"Can we get a Black rehabilitation center"? Factors impacting the treatment experiences of Black people who use opioids

Ethnic Identity and Past 30-Day Opioid Misuse: Mediating Effect of Relational Support

INTRODUCTION

Black Americans in Kentucky are disproportionately dying from opioid overdoses compared to other racial and ethnic groups. Despite increased mortality among this population, limited research examines factors associated with recent opioid misuse among Black adults in Kentucky. Previous literature shows that relational support and ethnic identity protect racial and ethnic minority groups from substance use behaviors, but limited research examines how these factors are associated with opioid misuse among Black adults. Grounded in Social Identity Theory, the present study examines the effect of ethnic identity on opioid misuse and the mediating effect of relational support.

METHOD

Participants were 735 Black adults in Kentucky stratified by age and gender. Participants completed a quantitative survey examining ethnic identity, relational support, and past 30-day opioid misuse. Data were examined using PROCESS macro mediation analysis to determine the association between ethnic identity and recent opioid misuse, and whether relational support mediates this relationship.

RESULTS

While there was not a direct effect of ethnic identity on recent opioid misuse, there was a significant indirect/mediated effect. Specifically, increased ethnic identity is significantly associated with decreased past 30-day opioid misuse through increases in relational support.

CONCLUSIONS

Results highlight important implications for working with Black adults who misuse opioids (e.g., in clinical substance use treatment settings) that are discussed, such as the importance of fostering strong relational supports, such as instrumental and emotional support.

Co-production in community-based substance use disorder treatment services: a scoping review

PURPOSE OF REVIEW

The personal and social harms from unmanaged substance use disorders (SUD) are substantial. Too few people with SUD are engaged in treatment, partly due to the acceptability and accessibility of services. Co-production - sharing power and decision-making between professionals and people with lived experience (PWLE) - could address barriers to improve uptake and outcomes of SUD treatment. This scoping review examined recent (01/09/2023-08/03/2025) literature on co-production in community SUD treatment services.

RECENT FINDINGS

Co-production has been used to address barriers to care and co-design new interventions and services, especially for marginalised populations and groups with complex needs. Methods, processes, and the degree of meaningful involvement of PWLE varied across projects. Most work occurred in higher income countries and the impacts on PWLE were rarely explored.

SUMMARY

Co-production is feasible and can inform the development of more patient-centred SUD treatment services. Projects should be grounded in theory and power differentials in decision-making addressed to ensure equitable and meaningful participation throughout the process. There is a need to explore co-production in the design and evaluation of general SUD treatment, sustainability, impacts on participants, and evaluation of long-term outcomes.

The first five years of implementing Missouri's medication first approach to opioid use disorder treatment: Plateaus, regressions, and underbellies of progress

INTRODUCTION

Missouri's Medication First ("MedFirst") approach promotes same-day and long-term low-threshold access to medications for opioid use disorder (MOUD). Since 2017, Missouri's SAMHSA-funded State Targeted and State Opioid Response (STR/SOR) grants have supported MedFirst services (both medical and psychosocial) for uninsured individuals with opioid use disorder at state-contracted treatment programs. Though MedFirst demonstrated early success, results - with attention to possible racial disparities - must be revisited after five years of implementation.

METHODS

Using state behavioral health claims, we examined four outcomes: (1) MOUD utilization, (2) time-to-medication, (3) psychosocial service volume, and (4) substance use disorder (SUD) treatment retention. Models compared four groups: (a) individuals in MedFirst during the first and fifth year of implementation (2018 vs. 2022), (b) individuals in MedFirst compared to non-MedFirst, (c) individuals prior to MedFirst (2017) compared to individuals during MedFirst's fifth year (2022), and (d) White compared to Black individuals within and outside MedFirst.

RESULTS

Overall, MedFirst outcomes were superior to non-MedFirst outcomes. Among individuals in MedFirst, however, outcomes were generally poorer in 2022 than in 2018, and Black individuals had shorter treatment episodes and were less likely to receive MOUD than White individuals. Overall, Missourians had only slightly better outcomes in 2022 than prior to STR/SOR initiation.

CONCLUSIONS

Since Missouri's initial implementation of STR/SOR-funded MedFirst, select overall treatment outcomes have improved. Within MedFirst programs, however, outcomes worsened over time, and racial disparities were evident. Though fentanyl's dominance of the drug supply alongside the COVID-19 pandemic contributed to these results, fidelity drift, particularly due to financial implications of MedFirst, likely also negatively impacted sustainability.

Embracing anti-racism: Co-creating recommendations with Black people for how addiction treatment needs to change

In the United States, Black people face harsher health and social consequences of addiction compared to people who are not Black. These differential consequences are largely attributable to systemic racism. While addiction treatment may mitigate health disparities related to substance use, Black people also experience structural barriers and direct interpersonal racism which contribute to inequitable access and treatment outcomes. Improvements in addiction treatment for Black people are urgently needed, but there is little guidance or consensus on how to achieve this. Our interdisciplinary work group is comprised of 16 researchers and clinicians from one urban safety-net hospital in the Northeast US, and 9 community members with lived experience of substance use disorder (SUD) who came together from 2022 to 2024 for a community-engaged initiative to identify how to make addiction treatment more appealing, effective, and equitable for Black people. This paper's objective is two-fold. First, we provide a broad overview of the project, which included 6 scoping literature reviews, 7 focus groups, and 4 day-long convenings which included an additional 30 experts on addiction treatment for Black patients, drawn primarily from the Northeast U.S. Altogether, we engaged more than 70 people with expertise in substance use and treatment, the majority of whom identify as Black. Second, we present major findings from the convenings, where we identified actions that can be taken now to improve the care of Black people and challenge the racist features of our addiction treatment system. Making addiction treatment more appealing, effective, and equitable will help to achieve health equity for Black people who use substances.

Knowledge, experiences, and perceptions of medications for opioid use disorder among Black Kentuckians

BACKGROUND

Opioid overdoses have continued to increase at higher rates among Black Americans compared to people from other racial groups. Despite demonstrated effectiveness of MOUD in reducing risk of opioid overdose, Black Americans face decreased access to and uptake of MOUD. The current study aimed to examine the knowledge, perceptions, and experiences with MOUD among a sample of Black adults who use prescription opioids nonmedically in order to inform tailored efforts to improve MOUD uptake.

METHODS

Data were derived from a larger study assessing cultural and structural influences on drug use and drug treatment among people who use prescription opioids nonmedically. Semi-structured qualitative interviews were conducted with 34 Black men and women across four generational cohorts: born 1955-1969; 1970-1979; 1980-1994; and 1995-2001. Participant responses were analyzed using thematic analysis.

RESULTS

Nearly half of participants (44.1%) reported no knowledge or experience with MOUD. Among participants who had any knowledge about MOUD, four major themes regarding their perceptions emerged: MOUD Helps with Recovery; Not Needed for Level of Drug Use; Side Effects and Withdrawal; Equivalence with Illicit Drug Use. The majority reported negative perceptions of MOUD (52.6%), and the youngest cohort (born 1995-2001) had a higher proportion of negative perceptions (80%) relative to other age cohorts (born 1980-1994: 50%; 1970-1979: 75%; 1955-1969: 16.6%).

DISCUSSION

Findings indicate a significant knowledge gap and clear points of intervention for improving MOUD uptake. Interventions to improve communication of health information in ways that are culturally relevant and tailored by age group can be used in conjunction with efforts to improve MOUD access among Black individuals who use opioids nonmedically.

"Drug Use with Racism…The Reason I Wanted to Do This Study": Perceptions of Race and Racism's Impact on Drug Use among Black Americans Using Opioids

Background: Several studies link racism with drug use disparities among systemically marginalized populations. However, few invite Black Americans to discuss how they perceive racism's impact on their drug use. Objectives: To examine qualitative accounts from N=40 Black adults reporting non-medical prescription opioid use on their experiences of racism and drug use. Results: A deductive structural tabular thematic analysis informed by Jones's (2000) levels of racism resulted in two themes: (a) Experiences of Racism (subthemes: Denying Experiences of Racism and Endorsing Experiences of Racism) and (b) Race, Racism, and Drug Use (subthemes: Rejecting Race and Racism's Impact on Drugs and Rejecting Race and Racism's Impact on Drugs). Conclusions: Participants provided examples of internalized, personally mediated, and institutionalized racism associated with their drug use. Implications for policy, practice, and research are discussed. Specifically, implications detail how to center Black Americans and demonstrate anti-racism when developing treatment strategies and drug policies.

Identifying facilitators and barriers to the uptake of medication for opioid use disorder in Washington, DC: A community-engaged concept mapping approach

INTRODUCTION

Opioid overdose is a major public health challenge. We aimed to understand facilitators and barriers to engagement in medication for opioid use disorder (MOUD) among persons with OUD in Washington, DC.

METHODS

We used a cross-sectional mixed-methods concept mapping approach to explore MOUD engagement between 2021-2022. Community members at-large generated 70 unique statements in response to the focus prompt: "What makes medication for opioid use disorder like buprenorphine (also known as Suboxone or Subutex) difficult to start or keep using?" Persons with OUD (n = 23) and service providers (n = 34) sorted and rated these statements by theme and importance. Data were analyzed with multidimensional scaling and hierarchical cluster analysis, producing thematic cluster maps. Results were validated by our community advisory board.

RESULTS

Seven themes emerged in response to the focus prompt: availability and accessibility; hopelessness and fear; unmet basic needs; characteristics of treatment programs; understanding and awareness of treatment; personal motivations, attitudes, and beliefs; and easier to use drugs. "Availability and accessibility," "hopelessness and fear," and "basic needs not being met" were the top three identified barriers to MOUD among consumers and providers; however, the order of these priorities differed between consumers and providers. There was a notable lack of communication and programming to address misconceptions about MOUD's efficacy, side effects, and cost. Stigma underscored many of the statements, showcasing its continued presence in clinical and social spaces.

CONCLUSIONS

This study distinguishes itself from other research on MOUD delivery and barriers by centering on community members and their lived experiences. Findings emphasize the need to expand access to treatment, dismantle stigma associated with substance use and MOUD, and address underlying circumstances that contribute to the profound sense of hopelessness and fear among persons with OUD-all of which will require collective action from consumers, providers, and the public.

"You said burnout? Whew, chile!" A multigenerational collaborative autoethnography on the complexities of burnout and care among Black women researching substance use

BACKGROUND

Researchers and participants who are members of minoritized populations experience negative psychosocial and wellness outcomes like burnout. Burnout may manifest uniquely for Black women in academia conducting research with Black women participants navigating similar sociocultural contexts.

OBJECTIVES

This article qualitatively interprets our experiences as 15 Black women scholar-practitioners at a midwestern university conducting community-engaged research. We discuss our experiences of care and burnout while working to reduce opioid use disparities among Black women community members as we simultaneously navigate multilevel challenges in academia.

DESIGN

We employ collaborative autoethnography, an autobiographical writing method, using a Black feminist framework and intersectionality methodology.

METHODS

We are 15 Black women researcher-subjects on the REFOCUS study-a mixed-methods National Institute on Health-funded project examining nonmedical prescription opioid misuse among Black Kentuckians. We examined a series of multigenerational sista circles and individual journal entries we completed to understand the multilevel power dynamics impacting our individual and collective work, burnout, and care.

RESULTS

Themes were: (1) "I see me in you": Research with Black Women, (2) "Pervasive, cellular, and epigenetic": Burnout Experiences; (3) "Taxing but rewarding": The Price We Pay to See an Outcome, and (4) "Thank God for the collective": Complexities of Caring Through the Process.

CONCLUSION

We highlight the importance of continued efforts to address workload inequities among Black women in academia, particularly for those working to combat health disparities among Black women or within Black communities. We make recommendations for structural, institutional, and interpersonal steps to improve the support of Black women across career stages.

Outcomes of State Targeted/Opioid Response Grants and the Medication First Approach: Evidence of Racial Inequities in Improved Treatment Access and Retention

BACKGROUND

Since 2017, Missouri has increased access to medication for opioid use disorder (OUD) within the State's publicly-funded substance use specialty treatment system through a "Medication First" approach. Results from a statewide assessment of the first year of State Targeted Response implementation showed increases and improvements in overall treatment admissions, medication utilization, and treatment retention. The current study, which focuses on the St. Louis region, the epicenter of Missouri's overdose crisis, examines whether improvements were experienced equally among Black and White clients.

METHODS

This study is a retrospective analysis using state-level billing records for individuals with OUD receiving services through publicly-funded substance use treatment programs between July 1, 2016, and June 30, 2019, with claimed services updated through November 1, 2020. Comparisons across time periods, treatment groups, and Black and White clients were assessed using chi-square tests of independence and multivariate negative binomial regressions.

RESULTS

White individuals in St. Louis experienced larger increases in treatment admissions and utilization of medications for OUD than Black individuals, and Black clients were retained in treatment for shorter lengths of time than White clients.

CONCLUSION

In Missouri, rates of drug overdose deaths are more than three times higher for Black people than White people. Racial inequities in OUD treatment utilization and retention must be intentionally targeted and corrected as one component of reducing this sizable disparity in fatalities.