Embracing anti-racism: Co-creating recommendations with Black people for how addiction treatment needs to change

In the United States, Black people face harsher health and social consequences of addiction compared to people who are not Black. These differential consequences are largely attributable to systemic racism. While addiction treatment may mitigate health disparities related to substance use, Black people also experience structural barriers and direct interpersonal racism which contribute to inequitable access and treatment outcomes. Improvements in addiction treatment for Black people are urgently needed, but there is little guidance or consensus on how to achieve this. Our interdisciplinary work group is comprised of 16 researchers and clinicians from one urban safety-net hospital in the Northeast US, and 9 community members with lived experience of substance use disorder (SUD) who came together from 2022 to 2024 for a community-engaged initiative to identify how to make addiction treatment more appealing, effective, and equitable for Black people. This paper's objective is two-fold. First, we provide a broad overview of the project, which included 6 scoping literature reviews, 7 focus groups, and 4 day-long convenings which included an additional 30 experts on addiction treatment for Black patients, drawn primarily from the Northeast U.S. Altogether, we engaged more than 70 people with expertise in substance use and treatment, the majority of whom identify as Black. Second, we present major findings from the convenings, where we identified actions that can be taken now to improve the care of Black people and challenge the racist features of our addiction treatment system. Making addiction treatment more appealing, effective, and equitable will help to achieve health equity for Black people who use substances.