As the Trump Administration recognizes National Native American Heritage Month, we recognize and celebrate the traditions and strengths of American Indian and Alaska Native (AI/AN) communities. When Native communities lead scientific research that shapes their own care, the science becomes grounded to their needs. Tribes and Native-serving organizations understand their communities’ strengths and challenges in ways no outside team can replicate, and that depth of insight, coupled with healing traditions and epistemologies refined over generations, produces evidence that communities can trust and are more likely to use.
In 2024, the NIH launched the Native Collective Research Effort to Enhance Wellness (N CREW) Program, an ambitious initiative to support research to address the entwined crises of pain and drug addiction affecting Native people. AI/AN people experience disproportionately high rates of drug and alcohol addiction, drug overdose, chronic pain, and co-occurring behavioral health conditions. These challenges are driven by myriad factors, including limited access to culturally responsive prevention and treatment services as well as historic disruptions of traditional family and community structures.
On the other hand, Native communities possess significant strengths — cultural protective factors, strong family and community connections, and traditional healing practices that complement evidence-based medical care — that can support prevention, recovery, and long-term wellness. Interventions developed by Native people that leverage these strengths are critical to tackling the behavioral and physical health challenges that Native people face. The vision of N CREW is to build capacity for and support rigorous research that is directed and led by Tribes and Native Serving Organizations (T/NSOs) and is thus founded on Native knowledge, expertise, and strengths.
N CREW is funded through the Helping to End Addiction Long-term® Initiative (or NIH HEAL Initiative®), and managed jointly by NIDA, the National Institute of Neurological Disorders and Stroke (NINDS), and the National Center for Advancing Translational Sciences (NCATS) and in partnership with the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the National Center for Complementary and Integrative Health (NCCIH). It was conceived in response to Consultations between NIH and Tribal Leaders in 2018 and 2022, where the opioid public health emergency — including the entwined problems of increasing opioid and amphetamine use and pain — was identified as a top priority for Native communities. A dominant theme in these meetings was the inadequacy of past government-funded research projects on substance use in AI/AN communities that had been conducted and designed by outsiders, which often had unintended adverse consequences for the people studied.
In contrast, N CREW’s approach is to support tribally directed research that uses indigenous methods across the Program. For example, rather than using focus groups, where researchers pose prescribed questions and participants respond as they please, talking circles follow a structure already familiar within Native communities. Though traditions vary by Tribal nations, Elders often speak first, and they or other respected community members introduce broad themes to guide the data collection. Each person then takes a turn speaking in sequence rather than jumping in.
Traditional healing practices, such as smudging, sweat lodges, and other sacred ceremonial approaches are also being incorporated into interventions informed by indigenous worldviews that emphasize relationality, reciprocity, and other Native values. For example, Native conceptions of health and well-being are more multidimensional and holistic than those that prevail in Western biomedicine, involving not only physical and mental but also emotional and spiritual dimensions; harms are conceptualized at both the group and individual levels. For example, N CREW investigators are developing an Indigenous measure of pain that goes beyond physical pain to include personal, identity and relational, and collective and historical domains. From this holistic perspective, Native communities see knowledge, the researcher, and the topic as existing within a web of interconnections — to people, land, ancestors, and community — rather than as separate, detached entities, and they expect research to be answerable to those relationships, not just to institutional standards of methodological rigor.
N CREW’s role is to provide communities with the necessary resources to develop their own research capacity and infrastructure, including training in research methods and partnership opportunities to advance the research they prioritize. Toward these goals, in Phase I, N CREW funded 14 T/NSOs directly — including individual tribes, organizations serving tribes within and across states, and urban Native-serving organizations — as well as four Native Research Resource Partners (NRRPs) at established research institutions. The NRRPs are designed to support the T/SNOs and the program as whole through the provision of research training and technical assistance, evaluation and data support, partnership building, and coordination among other functions. Twenty-seven pilot projects were also funded in Phase I.
As part of the initial development and planning phase, workgroups convened to consider how the definitions of pain and addiction may differ for Native people, including among individuals, Tribes, and communities. Early work has focused on how to incorporate Native beliefs, traditions, and healing approaches into pain management and addiction prevention and treatment. Many sites are developing new interventions or adapting existing interventions and testing their efficacy in their communities. For example, one site in Wyoming is testing how existing complementary and alternative approaches to treating substance use disorders and pain combined with traditional practices may improve outcomes for individuals in recovery from addiction. Another site in Oklahoma is seeking to identify where their system of care loses the pain patients they serve in order to identify opportunities to keep them in care. Still others are testing combined substance use disorder and suicide prevention interventions, and so on.
The workgroups also considered how to prevent community-level harm by ensuring that data generated through N CREW are only available to people who would use it responsibly. For many T/NSOs, this starts with reclaiming control over their own data and increasing access to data broadly. Tribes and Native Serving Organizations are building the infrastructure, including their own secure REDCap (Research Electronic Data Capture) systems, to hold data in-house rather than leaving it with outside institutions, laying a foundation for their research projects.
This data ownership and the investments in improving access for those who need it are already paying off in care. One New Mexico NSO linked behavioral health data to a Tribal registry to generate real-time estimates of opioid overdose and neonatal abstinence syndrome. And a Utah site is using natural language processing to identify patients with substance use disorders from medical record data, helping ensure people who need treatment are found and connected to it.
As the initial planning phase of N CREW nears its end, the second, implementation phase is set to get underway beginning in 2027. It will continue to focus on capacity building and infrastructure, while also supporting community-prioritized research projects. Awarded projects are listed publicly.
Sustainable solutions to the opioid crisis will come from empowering those most affected by it to find the solutions that work for their traditions and needs. “In truth, our people have been researchers and clinicians and healers and educators and evaluators for thousands of years,” notes Dr. Donald Warne (Oglala Lakota), co-director of the Johns Hopkins Center for Indigenous Health and lead on another N CREW pilot project. “We just had different methodologies.” He says that N CREW provides the resources to conduct research and address addiction and pain in Native communities more robustly and effectively by incorporating their own knowledge and strengths.
Dr. Nora Volkow, Director
Here I highlight important work being done at NIDA and other news related to the science of drug use and addiction.
