Table 1 Participant quotes regarding race-related barriers to engaging in lifesaving behaviors following an opioid overdose

Practical barriers: naloxone

The opioid or the opioid response in my community, uh, aims more so from my vantage point for White people. Um, it has been an epidemic. It became an epidemic when more White folks were in trouble with opioids. Um, for instance, the naloxone, you know, all these avenues that they have to, um, utilize before they go into, before, before they overdose in the African American community. I think the resources have been limited, but since it has become an epidemic for the Caucasian persuasion, um, I think it's, it's trickling down where it can be effective in the African American community

Practical barriers: naloxone

Interviewer: There are some legitimate claims that Black dominated communities do not receive equitable overdose education. Subject: Absolutely. Interviewer: And naloxone distribution as a White… Subject: As a matter of fact, in those communities what not, what, what education is there? Like as a, like that's just a research thing. If you just look. Interviewer: Mm-hmm. < affirmative > . Subject: It isn't there. There's, I mean, in my community it's a basically an everything desert

Practical barriers: naloxone

Well, this is the first time I ever see this in the Black community. What you guys are doing now, um, I go a lot to the [community organization] and also to [community organization]. Those are two things that are next to me. But, um, nobody never introduces or even had prevention, um, classes on drug use. Uh, you know, yes, sometimes I have to teach it and, and to the staff and train them on substance abuse, but we need to know this even deeper. Just don't hand us a, a package [of naloxone] and tell us “Have that in your car for an incident.” What I'm [going to] do if I have no clue how to use it, how to educate people?

Practical barriers: naloxone

The Black people don't understand how important it is to use…to know if you're [going to] use safely, check your stuff. Know who you’re getting it from, you know? Um, or just, you might just don't even know how to [administer naloxone]. Then you might need somebody to teach you how to [administer] it

Practical barriers: first responders

I think they didn't, they just don't care until something like, drastic in the news comes. They don't, you know, they're not caring, like actually caring to stop a person, like coming off of the street. “What you got?” you know, “Where you get it from?” you know, stuff like that. But if you're in a White neighborhood and you see some, a Black person coming, they're [going to] stop [them] and you know, check [them] and because they don't want you in their neighborhood buying drugs. But it's okay to buy drugs in a Black community. You know?

Practical barriers: first responders

Neighborhoods, um, they don't like coming to quote unquote “ghettos.” You know? They'd rather pull up and, you know, it's proportionally more, even though it's getting better, it's proportionally more Black people that are living [in] impoverished neighborhoods. So, um, yeah. So, less response, slower response rates into those areas specifically. Whereas I say on the other end, it's a Carmel overdose and they're there in two seconds

Practical barriers: first responders

Interviewer: Okay. So, but do you fear that if you had naloxone and you got pulled over for a ticket and the police saw the naloxone, do you think that they would harass you? Subject: Absolutely…I, I think that their history with working with our community is, uh, guilt first. Um, judge prosecutor executioner first, and then we'll find out that it's naloxone later

Practical barriers: first responders

A lot of times they don't, you know, because, uh, of who we are, you know, we have always been second fiddle. You know? We're not, uh, important, uh, to some of the, uh, emergency personnel, you know, that come, uh, to the scene of a crime or whatever. Uh, they're more apt to respond to their demographic, to people that look just like them

Mental barriers: stigma

Subject: Um, a White addicts get a little bit more sympathy than our Black, than their Black counterparts, so. Okay. Um, yeah. Interviewer: Okay. When you say, when you say they get more, more sympathy, you think people understand the disease in reference to them? Subject: It's more of a, “they are having a mental illness” for a White counterpart and it is more of a…where a Black person's more, “they were just lazy and they're just drug addicts.” Okay. So, you know, I've seen it with my own eyes, so

Mental barriers: stigma

My vantage point is that when individuals, again, of, of a certain ethnicity are stopped and they're perceived as, as violent or, uh, non-compliant

mental barriers: stigma

What I mean…unfortunately, you know, we, we still have that stigma of the police and it's just, it's the true stigma. I mean, it's true, you know, um, shoot first, ask questions later. And that's a scary thing, especially for young Black men, you know?

Mental barriers: stigma

Interviewer: Do you think race plays a part? Subject: Definitely. I think it has to do with, yeah…I think it has to do with where they’re being dispatched to. Like the areas, the communities. Cause when you, when you hear of a certain area, you know what type of people are there

Mental barriers: mistrust

You know, the Black community, that's med for one…that's medicine, real medicine from the cops giving it to [them]. The ambulance people are trying to give it to [them] and they don't even want it. Which is why I feel like one of the reasons…I feel like there's such a struggle with it is because they don't trust it

Mental barriers: mistrust

Subject:…the [affluent] communities, they're more friendly, they're more willing to talk to you. They're more willing to gain knowledge then our Black communities are. Interviewer: So you think we're, um, Subject: Stuck up. Interviewer: We're, we're not…you think we're stuck up? Subject: Okay. [We’re] stuck up. Interviewer: Okay. Why are we stuck up? What causes that? Subject: The way we've come up, our lifestyle, the things we've seen, the families we grew up with, us trying to build these walls from our childhood. Like, not knowing who to trust and who not to. It just makes us nonchalant and stuck up

Mental barriers: mistrust

So, yes. That's the only thing is, you know, as, as a race we've grown to be weary of stuff that's offered to us. It's always a catch. So, it is just about getting to the right people

Mental barriers: fear

Interviewer: What proportion of the residents in your community do you think would be, uh, fearful of carrying naloxone if they think the police might…? Subject: I think 80, like 80%. And I'm like you, that the Black community don't know, um, a lot and probably gets the information, you know, the, at the end of the stick

Mental barriers: fear

I don't believe that, um, that they’re so much [afraid] of being arrested, like for the possession of drugs. It's a bigger problem. And television and what's going on around the world, um, has affected how people look at the police. So probably everybody is fearing < laugh > , you know, for [their] life if they get stopped. [Because] it's so much going on in the world, you know what I'm saying? Which probably ain't even got to do with no drugs. It's kind of the, the stigma behind, um, your color, you know?