The Cherokee Nation was the first tribe to sue.

In April 2017, before most state attorneys general had even convened task forces, the Cherokee Nation filed suit against McKesson, Cardinal Health, AmerisourceBergen, CVS, Walgreens, and Walmart. The claim was specific: these companies violated sovereign Cherokee law by failing to prevent the diversion of pain pills to the black market, flooding 14 counties with opioids and profiting from the wreckage.

The wreckage: more than 1,000 people dead in those 14 counties between 2020 and 2024. Many of the deaths were in rural areas — the places where Cherokee language and culture are often strongest. The epidemic didn’t just kill people. It killed the keepers.

The Cherokee Nation recovered approximately $150 million.

That’s roughly 0.3 percent of the more than $50 billion in total opioid settlements negotiated nationwide. The tribe that sued first. The tribe with sovereign jurisdiction over the land where the pills were dumped. Three-tenths of one percent.

Here is what they are building with it.

A 45,000-square-foot residential treatment center in Tahlequah, the tribal capital. One hundred inpatient beds. An outpatient hub with follow-up support. Construction began in March. Completion is scheduled for August.

The building faces east, toward the rising sun.

There is a stickball court. Stickball — anetso — is a game that predates European contact, once used to settle disputes between communities before they became wars. Missionaries tried to stamp it out in the 1790s. The Cherokee Nation has been reviving it through community game days, teaching young people the sport as what one language teacher called a “gateway drug into Cherokee culture” — fall in love with the game, fall in love with the ceremonies and traditions that surround it.

There is a garden growing selu — corn. Cherokee corn, planted in Cherokee soil, tended by people in recovery on Cherokee land.

There is a sweat lodge nearby. There are meditation spaces. Large windows overlook rolling hills. Cherokee language experts are finalizing the center’s name through listening sessions with elders.

The facility will be free for tribal citizens. It will be the Cherokee Nation’s first independently operated treatment center. Currently, people seeking help are referred to contracted facilities outside tribal control. Senior Director of Behavioral Health Juli Skinner — a Ponca Tribe citizen — says the tribe needs to connect approximately 50 to 70 citizens per month to residential treatment. This center will let them do it on their own terms, in their own language, on their own land.

Principal Chief Chuck Hoskin Jr. framed it plainly: “Whether what it means to be Cherokee is going to continue on; that’s only true if we have people that continue our lifeways.”

That’s the prescription. Culture as medicine. Not a metaphor. An architectural plan, a budget line, a stickball court poured in concrete.

Now here is what the states are building.

West Virginia — ground zero of the opioid crisis — spent more than half its settlement dollars on law enforcement in 2024. Logan County put nearly $1 million of its $3.9 million share toward jail bills. Boone County: $452,766 on jail bills. Franklin County, Missouri: $352,000 for a narcotics detective. New Jersey’s legislature diverted $45 million to four hospital systems with no strings attached — prompting the state’s own attorney general to call it “blood money” spent as a “slap in the face” to families.

Mississippi’s legislature bypassed its own advisory council’s recommendations, redirected funds to groups that never applied, and replaced the Department of Mental Health with a private company as the recipient of a $4 million maternal substance use grant.

We have seen this before. The 1998 tobacco settlement delivered $240 billion. By 2023, states were spending 3 percent of tobacco settlement revenue on smoking prevention. New York used settlement money to buy golf carts. States subsidized tobacco farmers with tobacco settlement money. Twenty-three percent went to fill budget deficits.

The opioid settlements were supposed to be different. The agreements require that at least 70 percent be spent on opioid-related expenses. But “opioid-related” is a wide door. Jails are opioid-related. Narcotics detectives are opioid-related. Gun silencers purchased by police departments — CBS News documented this — are, apparently, opioid-related.

A stickball court is also opioid-related. A garden growing selu is opioid-related. A building that faces east is opioid-related.

The difference is that one of these prescriptions was written by the people who buried the dead.

In Stilwell, Oklahoma — a small town in Adair County, deep in Cherokee Nation territory — Ashley Caudle restocks Narcan at her storefront almost daily. That’s the scale. Not a policy paper. A woman refilling a shelf.

Native Americans now experience higher opioid-related death rates than white Americans. The CDC reports that AI/AN individuals registered 65.2 drug deaths per 100,000 in 2022 — twice the national average. Overdose death rates jumped 39 percent in a single year. Treatment access is lower for Native populations than for any other racial group, due to chronic underfunding of Indian Health Service facilities, overregulation of methadone, and the compounding weight of poverty and housing instability that shouldn’t need explaining in 2026 but apparently still does.

The Cherokee Nation got 0.3 percent of the settlement money. They are building a treatment center with a stickball court. West Virginia got more. They are paying jail bills.

The opioid crisis was a prescription. Doctors wrote it. Distributors filled it. Pharmacies dispensed it. The companies settled because the receipts were that clear — McKesson, Cardinal, and AmerisourceBergen paid $75 million to Cherokee Nation alone, the first tribal settlement of its kind.

The recovery is also a prescription. The Cherokee Nation wrote it. The ingredients are corn, and stickball, and a building that faces the sunrise, and a name chosen by elders, and a woman in Stilwell who refills the Narcan shelf every morning because that’s what’s needed today while the concrete cures on what’s needed tomorrow.

The prescription that caused the crisis was manufactured. The prescription that’s treating it was already there.

It just needed someone to fund it who actually understood the diagnosis.

// NEON BLOOD

Sources: KOSU/Jessica Meza, KRMG, CBS News, 100 Days in Appalachia, Mississippi Today, Brookings Institution, CDC, CNN (2017), KFF Health News