“I don't want it in any form:” A qualitative study on black perceptions of buprenorphine in the fentanyl era

Background: The current phase of the US opioid overdose epidemic is marked by growing racial inequities, driven in part by unequal access to medications for opioid use disorder (MOUD) including buprenorphine. This report provides a much needed update on the racialized patterns of treatment uptake in an evolving drug use and treatment landscape. Methods: We conducted semi-structured qualitative interviews with 28 African American people with a self-reported history of OUD who had lived in the Twin Cities (Minneapolis and Saint Paul), Minnesota for at least a year. Interviews explored participants’ attitudes, knowledge, and perceptions of medications for OUD (MOUD) with a focus on methadone and buprenorphine. Findings: 67.9 % of participants were male and the mean age was 53.4. More participants knew about and had taken methadone (100 %, 89.3 %, respectively) as compared to buprenorphine (89.3 %, 75 % respectively). We identified three key themes: 1) the unfamiliarity of buprenorphine; 2) the remembered damage of buprenorphine-induced precipitated withdrawal; and 3) readiness to quit and its impact on medication choice. Conclusions: Black perceptions of MOUD consist of universally dim views toward methadone and highly ambiguous attitudes toward buprenorphine. Strategies to improve Black access to buprenorphine must therefore be grounded in a better understanding of the historical context of MOUDs in this community and the medical mistrust it engenders. Better strategies for safe induction of people with fentanyl dependence are also needed, particularly those informed by the concerns and priorities of Black and other racially minoritized communities.