The rate of fentanyl overdose deaths across Indian Country has skyrocketed in recent years. Health officials say the cheap and potent opioid has largely replaced heroin and oxycodone as the most significant addiction threat. The Center for Behavioral Health (CBH) – part of the Health and Human Services Department (HHS) – has issued warnings about the drug, as the Seminole Tribe’s members have also been affected by its use.

The Tribune asked CBH director Tony Bullington about the fentanyl problem and what can be done about it. Bullington has experience in psychology, mental health counseling, family preservation services and clinical supervision. He has worked for the tribe since 1998 at HHS and the Education Department. Bullington earned a doctorate in counseling in 2017 and has been CBH director since August 2022. Answers have been edited for length and clarity.

Tribune: HHS had a video produced that describes fentanyl as the ‘single deadliest drug threat’ the tribe has ever faced.

Bullington: Fentanyl has surpassed the recent opioid crisis because if its potential lethality. It is a powerful pain killer – 100 times more potent than morphine and 50 times more potent than heroin – and is also used as an anesthetic. A very small amount can result in respiratory or heart failure. Drug dealers are using fentanyl to lace other substances, including cannabis, to enhance the effects. The extreme danger for the user is the increased risk of overdose resulting from just a little too much fentanyl being added.

Tribune: How has it affected the tribe?

Bullington: We have seen several tribal members that overdosed from fentanyl be revived by the administration of Narcan* by EMS (Emergency Medical Services) and SPD (Seminole Police Department) officers. Tragically, we have also had to work with families who lost loved ones to fentanyl overdose. Over the years I have heard people from communities outside of the tribe make statements about the enormous problem of alcohol and substance use in the tribe. According to referrals, staff caseloads, and general knowledge, it appears that the issue in the tribe affects around 10% of the population. I think the problem looks bigger sometimes because the tribe is relatively a small population.

Tribune: Narcan has become much more significant?

Bullington: Yes, Narcan is very effective to revive people from fentanyl overdose if administered soon enough. We have worked with EMS, SPD, health clinics and community members regarding the availability of Narcan and educating the tribal communities. The recent videos have been well received and we hope to continue expanding community awareness.

Tribune: There are treatment/recovery options?

Bullington: I have instructed our staff to have open, frank conversations with members seeking treatment. One of the dangers for chronic abusers when they do go into treatment and successfully complete it is the possibility of relapse. When people have achieved several months of sobriety and living drug free, their systems revert back to pre-usage functioning. The temptation with relapse will be for them to think that they need to return to the usage level prior to coming into treatment. When this happens, it will often result in an accidental overdose and possibly have a fatal result. I stress to our staff to begin at the outset of treatment to establish a strong relapse prevention plan with the member.

Tribune: You’ve recently started a new initiative?

Bullington: To assist in helping members to stay in recovery, we established a new initiative in January 2022 where we appointed staff as a continuum of care team. They visit members upon admission to residential treatment, emergency detox admissions, psychiatric admissions or those under the Marchman Act.** The goal is to build relationships and to help develop discharge plans that will have the member involved in follow-up services.

The past few years, the field of addiction treatment has moved from the long held position of an abstinence goal model to include a harm-reduction model. It is unrealistic to try to motivate everyone to abstinence. Harm-reduction is a safer alternative. There are approved Medication Assisted Treatments (MATs) that are available for both drug users and those who abuse alcohol. I would also encourage all members not to buy any substance from the streets. The chances of it being laced with fentanyl or other substances are exponential.

Tribune: CBH also hosts education groups on the reservations?

Bullington: Yes, we have groups that focus on life skills and educational topics to address member interests and aftercare for those in recovery. We offer in-person and virtual participation in the groups, and we are exploring ways to offer more opportunities, including some for the youth.

Tribune: Any other advice you’d like to give on this subject?

Bullington: I would encourage any members who are struggling with addiction or issues with alcohol abuse to speak with family members, clan members, or staff in the tribe’s Culture Department about seeking cultural help via Indian medicine or other remedies. They are also welcome to come into the nearest CBH office and meet with staff to discuss possible treatment options. I would encourage family members to offer cultural interventions via Indian medicine, and if they refuse help, to seek support from the nearest CBH office. We can provide support for the family and explain the Marchman Act process. I look at the Marchman Act as a last resort to possibly save the members’ life after other alternatives have been exhausted.

CBH’s contact numbers during normal business hours are Brighton (863) 763-7700; Hollywood: (954) 965-1314; Big Cypress: (863) 902-3206; Immokalee: (239) 867-3480; and Tampa: (813) 620-2865. Bullington said calls after normal business hours should be directed to the Seminole Police Department at (954) 967-8900. SPD will direct the tribal member to on-call CBH staff, if needed.

*Narcan is a medicine that typically comes in a nasal spray or injectable form that is used to treat a known or suspected opioid overdose emergency.**In Florida, the Marchman Act was passed to help get people the addiction treatment they need when they refuse to get it themselves. Through the Act, a loved one can be put on a hold for up to 72 hours as they go through an evaluation.