U.S. Surgeon General Vivek H. Murthy, MD, met with Native Americans in Oklahoma to discuss prescription drug abuse and opioid addiction, the Associated Press reports.

Murthy held a town hall meeting with Native American youth who are developing prevention programs in their own communities, and held a listening session with tribal leaders, parents and youth. It was the first time a U.S. Surgeon General has met with tribal leaders, according to the AP.

Speakers at the meetings said Native American communities must deal with many burdens on top of addiction, including poverty, abuse, sex trafficking and limited Indian Health Services resources.

“The prescription opioid epidemic that is sweeping across the U.S. has hit Indian country particularly hard,” Murthy said. He acknowledged the community’s efforts to integrate traditional culture into treatment and prevention programs. “When we strengthen culture and identity, we strengthen our communities,” Murthy said. “Community is an antidote to isolation.”

A study funded by the National Institute on Drug Abuse that was published in 2014 compared data from a survey given to American Indian students at 33 schools on or near reservations in 11 states, with nationwide data from the Monitoring the Future study. The researchers found a much higher prevalence of drug and alcohol use in the American Indian 8th and 10th graders compared with national averages.

American Indian students’ annual heroin and OxyContin use was about two to three times higher than the national averages in those years. The study also found American Indian youth are initiating alcohol and drug use earlier than their non-native peers.