The N CREW Program is a new initiative launched by the National Institutes of Health to support Native American communities in gaining knowledge about and addressing issues relating to substance use, overdose, mental health, and pain. Native communities experience the highest rates of overdose death rates in America, highlighting the importance of this new program and the development of culturally-focused solutions.
What is the N CREW Program?
The Native Collective Research Effort to Enhance Wellness (N CREW) Program is a new initiative created by the National Institutes of Health (NIH). It has been developed to help Native American communities learn more about substance use, pain, and mental health issues while supporting Native-led research in these areas. The aim is to develop interventions with an effective and culturally grounded basis.
NIH recognizes that addressing substance use-related issues within Native communities requires Indigenous Knowledge and a cultural focus. The N CREW Program aims to utilize and support this, helping improve and build upon Native-led research and intervention development. [1]
The Program is to take place over seven years, with two phases and an overall budget of $268 million. It aims to directly address the issues and priorities identified by Native American communities through Native-led research projects. [2]
Phase 1, from 2024-2026, has a budget of $25 million and involves the planning and implementation of research projects. NIH has also created the Native Research Resource Network (NRRW), which will provide training for Tribes and Native American Serving Organizations (T/NASOs) to assist in research development and meeting program goals.
Phase 2, from 2026-2030, has a budget of $240 million. This phase involves various activities being put into action to achieve the program objectives. NIH has not yet explained this phase, stating that details will be released as the program develops. [2]
Goals of the N CREW Program
The NIH states that the focus points of the N CREW Program are:
- “Supporting research prioritized by Native communities, including research elevating and integrating Indigenous Knowledge and culture.
- Enhancing capacity for research led by Tribes and Native American Serving Organizations by developing and providing novel, accessible, and culturally grounded technical assistance and training, resources, and tools.
- Improving access to, and quality of, data on substance use, pain, and related factors to maximize the potential for use of these data in local decision-making.” [NIH 2024].
Substance use in Native communities
Over the last few years, issues relating to drug overdoses and the opioid epidemic have been an increasingly discussed topic throughout North America. [3] Although this is a significant issue among all communities, substance use, and substance-related disorders have affected Native American communities disproportionately, with Alaska Native and American Indian people experiencing the highest overdose death rates in the country. [4]
The extent of substance use issues among Native communities is believed to be linked to many factors. Colonization, loss of traditional lands, oppression, discrimination, and epidemic disease have contributed to generations of trauma, health issues, and poverty, all of which have likely contributed to the development of severe mental health and substance use issues among Native communities. [5][6]
This issue is also exacerbated due to barriers to receiving treatment. This includes financial limitations, low insurance coverage, limited access to transportation, stigmatization or lack of cultural considerations from service providers, doubt or distrust in service providers, and limited treatment programs for opioid use disorder. [5]
Bridging the research gap: Why N CREW is critical
In 2018 and 2022, NIH held Tribal Consultations, during which many tribal leaders recognized the impact of these issues within their communities, stating that the opioid overdose crisis is of high priority and must be addressed. They also highlighted the importance of doing this through Native-led research that understands and incorporates Native approaches while addressing substance use and pain management, such as traditional plant-based medicines, healing practices, and ceremonies. [2]
Native American communities not only face disparities in drug-related harm but also stigma and misunderstanding around these issues and intervention implementation.
For example, substance use research and interventions focused on Native communities have so far been somewhat reductionist. They have tended to isolate substance use issues, rather than looking at the broader range of holistic and sociocultural factors involved. This approach has perpetuated the stigma and disempowerment faced by Native communities. [7]
N CREW is critical as it will help implement research and interventions that include individual and community perspectives. It will address substance use issues within the context of general health and well-being, using Indigenous Knowledge and approaches that have existed for centuries. [1]
Additionally, N CREW will support community-led research which will highlight and incorporate the different perspectives and needs of individual Tribal groups. This helps support the development of research and solutions informed by Traditional Knowledge. [2]
NIH’s broader strategy to combat substance use and pain
NIH, along with the Presidential Administration and the Department of Health and Human Services (HHS), has implemented various research projects and initiatives in recent years to combat substance use issues, particularly the opioid epidemic. The N CREW Project is included in this framework, alongside:
The future impact of N CREW
N CREW will be implemented over seven years, with the second phase commencing in 2026, at which time the Program will build on the initial work with ongoing activities. Additional actions may be implemented as the Program progresses, if and when new priorities are identified. [2]
The work conducted throughout the program will influence current and future generations within Native American communities, helping to address substance use issues, chronic pain conditions, and mental health problems.
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