"Building the connection route to help": a qualitative study of opioid use disorder recovery processes for black women age 18-30

Black women's opioid overdose death rates now exceed those of White women, yet Black individuals are less likely to receive medications for opioid use disorder. Black women also face gendered racism that compound barriers to treatment. Little is known about how Black women navigate treatment once they seek it. Using Constructivist Grounded Theory, we conducted semi-structured interviews with 30 adult Black women with opioid use disorder, aged 18 to 30 years. The purpose of this study was to explore how they navigate and manage the treatment and recovery process. Most participants (83.3%) reported two or more prior treatment attempts. Participants described a central process, building the connection route to help, in which they navigated connections to treatment through trusted relationships, most often friends and family, and, less commonly, institutional pathways such as hospital referrals. This process was shaped by trauma, a culturally based internalized checklist of the ideal Black woman, age, and gendered racism. Five stages comprised the process: reasons for opioid use, self-stigma as a Black woman with opioid use disorder, recognition of addiction, treatment-seeking, and experiences in treatment support services. Findings suggest that trusted relationships serve as critical entry points to treatment for Black women and that treatment programs should engage these relational networks to support treatment-seeking and sustained engagement.