Trauma Profiles and Cocaine Use Among Formerly Incarcerated Black Men Who Co-Use Opioids and Stimulants.

Trauma exposure and structural inequities contribute to mental health disparities among Black men and create barriers to care. Black men face elevated risk from opioid and stimulant co-use, including overdose from unintentional opioid exposure, yet heterogeneity in trauma exposure among men who co-use substances is understudied. Using latent class analysis, this study identified unobserved trauma subgroups and examined associations with cocaine use in a sample of Black men co-using opioids and stimulants; most were formerly incarcerated (88%). Three profiles emerged: Low Trauma (36%), High Non-Sexual Trauma (42%), and High Trauma Across All Categories (21%). In regression models, men in the High Trauma Across All Categories class had higher odds of lifetime powder cocaine use (OR=4.13, p<.01) and crack cocaine use (OR=2.08, p<.05) versus the Low Trauma class. Older age was associated with stimulant use, while incarceration history predicted powder cocaine use only. Findings underscore within-group heterogeneity and support trauma-informed interventions to reduce overdose risk among Black men who co-use opioids and stimulants. Targeted screening and tailored services may strengthen engagement in care and harm reduction.