Samantha Brawley got hooked on painkillers after high school, an addiction that stole nearly a decade and cost her most of the savings that were supposed to help improve her life.
Finding her next Percocet, and the next, was easy on the Qualla Boundary, the Cherokee reservation home to roughly 8,000 people in the Great Smoky Mountains of western North Carolina.
“I began taking two or three a day for a year, maybe two years,” said Brawley, 30, a member of the Eastern Band of Cherokee Indians.
“Then it was as many as I could afford. I’ve done 10 a day.”
She says she’s been off drugs for two years now. Today, Brawley helps lead a drug-recovery program in hopes of reducing overdose deaths from prescription drugs and heroin.
The Qualla Boundary was one of 10 locations across the country identified last year as a “high intensity drug trafficking area” by the Office of National Drug Control Policy. In September, federal authorities arrested 76 people and seized opioids valued at more than $1 million during a raid on the reservation.
The number of patients diagnosed with a drug-related condition at Cherokee Indian Hospital increased 300 percent between 2012 and 2018, according to hospital spokesperson Sheyashe Littledave. Last year, more than 4,500 patients received such a diagnosis.
Now the tribe has joined a federal lawsuit that accuses several drug makers of contributing to the opioid epidemic through corrupt practices, such as shipping too many drugs into the region.
Drug companies are responsible for reporting suspicious orders of opioids to federal officials, said Chief Richard Sneed.
Drug Firm ‘Complicity’
“There’s complicity in this national epidemic because the drug companies were not doing what they were supposed to do,” Sneed said. “By not reporting the predatory numbers it led to more people becoming addicted.”
The plaintiffs want the drug companies to pay for the economic burdens opioids have caused — medical care for addicts and babies born to drug-dependent mothers, counseling and increased needs for law enforcement.
When the U.S. government ordered the Cherokee tribe from its western North Carolina land in the 1830s as part of the Trail of Tears, thousands were forced to march to Oklahoma, where they formed the Cherokee Nation.
Roughly 800 Native Americans stayed behind on the 56,000-acre Qualla Boundary and became known as the Eastern Band of Cherokee Indians. Now the tribe’s 16,000 members — many of whom live outside the reservation — make up the largest federally recognized tribe east of the Mississippi River.
Many tribal members live along the banks of the Ocanaluftee River, or in coves and valleys of the mountains. Motorists can see fog rising like steam from the river while driving along curving, narrow roads dotted with flea markets and military surplus stores. In the summer, roadside signs tout watermelons, peaches, strawberries and tribal wares.
It can be hard to imagine that a place so rich in history has become saturated with drugs.
The tribe’s crisis mirrors a larger epidemic: More than 46,000 people in the United States died of opioid-related overdoses in 2017, more than double the number in 2007, according to the National Institute on Drug Abuse.
In North Carolina, fatal overdoses increased more than 22 percent in 2017 compared to the prior year, marking the largest jump of any state except Indiana, the Centers for Disease Control and Prevention said.
Western North Carolina has been hit particularly hard by opioids. An eight-county region that includes the Qualla Boundary saw 17.7 unintentional overdose deaths per 100,000 people between 2012 and 2016, state statistics show. That compares to 12.2 overdose deaths per 100,000 people statewide.
Using revenue generated by Harrah’s Cherokee Casino Resort, the Eastern Band of Cherokee Indians has spent millions on medical facilities in an effort to combat opioids.
Tribal leaders opened an $80 million hospital in 2015 and a $16 million residential treatment center last year called Kanvwotiyi, or “a place they go to be healed,” said Casey Cooper, chief executive officer of the Cherokee Indian Hospital Authority.
Meanwhile, the tribe’s old hospital building is being transformed into a “crisis stabilization unit” that is expected to open next year for patients with mental-health issues and members who need immediate detox services.
In 2017, after learning that more than 600 people living in the Qualla Boundary had been diagnosed with Hepatitis C, tribal leaders approved a syringe-exchange program. More than 300 people are enrolled, Sneed said.
“There are so many different areas,” Cooper said. “The opioid crisis has really motivated tribal leaders to invest in the best health and treatment services.”
Sneed said the tribe in 2002 took over the administration of health care from the federal Department of Health and Human Services’ Indian Health Service and created the Cherokee Indian Hospital Authority.
“It has worked out tremendously,” said Sneed, adding that the decision was especially important because North Carolina lawmakers have so far declined to take part in the federal expansion of Medicaid. “We found the resources to take care of our people.”
‘Perfect Storm of Addiction’
Tribal leaders say they became aware of the opioid issue about a decade ago when members started dying from prescription drug overdoses. As tighter industry controls were put in place to make prescription drugs less accessible, many people turned to heroin.
“It was a perfect storm of addiction,” Sneed said. “Many of our members became addicted by legal prescriptions. … This is a small, tight-knit community. One death impacts the entire community.”
The tribe noticed a spike in overdoses in the months when per-capita payments were dispersed, said Jeffrey Long, a tribal member who works with the Western North Carolina AIDS project. Adult members of the tribe can receive between $5,000 and $7,000 each December and June, their share of revenues generated by the casino.
When many people received payments last June, Long said, “we had a cook-out to give people something to do, somewhere to come, so they won’t get their first fix.”
Children also get money, which is put in a trust. Until about five years ago, the money was handed out in a lump sum when they earned a high school diploma or turned 18, said Mike McConnell, interim attorney general for the Eastern Band of Cherokee Indians. Now the funds are distributed in increments at age 18, 21 and 25.
“The tribe determined that was probably not the wisest thing to do,” McConnell said about the single large payment. He added, “Hopefully, people can make wise choices with the money given them.”
Brawley estimates that about half of the $60,000 she received when she turned 18 went to drugs.
Attorneys for the tribe filed a complaint January 2018 in U.S. District Court for the Western District of North Carolina. The lawsuit claimed that drug companies conspired to target the tribe through deceptive marketing practices and persuaded doctors to prescribe highly addictive painkillers.
The tribe’s lawsuit became part of the National Prescription Opiate Litigation, which includes more than 400 federal lawsuits filed by cities, counties and Native American tribes against the largest opioid manufacturers, companies that distribute opioids and pharmacy chains that sell them.
More than 50 North Carolina counties and several cities — including, Fayetteville, Wilmington and Winston-Salem — are listed as plaintiffs in the litigation, according to the state attorney general’s office. The case will be heard in U.S. District Court for the Northern District of Ohio.
N.C. Attorney General Josh Stein, who has made the opioid crisis a focus for his office, is helping to lead the case. Stein said he wants to crack down on those who are responsible for fueling the epidemic — not only in the streets, but also in boardrooms.
In late 2017, Stein filed lawsuits against against drug manufacturer Insys Therapeutics, Inc. alleging the company fraudulently marketed a spray form of the synthetic opioid fentanyl, which is about 50 times stronger than heroin and 100 times more potent than morphine, according to the U.S. Drug Enforcement Administration.
Months later, Stein sued drug manufacturer Purdue Pharma, which makes the painkiller OxyContin.
“We want to hold drug traffickers accountable,” Stein said, “but we also believe in corporate accountability.”
‘Praying for a Miracle’
One afternoon in late August, Brawley sat along the banks of Soco Creek in front of her friend’s home high up in the mountains. Dressed in jeans, with a silken blue and pink shawl wrapped around her shoulders, she talked about how opioids have affected her community.
“So let’s see, right now over 15 people I knew personally have died from overdoses,” she said. “One boy died last week. He was 15. That same day we celebrated a recovery, we buried a person on the reservation. The same day we had a recovery rally in July, we buried a girl who had died from opiate use — heroin. She was like 21.”
Brawley said she quit drugs when she got pregnant by her dealer.
“I had been praying for a miracle and I got pregnant,” she said. “And my grandmother had been praying for a miracle. She knew I wasn’t going to stop for … these treatment centers. And I got pregnant and I believe to this day that it was my grandmother who spoke that truth. I have this beautiful child who saved my life.”
Liam was born in 2014. When Brawley relapsed just before her son’s first birthday, she sought treatment at the Mary Benson House, a year-long program in Asheville where children can stay with their mothers. She completed the program in nine months.
“Having your child there gives you a sense of motivation and more determination to do something different,” she said.
Brawley now works as a peer support specialist with Meridian Behavioral Health, an outpatient service in Sylva. Each day she visits clients who are still addicted. She relies on Suboxone to beat back her own cravings, and she said Dec. 30 marked two years of sobriety.
Tribal member Charles Beam, 24, said he was in his late teens when he became addicted to opioids and alcohol. He said he’s been off drugs for more than three years and alcohol-free for a little over a year. Beam and Brawley have been co-leaders at Celebrate Recovery, a volunteer program, for nearly two years.
“She speaks at all the recovery rallies,” Beam said of Brawley. “She’s a big spokesperson for Cherokee and all of the surrounding counties. She’s an awesome role model. She’s come a long way.”
It was important to Brawley to stay on the reservation instead of starting a new life elsewhere. And she echoed the commitment of her tribe’s leaders in their battle against opioids.
“I got high here, I got clean here,” she said. “And I can give back here.”
Thomasi McDonald is a 2018 John Jay/H.F. Guggenheim Justice Reporting Fellow. This story was written as part of his fellowship project. The full story and a video report is available here.