PINE RIDGE, SD — In a growing number of US states, people can both drink alcohol and legally smoke marijuana recreationally. In others, they can use alcohol but not pot. But on the Pine Ridge Indian Reservation in South Dakota, the opposite is true: Marijuana is legal, but alcohol is prohibited.

Citizens of the Oglala Sioux tribe voted overwhelmingly in 2020 to legalize recreational and medical marijuana on their sprawling reservation, which has banned the sale and consumption of alcohol for more than 100 years.

Clients who visited a dispensary on a recent Friday said they see marijuana as a safe and natural way to get relief from mental disorders and chronic illnesses that are common among tribal citizens. But they said alcohol wreaked havoc on tribal members’ health, safety and life expectancy.

“Cannabis is a natural plant that comes from the Earth – and our people lived off the earth and got their medicine from the earth,” Anne Marie Bean said as she shopped at the No Worries Dispensary in the small town of Pine Ridge. “Our local people suffer a lot from diabetes and cancer and various other diseases, but cannabis really helps them.”

Bean and her 22-year-old daughter said they use marijuana to ease their anxiety.

Marijuana use can lead to physical and mental problems, but shoppers at the No Worries store said it’s less dangerous than alcohol, methamphetamine and opioids. These drugs lead to high rates of premature death on the reservation due to car accidents, violence and disease.

The Pine Ridge Reservation, established in 1889, is spread over more than 2 million acres of small towns, ranches, prairies and otherworldly wilderness. The U.S. Census Bureau says about 20,000 people live there, but community members say that’s significantly less and that the population could be as high as 40,000.

Alcohol has been illegal there for most of the reservation’s history, but that hasn’t stopped smuggling and abuse. “It’s killing our youth — it’s killing our future generation,” Bean said.

The Oglala Sioux Tribe said in a 2012 lawsuit that about 25% of children born on the reservation had health or behavioral problems caused by alcohol exposure in the womb. The case was filed against already closed beer shops across the border into Nebraska.

Life expectancy is just 64.5 years in Oglala Lakota County, which includes much of the Pine Ridge Reservation. according to 2019 estimate from the Institute for Health Metrics and Evaluation at the University of Washington. That’s the lowest of any county in the U.S. and about 15 years below the national average.

Indians have a high rate of health problems which experts attribute to poverty and the ways their communities have been harmed and fragmented by federal policies. Those living on reserves often have limited access to health services and healthy food, and their primary health care provider is the Indian Health Service, which has been dogged by complaints from underfunding and poor quality care.

Last Friday, Bean was among dozens of customers who pulled into the No Worries dispensary’s gravel parking lot. After showing ID through the ticket window, customers entered the store to buy bulk marijuana, joints and food items prepared in a commercial-grade kitchen.

Only a few No Worries clients said they use marijuana purely recreationally. They are also said to use it to relieve anxiety, pain and other medical conditions.

One client’s eyes filled with tears as she lifted her shirt to reveal an ostomy bag that doctors attached to her midsection after removing part of her intestine.

Another client, Chantilly Little, said she was recovering from an addiction to stronger drugs. The 27-year-old woman said she has seen drugs kill tribals and wants to be a responsible parent. “I’d rather smoke than do other drugs because I almost gave up on my kids,” Little said.

Stephanie Bolman — a breast cancer patient, former health care worker and Lower Brule Sioux Tribal Council member — was traveling in the area and decided to visit the No Worries store.

Bolman doesn’t use marijuana, but he wanted to see the dispensary. She is interested in legalizing medical cannabis on her reservation, located along the Missouri River in central South Dakota, about four hours east of Pine Ridge.

“Unfortunately, the health services provided by the Indian Health Service have failed miserably in countless ways,” Bollman said. “It has left many to fend for themselves and endure so much pain and suffering that medical marijuana has proven to be a lifesaver.”

In 2020, when tribal citizens approved marijuana initiatives for the Pine Ridge Reservation, they rejected a proposal to legalize the sale and consumption of alcohol at the reservation’s two casinos.

In 2013, voters approved a referendum to legalize liquor reservation across the country by a narrow margin. But the tribal council never implemented the change.

The Lakota people did not use marijuana in pre-colonial times, said Craig Howe, a Lakota historian. The Lakota and other Great Plains tribes did not use either alcohol until it was introduced by white traders in the 1800s.

Alcohol “was meant to control our people and ended up being a weapon of mass destruction,” said Ruth Cedar Face, an addiction counselor and member of the Oglala Sioux Tribe.

Cedar Face said medical marijuana can be helpful for certain medical and mental health conditions, but it’s not a cure-all. “When it becomes a problem, when it becomes an addiction, it’s because they’re treating the things they need to deal with, like the trauma that’s usually at the root of any kind of addiction or unhealthy behavior,” she said.

Cedar Face said marijuana can also cause psychosis, lung damage, reduced brain development and other problems for some users. especially teenagers and young adults.

People must be 21 or older to buy or use cannabis, according to Oglala Sioux law. They can face jail time for providing marijuana to minors and fines for using the drug while driving.

Dispensaries can only sell marijuana grown on the reservation, and customers are prohibited from transporting cannabis elsewhere. But about 40 percent of No Worries’ customers live off the reservation, with many traveling from the Black Hills of South Dakota or northwest Nebraska, owner Adonis Salts said.

Recreational marijuana is illegal in South Dakota, meaning law enforcement officials can charge anyone caught transporting or using cannabis outside of reservation boundaries. But the sheriff’s office in Pennington County, which borders the Pine Ridge Reservation, said it has not arrested anyone on such charges.

This contrasts with the experience of the Flandreau Santee Sioux tribe in the eastern part of the state. State and local law enforcement officials charge Indians and non-Natives who have left the reservation with cannabis from the reservation’s medical dispensary, according to Seth Pearman, the tribe’s attorney general.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of three major operational programs in the KFF (Kaiser Family Foundation). KFF is a charitable, non-profit organization providing information on health issues to the nation.

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