Interview with Sheena Kanott Lambert, Eastern Band of Cherokee Indians (EBCI)
Interview with Sheena Kanott Lambert, Eastern Band of Cherokee Indians (EBCI), Public Health Director
For the Eastern Band of Cherokee Indians, opioid prevention, and harm reduction efforts flow through many areas of their public health prevention. “We started a Syringe Services Program (SSP) here in 2018, mainly because we had high rates of overdose deaths, and at the time, high rates of Hepatitis C as well. It’s controversial to start an SSP, and as public health professionals we had to persuade the Tribal Council to start one.” Over time, “we were able to hire peer support specialists teach on nasal naloxone; I think it genuinely made a huge difference in our communities over the years.”
Sheena attributed much of their success to their Tribal Health Improvement Plan (THIP), which is based on their Tribal Health Assessment (THA) conducted by Public Health and Human Services (PHHS) at EBCI every five years; one of the four core health priority areas in the THIP is substance use. The plan has been community driven, created to reduce substance use, reduce overdose deaths, save lives, get people into recovery, and to reduce stigma.” One activity EBCI focused on in the past year was revamping their Cherokee Rally for Recovery, an event to promote the wellness and support of those recovering from substance use; “Our goal was to have 100 people and almost 500 people came. We were able to track how many people there were in active recovery, new to recovery, or supporters of those in recovery.”
“I can’t say enough about the impact the THIP has made on this topic. It’s all these pieces working together, breaking those barriers so people can get help, come forward and feel empowered and supported to get into recovery.”
EBCI launched a new emerging public health project called public health vending machines, in October of 2023. The 10-vending machine includes hygiene projects, safe sex supplies, nasal naloxone, fentanyl test trips, bug spray for encephalitis, and more. The items in the vending machines are fully funded by grant dollars and are set outside public buildings. The vending machines allow the public health team to track utilization rates of items used in the machine. They can also track which machines are the busiest, what time of day they are used most often, and what items are utilized most frequently. In just 8 months, we have dispensed over 24,000 products to community members in just Including 443 Nasal Naloxone and 189 fentanyl test strips.
Public Health vending machines have been placed in convenient locations all around the Qualla Boundary and can be accessed 24 hours a day; 7 days per week. This is especially helpful for people who may struggle to get appointments due to work schedules, transportation issues, or social stigma. These machines also reduce hard by providing essential harm reduction supplies like Naloxone, a medication that reverses opioid overdoses and fentanyl test strips. Additionally, these machines improve public health by providing supplies such as condoms, pregnancy test and first aid kits which promotes sexual health to prevent the spread of sexually transmitted infections and encourage basic wound care.
Lastly, the vending machines offer a stigma-free way for people to access sensitive healthcare products. This can be particularly important for those who may be uncomfortable approaching a healthcare provider directly. For example, a person who is experiencing homelessness may need hygiene products, feminine care products and first aid supplies. A few other examples include: a general community member who has witnessed an overdose and needs to access nasal naloxone or a teen who is sexually active and needs a condom. Enrolled members are automatically able to use the machines. No signing up or paperwork to complete, they simply type in their Tribal enrollment number in the machine. Some products have limitations (for example, deodorant is limited to once per week per person), but naloxone and test strips do not have limitations. “I think it’s worked incredibly well.”
EBCI Public Health began exploring the idea of the vending machine project by researching some other areas of the country that were using them and having amazing success. They then thought it was important to ask our community if they liked the concept. It was well received and most loved the idea.
“We’re finally starting to see data from our Overdose Mapping and Application Program (ODMAP) that our overdoses are going down drastically. It’s full circle when you see that data, that our efforts are paying off; it’s very powerful and refreshing to see the progress.”
Regarding changes in the community, Sheena expressed, “I feel like there’s been a paradigm shift. Some people have tried to understand [harm reduction] better. For example, with SSP, people thought we were just giving needles out and saturating the community with needles. We had to educate that people have to return needles to get more, that was important. Our return rate is very high (over 95%). We also have large receptacles that we painted red for people to deposit needles. We originally put those out for people who use substances, but now people with diabetes use them too. We’ve educated people on how the receptacles benefit everyone’s health.”
“Stigma reduction has been a major part. People didn’t really understand how addiction changes the brain; you also have the flip side of families reaping the ramifications of people using substances.”
Overall, Sheena recommends to their peers in this work: “be open minded with strategies to help. Always include culture in what you’re doing, who you are as a person and who you are as a nation.”