Cultural Adaptation of Overdose Education Programs: Recommendations from Black Americans with Lived Experience of Opioid and Stimulant Use.

Black Americans have experienced disproportionate overdose deaths due to structural barriers inflicted by systemic racism, particularly among individuals who co-ingest opioids and stimulants. Despite efforts to improve overdose prevention resources on a national level, Black Americans continue to have lower access to naloxone for overdose reversal, are less likely to have received naloxone training, and have lower engagement in other overdose prevention strategies. Community engaged and culturally informed approaches are needed to ensure equitable provision of overdose education and naloxone distribution (OEND). Using empirically supported community engaged methods, the current study centers perspectives of stakeholders with lived experience to identify cultural adaptation needs for OEND programs that specifically target Black adults who use opioids and stimulants. Semi-structured qualitative focus groups revealed several themes that provide insights on cultural adaptation needs, including: centering Black overdose experiences, changes to structure and format, dispelling naloxone myths, coping strategies and alternatives to drug use, motivations for wellness, and sharing with others. Findings can inform more effective dissemination of OEND in Black communities impacted by high overdose rates.