"Not Knowing that I Could Get Addicted at Any Moment": Drug Use Initiation Narratives among Black Americans

Overdose death rates increased by 44% among Black Americans in 2020. While Black individuals may initiate drugs at older ages than their counterparts, research shows a cross-over effect in adulthood where drug use (e.g., cannabis, alcohol, and opioids) and disorders are higher or comparable. The consequences of drug use are also more severe among Black Americans compared to other racial/ethnic groups, such as health-related adverse outcomes, overdose, legal concerns, and social problems. Despite risks, limited research examines drug initiation narratives among Black Americans. Using narrative analysis, we examined the contexts of drug use initiation among 39 Black adults across four age cohorts with a recent history of opioid use. The current study examines participants' use of identity positioning and withholding or forthcoming narrative styles to disclose contexts (i.e., who, what, when, where, why, and how) of drug use initiation among Black adults with recent prescription opioid misuse. Results highlight features of Black opioid users' awareness and self-representation while detailing systemic and cultural factors related to drug initiation. Results also indicate initiation ages, common substances first used (e.g., marijuana), routes of administration during initiation (e.g., smoking, swallowing), and the circumstances that lead to use. We discuss implications of drug use initiation narrative style and contexts on drug use interventions among this population.