Cherokee Nation Builds Treatment Center Rooted in Culture Using $150 Million Opioid Settlement

TAHLEQUAH, Oklahoma — In the rolling hills of eastern Oklahoma, where the Cherokee Nation has governed for generations, a new kind of healing is taking shape. Construction crews are putting the finishing touches on a 45,000-square-foot residential treatment center that represents something unprecedented in American addiction care: a facility where recovery is inseparable from cultural reclamation.

When the doors open next year, the Cherokee Nation's new behavioral health campus will offer 100 inpatient beds and intensive outpatient services. But what distinguishes this facility from the thousands of treatment centers dotting the American landscape isn't the bed count or the square footage. It's the understanding, honed over centuries of survival and adaptation, that healing happens through connection to identity, community, and tradition.

"Culture is such a protective factor," said Juli Skinner, senior director of the Cherokee Nation's behavioral health center and a citizen of the Ponca Tribe of Oklahoma. "Historical trauma has hit a lot of people — Native Americans, tribes — hard. Lost language, lost traditional ways, and we'll never get all of that back."

From Litigation to Healing

The $150 million financing this project didn't come from federal grants or tribal gaming revenues. It came from courtrooms. The Cherokee Nation was the first of 575 federally recognized tribes to sue opioid manufacturers in 2017, years before most state governments mounted their own legal challenges. That early action positioned the tribe as a lead plaintiff in negotiations that ultimately yielded roughly $1.3 billion for tribal nations nationwide.

Principal Chief Chuck Hoskin Jr. frames the litigation as an extension of tribal sovereignty — a refusal to let outside corporations devastate Cherokee communities without consequence. The tribe had watched from the sidelines during the tobacco litigation of the 1990s, and Hoskin vowed that history wouldn't repeat itself.

"There will never be another era in which there's some industry that does damage to the Cherokee Nation, damage to the Cherokee people, where we will be bystanders looking for state legislatures, state attorneys general to get us justice," he said.

The settlement money comes with strings attached, as it does for states and municipalities. The vast majority must fund opioid remediation — treatment, prevention, recovery support, and harm reduction. But within those constraints, the Cherokee Nation saw an opportunity to address a gap that conventional American healthcare has long failed to close: the disconnect between evidence-based clinical treatment and the cultural frameworks that give recovery meaning.

Culture as Clinical Intervention

Walk through the treatment center's plans, and you won't find the sterile institutional corridors common to residential facilities. Instead, the campus incorporates spaces designed for traditional Cherokee practices. Patients will tend an on-campus garden growing selu, the corn that has sustained Cherokee people for generations. They'll participate in stickball games — the ancient sport sometimes called "the little brother of war" that has served as both physical conditioning and community-building for centuries.

These aren't recreational add-ons. They're integrated into the clinical model as therapeutic modalities. The growing body of research on culturally responsive addiction treatment supports this approach: when treatment aligns with a patient's values, identity, and worldview, outcomes improve. For Native Americans, who have faced disproportionate overdose mortality since fentanyl entered the drug supply, culturally grounded care isn't a luxury — it's a clinical necessity.

The opioid crisis has devastated Native communities with particular ferocity. While overdose death rates for Native Americans tracked similarly to white Americans during the prescription pill and heroin waves, the arrival of fentanyl created a divergence that has persisted through the pandemic years. Native Americans now experience opioid-related mortality at rates exceeding most other demographic groups, a disparity rooted in historical trauma, geographic isolation, and systemic barriers to healthcare access.

Ashley Caudle, a Cherokee Nation citizen who runs a small business in Stilwell, twenty miles east of Tahlequah, witnessed this reality firsthand. She kept free Narcan outside her storefront last year and found herself restocking it weekly, sometimes daily. The demand told a story that statistics only partially capture.

A Model for Settlement Fund Deployment

The Cherokee Nation's approach offers a potential template for the tens of billions of dollars flowing to state and local governments through opioid litigation. While some jurisdictions have struggled to deploy settlement funds effectively — with money diverted to law enforcement equipment, general budget shortfalls, or programs with tenuous connections to addiction — the tribe's investment represents a direct, transformative response to community need.

The 100-bed facility will more than double the tribe's residential treatment capacity. The intensive outpatient hub will provide step-down care and ongoing support, addressing a critical gap in the continuum of services. Too often, patients discharge from residential treatment with nowhere to go, no support system, and no connection to ongoing care. The Cherokee model integrates these services on a single campus, with cultural programming providing the continuity that keeps people engaged.

For the approximately 450,000 Cherokee Nation citizens — many concentrated in Oklahoma due to the federal policies that forcibly removed the tribe from its southeastern homeland — the facility represents something beyond healthcare infrastructure. It's a statement about tribal self-determination, about the capacity of Native nations to solve their own challenges using their own frameworks.

The Broader Context

The Cherokee Nation's project arrives at a pivotal moment for American addiction policy. Overdose deaths have declined roughly 19% nationally since their August 2023 peak, driven by expanded naloxone distribution, medication-assisted treatment access, and harm reduction services. But these gains remain fragile, threatened by emerging synthetic drugs, federal funding uncertainty, and the persistent structural barriers that keep most Americans with substance use disorders from receiving any treatment at all.

Tribal nations have historically faced these barriers in amplified form. Geographic isolation, workforce shortages, jurisdictional complexities, and underfunded Indian Health Service facilities have created treatment deserts across Indian Country. The opioid settlements have provided tribes with resources to begin addressing these gaps, but the challenge of building sustainable, culturally appropriate systems remains immense.

The Cherokee Nation's treatment center won't solve these problems overnight. A 100-bed facility, however well-designed, can't meet the needs of hundreds of thousands of citizens spread across a vast territory. But it establishes a model — one that other tribes, and potentially state and local governments, can adapt to their own contexts.

Looking Forward

As construction continues toward an anticipated opening in 2027, tribal leaders are already thinking about replication and expansion. The facility's design incorporates feedback from Cherokee citizens in recovery, from behavioral health staff, and from cultural practitioners who understand how traditional practices can support modern therapeutic goals.

The integration isn't seamless — it requires ongoing negotiation between clinical protocols and cultural protocols, between federal healthcare regulations and tribal sovereignty. But that negotiation itself represents a kind of healing, a reclaiming of authority over how Cherokee people address the challenges facing their communities.

For Juli Skinner, who has spent over a decade working in Cherokee behavioral health, the new facility represents the culmination of a long effort to bring culture into spaces where it had been excluded. "Tribal traditions have given me a healthy way to self-regulate and strengthen my connection with Spirit," she said. Now, that pathway will be available to others seeking their own recovery — not as an alternative to clinical care, but as its essential foundation.

The opioid crisis took countless Cherokee lives and threatened to sever the connections that hold the nation together. The response, funded by the very corporations that profited from that devastation, aims to strengthen those connections — one patient, one tradition, one recovery at a time.