INTRODUCTION: In recent years, higher rates of overdose deaths have been observed among Black individuals in the United States compared to individuals who are white or other races, as part of the potent fourth wave of the opioid epidemic. However, much of the research addressing this surge has focused on Black individuals in urban areas, despite evidence that usage and overdose rates are accelerating among rural Black People Who Use Drugs (PWUD), a gap we aim to fill here via a qualitative assessment.
METHODS: Between September 2023 and June 2024, we conducted semi-structured interviews with a sample of Black adult PWUD who live in rural southern Illinois. The interviews were evaluated using abductive analytic methods.
FINDINGS: In general, participants highlighted exposure to parental substance use and poor mental health as key factors contributing to drug use initiation. Participants further described their social networks as small, emphasizing a desire to stay hidden to avoid social scrutiny. Finally, participants had mixed feelings about the nature and value of medications for opioid use disorder (e.g., buprenorphine, methadone, etc.) and expressed limited knowledge about where to access harm reduction resources like naloxone.
CONCLUSIONS: Rural Black PWUD may experience complex early-life exposures to substance use and later-life challenges in terms of communal integration due to stigma and structural disenfranchisment. These dynamics may specifically prevent the manifestation of strong support networks and engagement with treatment and harm reduction.
The experiences and attitudes of rural Black people who use drugs
Journal of Racial and Ethnic Health Disparities [Epub 2026 Jan 5]. doi: 10.1007/s40615-025-02798-8.