Sarina DiMaso, a member of the Chiricahua Apache and Taino Nations, returned home from a drug and alcohol binge seven years ago to find her 24-year-old daughter, Nicole, dead by suicide in DiMaso’s bedroom.

DiMaso, who was plagued by guilt and was trapped in a decades-long battle with opioid addiction, carried her daughter’s ashes in the passenger seat of her truck for two years, until a near-fatal crash into a tree convinced her to seek treatment.

“I woke up covered in bruises, bumps, and my daughter’s ashes,” DiMaso explained. “I felt as if my daughter had saved my life. That’s when I crawled out onto the ground, still inebriated at the time, and I asked my Creator to please help me with my drinking and drugging, my opioid addiction.”

DiMaso, 50, is one of many Native American Chicagoans caught up in the opioid epidemic, which has resulted in disproportionately high addiction and death rates in Native communities across the country.

In early February, more than 400 tribes and tribal organizations reached a tentative $590 million settlement with Johnson & Johnson and the country’s three largest drug distributors – McKesson, AmerisourceBergen, and Cardinal Health – after accusing the companies of flooding their communities with highly addictive opioids.

However, Indigenous leaders in Chicago, which has the third-largest urban Native American population in the country, with over 65,000 people representing 175 tribes, do not expect to receive any of that money due to the state of Illinois’ lack of tribal land. It’s part of a larger issue that prevents urban Natives from receiving support for issues that are just as prevalent in cities as they are on reservations.

Serna, a member of the Turtle Mountain Band of Chippewa Indians and the Oneida Nation, explained that because neither Chicago nor Illinois have any tribes or reservations, the city’s Native community has long struggled to access limited federal funding for American Indians.

The ancestral homelands of the Council of the Three Fires: the Ojibwe, Odawa, and Potawatomi Nations, are located in Chicago. Today, the city is home to citizens from nearly 200 tribes, many of whom were encouraged to leave their lands and assimilate into American society by the Indian Relocation Act of 1956.

According to the Indian Health Service, approximately 70% of American Indians and Alaska Natives now live in urban or suburban areas, but only slightly more than 1% of the $8.5 billion IHS budget goes to urban Indian health care organizations, known as UIOs.

According to the National Council of Urban Indian Health, which represents the country’s 41 UIOs, the majority of them rely on grants and other supplemental funding sources to provide essential care.

DiMaso is now a behavioral health counselor at the American Indian Health Service of Chicago, the city’s only UIO, where she provides relapse, recovery, and suicide prevention treatment.

According to the Centers for Disease Control and Prevention, opioid overdose deaths in the United States will reach a new high of 75,000 in 2021, with the rate of deaths among American Indians and Alaska Natives exceeding the national average every year since 2000.

Mensah regularly treats patients with chronic pain conditions, some of whom use opioids for pain management, despite the fact that he rarely prescribes opioids. According to him, at least 30% of AIHSC patients seek treatment for substance abuse issues.

Such issues, he says, are frequently exacerbated by the stressors of living in a city like Chicago, where over 1,800 people died from drug overdoses in 2020, according to the Cook County Department of Public Health.

Today, DiMaso is on what the Native community refers to as the “Red Road,” a path that promotes a healthy balance of the mental, physical, emotional, and spiritual selves. However, she is one of the few Indigenous counselors who is guiding her community down the same path with culturally competent care.

Even if they did not participate in the lawsuit, all 574 federally recognized tribes will be eligible to sign on to the opioid settlement agreement. According to Lloyd Miller, a lawyer who represented the tribes in the lawsuit, tribes and appointed tribal leaders will then decide how to distribute the money they receive over a seven-year period.