Dr. Anna Miller sits with her legs pulled up, boots kicked off, in an exam chair at Cherokee Nation W.W. Hastings Hospital. She's waiting for her first Suboxone patient of the day.

She knows the odds are stacked against these patients struggling to get off opioids. She's seen firsthand how crooked the path to recovery can be. She also knows she has a few singular advantages, unique to Indian Country, in tackling the crisis.

But those advantages are double-edged — and all too swiftly can turn into obstacles.

There is, for instance, the fact that health care is free to members of Cherokee Nation, as it is for most Native Americans under longstanding treaties with the U.S. government.

"The great advantage is that I basically have socialized medicine," Miller said, though she's quick to point out the care didn't come without a cost: "Free is not the right word to use. It's something that was earned by their ancestors in a treaty."

Those treaties ensure that patients don't have copays or deductibles to worry about when they receive medication or behavioral therapy to help wean them off opioids. That lifts a huge financial burden: The Suboxone alone can run hundreds of dollars a month.

At the same time, providers said, because there's no cost, it can be hard to get patients to fully commit to sticking with the long process of recovery. They don't lose a lot of money if they decide to drop out.

Then there's the close-knit nature of the tribe. That can be a huge help to doctors — the medical staff knows exactly which neighbors or relatives to call to track down a patient who hasn't shown up for his Suboxone strips.

But the strong connections binding the community can also drag down individuals trying to overcome addiction. It's hard to break habits when you're surrounded by so many friends with the same cravings for opioids.

The rate of drug-related deaths among American Indian and Alaska Native people has almost quadrupled since 1999, according to the Indian Health Service. It's now double the rate in the U.S. as a whole. Oklahoma — home to the 120,000 citizens of Cherokee Nation — leads the country in prescription painkiller abuse.

"It's a problem for the entire country," said Chuck Hoskin, the secretary of state for Cherokee Nation. "But we are up against it in Cherokee Country."

About half of participants in Suboxone programs nationally reduce their prescription painkiller abuse over the three-month treatment. But once they stop taking Suboxone, the success rate has been shown to fall to just under 9 percent.

Despite the long odds, Miller and the only other doctor in the Suboxone program, Dr. Charity Holder, find the work worthwhile.

"When people really start to realize the enormity of the problem," Miller said, "they realize maybe it's not that these are bad people. It's that they have a disease that needs treatment."

These patients "are desperate for help," Holder said. "If we just pay attention to this epidemic and take care of it, we're going to get people back out there."

She says that with optimism and determination. Yet she knows what her patients face when they leave the security of her office. "They go right back to their homes and to their exposure to narcotics," she said.

Curtis Wilson knows that cycle well.

An early addiction and a hopeless spiral

Wilson, now in his mid-30s, had been shooting heroin for about a year when he first took pain pills to get high with his uncle.

That was more than two decades ago — when he was just 12 or 13 years old. "It just kind of spiraled from there," said Wilson, who is Cherokee and works building Indian homes.

That early introduction to opioids isn't uncommon among Native Americans.

By 12th grade, nearly 13 percent of American Indian teens have used OxyContin, according to the American Drug and Alcohol Survey. And 2.6 percent of American Indian students in 12th grade have used heroin, nearly double the rate of the general population.

Wilson did pain pills for about 10 years, then stopped when he got together with his wife, Tracy. In 2004, after a bad accident, he turned back to pills. His drug of choice: K4 Dilaudid, a 4-milligram narcotic pill also known by its generic name, hydromorphone. He'd take between 12 and 14 pills a day, shelling out upwards of $800 a week on pain medication.

"I made sure all my bills was paid. The rest went up my arm or down my throat," Wilson said.

For a few years, his wife didn't have any idea what he was doing. He'd wait to get up until she left for work, then scoot over to the edge of the bed to shoot up. That changed in 2006, when Wilson went on a weeklong work trip to Little Rock, Ark. Just a few days in, he ran out of drugs. The withdrawal consumed him — nausea, diarrhea, twitching. He still had five days left on the build. Desperate, Wilson called his wife and told her that he needed help.

Cherokee Nation helped Wilson get into a five-day detox. It didn't last long.

"Soon as I got out, I knew where I was getting the pain medicine," Wilson said. He tried, once, to break his addiction by leaving the state. It worked for a few weeks. Then he came back to Cherokee Nation.

"The day we got back, I got some pills. The very day we got back," Wilson said.

Tracy took their three children and left him more than once. "It about killed me," he said.

Their three boys are grown now. One works on an oil rig — he gets to come home for Christmas — and another lives nearby. The third is getting treatment for his own addiction.

Wilson's new babies are his two dogs, Oreo and Hoss, who jump onto his lap the moment he sits down and cry when he tucks them into a back room. He lives now in Sallisaw, a small town smack in the middle of Cherokee Nation. There's a set of train tracks right outside his front door — he doesn't notice the noise much anymore — that run north to the small town of Stilwell.

Family is Wilson's soft spot — the boys, Tracy, and his sister, Cyndi Lindsey, who vividly remembers how quickly her brother changed when he started using painkillers.

"[He] didn't care about life, didn't care about anything but where he was gonna get his next fix from," she said. "It felt like I had lost my best friend."

Wilson, who wears a baseball cap and speaks with an easy drawl, struggles to reconcile his addiction with what it's done to his family. They struggle with that, too. "It can tear a family apart, and it can do it in a hurry," Lindsey said.

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