There's a narrative about the methamphetamine epidemic in Montana that says the state tackled it in the 2000s, yet now it's back with a vengeance because of super labs and drug cartels in Mexico. But here on the Fort Belknap Indian Reservation, it never really went away.
"Getting high in your car in front of the store; that ain't a big deal," says Miranda Kirk.
Kirk works on the reservation, which is about 40 miles south of the Canadian border. She says no one even bothers to hide their drug use.
"Leaving your paraphernalia out in the open for someone to walk in, that's alright. Having and seeing needles everywhere, that's ok. Even talking about selling your needles — that's normal too," Kirk says.
Kirk is a 27-year-old mother of four. Born and raised in Fort Belknap, home to the Aaniiih and Nakoda tribes, she grew up around drugs, alcohol and addiction. She struggled with opioids after a miscarriage landed her in the ER and she was discharged with a handful of prescriptions. But, she says, with the help of her church, she broke that addiction. Now, she wants to help others.
According to the Tribal Epidemiology Centers of the Indian Health Service, dependence on methamphetamine and other psychostimulants more than tripled for tribal members in Montana and Wyoming between 2011 and 2015.
"People are saying they're seeing it as young as third grade, because, 'Oh that's ok, I see that at home — my aunt does this, my mom does this, my dad does this, my grandpa does this.' So, they can't see the error in it. Or they don't see it as a risk," says Kirk.
Miranda Kirk and her sister, Charmayne Healy, felt like everyone had given up trying to do anything about the rampant drug use. And, they worried about their kids falling into the same trap. So they went to tribal leaders last year and said someone needs to do something — now.
George Horse Capture, Jr., vice president of the Fort Belknap Tribal Council, helped the sisters persuade the council to declare a state of emergency against methamphetamine last January. Tribal leaders then gave Kirk and Healy $150,000 to fund a substance-abuse prevention and treatment program.
The sisters were caught off guard, but right away, Kirk started hunting for a model that might work with the strengths of Fort Belknap. She heard about something called peer recovery, a movement centered on the idea that people who have succeeded in conquering their own addictions are uniquely equipped to coach others.
"The light bulb came on," Kirk says. "That works, because what got me clean, in a sense, were peer mentors. They've been there. That made it easier for me to be able to express myself and not feel judged, or condemned. Like I'm a horrible person for what I was going through."
She's determined to break the stigma attached to reaching out for help.
In early 2016, Kirk and her sister officially launched the Aaniiih Nakoda Anti-Drug Movement, a native-led peer recovery project.
Jessica Healy, 30, came knocking before they were even up and running. Her only son was taken away last year.
"They helped me. And it took a big step ... it took all that I had," Jessica Healy says.
She had been using drugs on and off since the age of 18.
Once a week, one of Kirk's peer recovery groups, the Life Givers Circle, meets at the Lodge Pole Elementary school.
"We talk about stuff and we make ribbon skirts, [do] activities, and we just help each other out," Jessica Healy says.
It's one of about four peer support groups that Kirk and Charmayne Healy have helped start, both on and off the reservation.
"It was a good feeling to be clean and to be close to people that had been going through the same thing. To know that there are others out there," Jessica Healy says.
In addition to peer meetings, Aaniiih Nakoda members go to schools and talk to kids about prevention. They help organize events like zombie walks, in which people pretend to be the drug-addled walking dead.
There's only one outpatient drug treatment facility in Fort Belknap, and no emergency housing or sober-living facilities. The only longer-term support available is Kirk's group.
Dr. Aaron Wernham, of the Montana Healthcare Foundation, says that what Montana needs is a more integrated, team-based approach to treating addiction. That means primary care doctors working next to behavioral health professionals, and coordinating care all along the way.
"Peer recovery fits in very well with it, but if you decided you were just going to build a whole treatment system around peer recovery, you probably wouldn't end up getting the results you want," he says.
A new state law enacted in March goes a long way toward recognizing peer support specialists as legitimate members of a treatment team.
The law sets clear professional standards, and paves the way for billing insurance companies and, potentially, Medicaid.
The challenge is how to bring that comprehensive care to Fort Belknap.
Until that happens, the sisters' grass-roots peer program is one of the only options available for people. And she's intent on doing that work, no matter what.
"You have to keep your phone on during the night because addiction don't sleep and normally we don't either," she says.
This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News.
LULU GARCIA-NAVARRO, HOST:
There is an absence of addiction treatment options in Native American communities, and so grassroots efforts are springing up. Montana Public Radio's Nora Saks takes us to the Fort Belknap Indian reservation just south of the Canadian border.
NORA SAKS, BYLINE: Here in Fort Belknap, no one bothers to hide their drug use anymore, says Miranda Kirk.
MIRANDA KIRK: Getting high in a car in front of the store, that ain't a big deal, or leaving your paraphernalia out in the open for somebody to walk in. That's all right. Having and seeing needles everywhere, that's OK, even talking about selling your needles and stuff. That's normal, too.
SAKS: Kirk is a 27-year-old mother of four. She was born and raised on the reservation and grew up around drug and alcohol addiction. Methamphetamine has been a problem here since the early 2000s, and painkillers are everywhere, too. She herself got hooked on opioids after a miscarriage and a long struggle with depression. She managed to break her addiction but got fed up with the rampant drug use. Last year she went to tribal leaders and said someone needs to do something now. Tribal Council Vice President George Horse Capture Jr. was moved.
GEORGE HORSE CAPTURE JR: It was very heart-lifting to see young people are recognizing what's happening to their numbers. It's their age bracket that's really taken a beating.
SAKS: He surprised Kirk by finding $150,000 to fund a response and by putting her in charge of it. Kirk took the mission seriously and started digging around. She thought about what had worked for her - close relationships with other recovering addicts and in her church.
KIRK: If you have that strong support system and if you have strong faith, that makes any kind of challenge, any kind of barrier in front of you seem like it's just a little tiny molehill instead of a mountain.
SAKS: Kirk discovered there's a tremendous history behind what she had figured out on her own - peer recovery. It's the idea that people who have succeeded in recovering from their own addiction are uniquely equipped to coach others. And in a small community like this one, Kirk had a hunch that trusted peer mentors could help other addicts get over the stigma of asking for help.
KIRK: So I went and did surveys and I got all this prep together, and I said, I can do this.
SAKS: A few months later, Kirk and her sister launched the Aaniiih Nakoda Anti-Drug Movement, one of the first native-led peer recovery projects in Montana. It's named for the two tribes that live on the reservation.
UNIDENTIFIED WOMAN: Hello.
SAKS: Nice to meet you.
Once a week, one of Kirk's pure recovery groups, the Life Givers Circle, meets in the Lodge Pole Elementary School. Jessica Healy is a regular.
JESSICA HEALY: We talk about stuff and we just help each other out.
SAKS: Healy, now 30, had been using drugs on and off since she was 18. When her only son was taken away last year, she reached out to Kirk.
HEALY: It was a good feeling to be close to people that had been going through the same thing and to know that there's others out there.
SAKS: Peers involved in Aaniiih Nakoda also get out and talk to kids about prevention and organize public events. Their goal is to make sure that tribal members who are struggling with addiction know they have somewhere to turn. One year in, out of 20 people who started the program, six have stuck with it, says Kirk.
KIRK: Well, that's three times than what I had planned for. It's a small - you know, a very small dent. But I'm excited because if we can have six in a year, then maybe we can double those results this year.
SAKS: Ideally, though, says Dr. Aaron Wernham of the Montana Healthcare Foundation, addiction needs to be treated like a chronic illness and care would include a team of primary care doctors working next to behavioral health professionals.
AARON WERNHAM: Peer recovery fits in very well with it, but if you decided you were just going to build a whole treatment system around peer recovery you probably wouldn't end up getting the results you want.
SAKS: The challenge is how to bring that kind of comprehensive care to Fort Belknap. Wernham estimates that less than 10 percent of Montanans with a substance use problem receive treatment. And the problems are worse on reservations. On Fort Belknap, Kirk's grassroots peer program is one of the only options people there have. And she's intent on doing that work no matter what.
KIRK: You have to keep your phone on because addiction don't sleep, and normally we don't either.
SAKS: For NPR News, I'm Nora Saks.
(SOUNDBITE OF VIKTOR KRAUSS' "OVERCAST")
GARCIA-NAVARRO: This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News.
(SOUNDBITE OF VIKTOR KRAUSS' "OVERCAST") Transcript provided by NPR, Copyright NPR.