum threshold for acceptability for FDA scientific review. If the required contents for acceptance are included, the FDA will accept the application. This company was issued an RTA letter because the company’s applications for these products lacked the required Environmental Assessments. The company may submit a new application for these products at any time; however, the products may not be marketed unless the FDA reviews the applications and determines that the marketing of the products is appropriate for the protection of public health.
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Coronavirus (COVID-19) Update: FDA Authorized Bivalent Pfizer-BioNTech COVID-19 Vaccine as Booster Dose for Certain Children Six Months through Four Years of Age
On March 14, 2023, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) of the Pfizer-BioNTech COVID-19 Vaccine, Bivalent for children six months through four years of age. Children who completed their three-dose primary series with the monovalent Pfizer-BioNTech COVID-19 Vaccine more than two months ago are now eligible for the single booster dose of the Pfizer-BioNTech COVID-19 Vaccine, Bivalent. Read more. Vaccination is critical to protecting our community and loved ones from getting the SARS-COV-2 virus. Getting vaccinated is an Act of Love.
Related Information:
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Funding and Opportunities | |
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SAMHSA Funding Opportunities!
The Substance Abuse and Mental Health Services Administration (SAMHSA) has released the following funding opportunities. Tribes and Tribal organizations are eligible and encouraged to apply.
Cooperative Agreements to Implement Zero Suicide in Health Systems (Zero Suicide)
The purpose of this program is to implement the Zero Suicide intervention and prevention model for adults throughout a health system or systems. Recipients will be expected to implement all seven elements of the Zero Suicide framework: Lead, Train, Identify, Engage, Treat, Transition, and Improve; and incorporate principles of health equity within the framework. With this program, SAMHSA aims to reduce suicide ideation, suicide attempts, and deaths due to suicide.
17 anticipated awards, with at least 2 awards made to Tribes/Tribal organizations. Between $400,000-$700,000 total award amount up to 5 years.
Deadline: May 8, 2023
Read more and apply at Zero Suicide
Tribal Behavioral Health (Native Connections)
The purpose of this program is to prevent and reduce suicidal behavior and substance use/misuse, reduce the impact of trauma, and promote mental health among American Indian/Alaska Native (AI/AN) youth, up to and including age 24, by building a healthy network of systems, services, and partnerships that impact youth.
Up to 59 anticipated awards, at $250,000 total award amount up to 5 years.
Deadline: May 15, 2023
Read more and apply at Native Connections
National Strategy for Suicide Prevention (NSSP)
The purpose of this program is to implement suicide prevention and intervention programs for adults (with an emphasis on older adults, adults in rural areas, and American Indian and Alaska Native (AI/AN) adults). This program is intended to address the Surgeon General 2021 Call to Action’s broad-based public health approach to suicide prevention by enhancing collaboration with key community stakeholders (e.g., county health departments, workplace settings, criminal justice settings, senior-serving organizations, community firearm stakeholders), raising awareness of the available resources for suicide prevention, and implementing lethal means safety.
5 anticipated awards, up to $400,000 per year, up to 3 years.
Deadline: May 15, 2023
Read more and apply at NSSP
Minority AIDS Initiative: Substance Use Disorder Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS (MAI: High Risk Populations)
The purpose of this program is to increase engagement in care for racial and ethnic medically underserved individuals with substance use disorders (SUDs) and/or co-occurring SUDs and mental health conditions (COD) who are at risk for or living with HIV. Award recipients will be expected to take a syndemic approach to SUD, HIV, and viral hepatitis by providing SUD treatment to medically underserved racial and ethnic individuals at risk for or living with HIV.
Up to 42 awards with up to 5 for Tribes/Tribal organizations. Up to $500,000 per year for up to 5 years.
Deadline: May 22, 20223
Read more and apply at MAI: High Risk Populations
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New ACF Funding Opportunities Available!
The Administration for Children and Families (ACF) is now soliciting applications for the Fiscal Year 2023 Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Grant Program: Development and Implementation (DIG) and Implementation and Expansion (IEG) Grants!
Funds under both Notices of Funding Opportunity (NOFOs) will support the implementation of high-quality, culturally grounded, evidence-based home visiting services to American Indian and Alaska Native (AIAN) families and children; implementation of performance measurement and continuous quality improvement systems; development of early childhood systems; and participation in research and evaluation activities to build evidence around home visiting, particularly in tribal communities.
Tribal MIECHV Development and Implementation Grants are intended for tribal entities that do not have prior experience with implementing evidence-based home visiting programs and are not currently implementing a program. Applications are due May 1, 2023. More information is available here.
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Tribal Epidemiology Centers Request Access to Epidemiological Data
On March 4, 2023, the Government Accountability Office (GAO) published a report providing recommendations for how the U.S Department of Health and Human Services (HHS) can clarify how public health data will be made available, as required by law, to Tribal Epidemiology Centers (TECs) and create procedures to do so. Among the 12 TECs, public health entities serving American Indian and Alaska Native (AI/AN) communities across the U.S., access to epidemiological data varies. Federal law authorizes TECs' access to data from HHS to monitor the spread of infectious diseases, such as COVID-19, and conduct other analyses supporting public health decision-making in AI/AN communities.
To improve engagement with Tribes and Tribal organizations, the Centers for Disease Control and Prevention (CDC) has launched a new website on Tribal Public Health Data. The website provides information about CDC Tribal health data, issues, tools, technical assistance, training, and Tribal data-related resources. The website includes a CDC Public Health Data set list and a form for Tribal members to request data.
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Local Food Purchase Assistance Cooperative Agreement Plan
The Local Food Purchase Assistance Cooperative Agreement Program (LFPA) uses non-competitive cooperative agreements to provide up to $900 million of American Rescue Plan (ARP) and Commodity Credit Corporation (CCC) funding for state, Tribal, and territorial governments to purchase foods produced within the state or within 400 miles of the delivery destination to help support local, regional and underserved producers. This program aims to maintain and improve food and agricultural supply chain resiliency. The cooperative agreements allow the states, Tribes, and territories to procure and distribute local and regional foods and beverages that are healthy, nutritious, unique to their geographic areas, and meet the population's needs. The food will serve feeding programs, including food banks, schools, and organizations that reach underserved communities. In addition to increasing local food consumption, the funds will help build and expand economic opportunities for local and underserved producers.
The performance period will be up to two years from the time of award to accommodate two harvest seasons.
Learn more about the Large Food Purchase Assistance Cooperative Agreement Plan more here.
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Medicaid Unwinding Toolkit for Tribal Enrollment Assisters
At the onset of the COVID-19 public health emergency, many flexibilities were implemented in the Medicaid program, including continuous enrollees coverage without the normal annual renewal process. Enrollees retained coverage regardless of a change in circumstance that would have otherwise deemed them ineligible for Medicaid coverage. This continuous enrollment requirement ended on March 31, 2023, before the end of the Public Health Emergency. States will soon begin to engage in normal eligibility determination processes. We will see a drop in enrollment as conditions start to disenroll those who no longer qualify for Medicaid. Some states may have already started this process but will need to wait until April 1 to terminate coverage for any individual.
The National Indian Health Board (NIHB), in collaboration with the Indian Health Service (IHS), created the Medicaid Unwinding Toolkit for Tribal Enrollment Assisters to familiarize Tribal health facility staff with this “Medicaid Unwinding” process. Millions of individuals could lose healthcare coverage; American Indians and Alaska Natives (AI/ANs) are no exception. NIHB estimates that as many as 236,000 AI/ANs could lose their coverage due to Medicaid unwinding. Tribally operated healthcare facilities must understand how to prevent as many patients as possible from falling off Medicaid coverage and assist those who need to change healthcare coverage plans due to changes in their circumstances, financially or otherwise. The toolkit provides (1) a summary of Medicaid unwinding guidance, (2) recommendations on how to prevent an eligibility redetermination crisis, (3) a summary of Medicaid telehealth flexibilities, (4) information on the impact of the unwinding on Tribal communities, (5) FAQs, and (6) customizable graphics for outreach and education purposes.
Learn more about Medicaid Unwinding here.
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Apply for Jobs at the National Indian Health Board
Are you interested in a career supporting public health in Indian Country? The National Indian Health Board (NIHB) is seeking qualified candidates for issue specific open positions in our Public Health Policy and Programs department! We are looking for people with expertise, experience, and passion in maternal health, behavioral health, environmental health, and other specialties who want to work in a dynamic, impactful setting to make a difference for Indian Country’s public health.
See all open positions and how to apply here.
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PHAB Standards & Measures for Emergency Preparedness Webinar
The National Indian Health Board (NIHB), in collaboration with the Centers for Disease Control and Prevention (CDC), is hosting a free webinar on the Public Health Accreditation Board's (PHAB) Standards & Measures for accreditation related to emergency preparedness on Thursday, April 13, 2023, from 3:00-4:30 PM EDT.
Join NIHB along with guest speakers, PHAB, and Tribal public health departments as we overview plans and processes for emergency preparedness and response, documentation requirements outlined for accreditation, and resources to support Tribal public health capacity and the development of Emergency Operation Plans (EOPs).
Webinar participants will be able to:
- Describe the purpose of the Public Health Accreditation Board (PHAB) Standards & Measures and key requirements related to emergency preparedness.
- Explain the difference between initial accreditation, reaccreditation, and the Pathways Recognition Program.
- Identify templates and tools to help Tribes meet the requirements for PHAB Standards & Measures related to successfully maintaining an All-Hazards Emergency Operations Plan.
Register in advance for this webinar here.
Thursday, April 13, 2023, 3:00 PM ET
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Tribal Accreditation Learning Community (TALC)
Performance Improvement (PI) is essential to building public health capacity in Indian Country. These formal activities address how Tribal public health departments plan, monitor, and improve their activities and programs. As a result, departments are able to support department efficiency with evidence and strengthen their organization and systems.
Join the National Indian Health Board’s (NIHB) Tribal Accreditation Learning Community (TALC) for a presentation and discussion on the Pillars of PI. TALC is a free, monthly webinar series held each month. It is designed for sharing and learning about public health performance improvement, system improvement, and accreditation in Tribal communities.
Learn more about this event on the TALC webpage TALC webpage here.
Monday, April 17, 2023, 3:00 PM ET
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2023 Maternal Health Tribal Learning Community Series
Please join the National Indian Health Board (NIHB) for the 2023 Maternal Health Tribal Learning Community Series. The first session in the series was on March 21 (recording available of here). The series will address topics such as:
- Sovereignty from First Breath
- Cultural Competency and Responsive Healthcare Practices
- Mental Health and Well-Being: Reconnecting Indigenous Lifeways
- Advancing Health Equity: Strengthening Community Engagement
Addressing maternal and child health disparities in Indian Country requires collective action, as American Indian and Alaska Native communities are experiencing alarming and disproportionately high rates of maternal health inequities.
Join us to learn together about maternal health work in Indian Country. Share your knowledge at the Tribal and community levels to inform maternal mortality prevention efforts going forward. Engage with other leaders in the field of maternal and child health. Remaining sessions are:
Tuesday, April 25
Tuesday, May 23
Tuesday, June 27
2:00 PM - 3:30 PM Eastern Time
We invite community members, Tribal leaders, Tribal healthcare and public health professionals, and anyone interested in learning more about Indigenous maternal health to join! Questions about the series may be directed to Elisha Sneddy, Project Coordinator, at [email protected]
Register for the 2023 Maternal Health Tribal Learning Community here.
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Advancing Native American Diversity in Aging Research
Advancing Native Students in Aging Research is designed for undergraduate students, especially those from American Indian, Alaska Native, and Native Hawaiian communities. This culturally grounded course combines short-term, intensive laboratory and didactic courses and mentored pilot research in fundamental, translational, clinical, and behavioral aspects of Alzheimer’s disease and related dementias (ADRD) and the mechanisms of aging with ongoing mentoring to ensure both the launching and the retention of these promising candidates in research careers.
Additionally, this NIH/NIA sponsored course will educate undergraduate students on both the federal government’s policies and community best practices with respect to aging programs and their implementation. Additionally, the course will cover the implications of mechanistic discoveries on biological aging and on improved strategies for understanding and treating ADRD. Through ongoing interactions, the course helps to expand and sustain their independent research careers on the clinical, translational, behavioral, and fundamental aspects of Alzheimer’s and aging.
Advancing Native American Diversity in Aging Research offers dynamic training courses and career advancement strategies that provide a fresh series of daily lectures by Native professional on emerging concepts, followed by extended discussions, laboratory research, technologically intense workshops, and informal seminars over week-long periods.
Please download the application here. Or email at [email protected] with any questions. Any student who is accepted will receive a full scholarship which covers room and board and travel.
University of Minnesota, Minneapolis, MN
August 6-11, 2023
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Save the Date for the National Tribal Opioid Summit
Join NIHB as we partner with the Northwest Portland Area Indian Health Board’s National Tribal Opioid Summit, to be held August 22-24, 2023, at the Tulalip Resort in Tulalip, Washington.
The summit will provide an unprecedented opportunity of national scope for Tribal nations and communities to share stories, build strength, and collaborate to address the opioid crisis. This inaugural summit will provide dedicated space to addressing the fentanyl crisis with a Tribally driven agenda.
August 22 - 24, 2023
More information to come!
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