American Indians and Alaska Natives in the United States continue to persist and thrive, but the opioid crisis and opioid overdose deaths are a current threat to health and wellbeing. American Indians in Minnesota have the highest opioid overdose death rate of American Indians and Alaska Natives in the United States. Aim: As one effort to address this, a partnership was initiated between a Minnesota rural tribal nation, Gaa-waabaabiganikaag (White EarthNation), and investigators at the University of Minnesota Medical School, Duluth Campus, with funding support from the National Drug Early Warning System (NDEWS). These partners embarked on a NDEWS HotSpot study to identify risk and protective factors for opioid overdose deaths for White Earth Nation.