Prescription Opioid Diversion Sources Among African Americans: Implications for Overdose Prevention.

Recent data show that African Americans (AAs) experienced a greater increase in overdose deaths involving prescription opioids relative to other racial/ethnic groups. One possible mechanism through which elevated risk for overdose is conferred to AAs could be due to greater exposure to contaminated counterfeit pills. Unfortunately, prescription opioid diversion is understudied among AAs and less is known regarding which sources AAs use to access pharmaceutical opioids. The objective of this study, therefore, was to identify and describe the most commonly used diversion sources for prescription opioids among AAs. Qualitative interview data are also presented to contextualize the most prevalent sources. This study used data from the Florida Minority Health Study, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of AAs. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. Analyses revealed that the most widely used sources for prescription opioids were dealers (33.0%) and friends/relatives (34.7%). Additionally, interview data indicated that dealers are the access point where larger volume acquisitions are made and high potency formulations are accessed. These findings suggest that AAs may utilize nonhealthcare related sources at higher rates than healthcare related sources to acquire prescription opioids. This is concerning because opioid pills acquired through nonhealthcare related sources are especially susceptible to fentanyl adulteration. These findings invite further study using nationally representative data to determine if AAs disproportionately use nonhealthcare related sources compared to persons from other racial/ethnic groups.

Attitudes toward extended-release naltrexone treatment for opioid use disorder among African Americans.

BACKGROUND: Extended-release naltrexone (XR-NTX; Vivitrol®) is a long-acting injectable form of naltrexone, which is a medication used to treat opioid use disorder (OUD). In 2010, XR-NTX received Food and Drug Administration approval to treat OUD, becoming the first non-addictive and non-psychoactive medication for this condition. Because uptake of XR-NTX has been relatively low, less is known regarding how persons with OUD view this form of treatment. And because previous studies tend to rely on samples that lack racial diversity or are conducted outside the United States, we know very little about how African Americans view XR-NTX. The objective of this study, therefore, was to identify/explain the most salient attitudes toward XR-NTX as a form of OUD treatment among African Americans. METHODS: In-depth interviews (n = 30) were conducted with a sample of African American adults who used opioids in Southwest Florida between August 2021 and February 2022. Audiotapes of interviews were transcribed, coded, and thematically analyzed. RESULTS: Analyses revealed that participants' attitudes toward XR-NTX were generally positive. Specifically, participants found XR-NTX's monthly injection administration, non-addictive and non-intoxicating properties, and perceived effectiveness (compared to other medications for OUD) most appealing. CONCLUSIONS: Study findings suggest that African Americans who use opioids may have more favorable attitudes toward XR-NTX than other medications for OUD (e.g., methadone), which tend to be highly stigmatized. These data uniquely contribute to the literature by capturing the voices of African Americans who use opioids, a group with high rates of opioid-related deaths.

Patterns of polydrug use among Black Americans who misuse opioids.

In the United States, opioid-related deaths involving polydrug use are now more prevalent than those involving only opioids. What often goes unnoticed is that deaths involving more than one substance are increasing more rapidly among Black Americans than Whites. Unfortunately, little research attention is paid to understanding opioid-related polydrug use patterns among Black Americans. As a result, less is known regarding which drug combinations are most common among this population and their reasons for co-using certain drugs. Therefore, the objective of this mixed methods study was to identify which substances were most commonly co-used with opioids among Black Americans, while also capturing their motives for combining opioids with other drugs. This study used data from the Florida Minority Health Study, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of Black Americans who misuse opioids. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. Analyses revealed that opioids were most commonly combined with alcohol, cocaine, and methamphetamine, respectively. Opioids were co-used with alcohol in an attempt to enhance the desired effect (i.e., intoxication), while stimulants and opioids were combined to counteract the undesirable side effects of the other. This study begins to answer the question of which/why substances are combined with opioids among Black Americans and should inform behavioral health interventions targeted at this population. Data on this topic are especially timely as the United States goes through the current fourth wave of the opioid crisis that is characterized by deaths due to polydrug use. These findings invite further study using nationally representative data to determine the extent to which polydrug using patterns differ across racial/ethnic groups.

Motivations for Misusing Opioids Among African Americans.

BACKGROUND: A wide range of opioid misuse motives have been documented in the literature, including to relieve physical pain, feel good/get high, relax, manage feelings/emotions, sleep, and moderate the effects of other substances. Despite a rise in opioid misuse among African Americans over the last 2 decades, their motivations for misuse remain unclear. Much of the research on opioid misuse motivations either rely on samples with little racial diversity or do not stratify their findings by race. As a result, less is known about the specific reasons why African Americans engage in opioid misuse. The objective of this study, therefore, was to identify and explain the most common motives for misusing opioids among African Americans. Qualitative interview data are also presented to explain/contextualize the most prevalent motivations. METHODS: This study used data from the Florida Minority Health Survey, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of African Americans. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. RESULTS: Analyses revealed that while some (33.9%) misused opioids for purposes of recreation/sensation seeking (eg, feel good/get high), the majority (66.1%) were attempting to self-treat perceived medical symptoms (eg, physical pain, anxiety/trauma, withdrawals, insomnia). CONCLUSIONS: This study contributes to a better understanding of why some African Americans engage in opioid misuse and findings highlight the need for interventions to be trauma informed and address unmanaged physical pain among African Americans. Given that most studies on motivations are quantitative in nature, the study contributes to the literature by capturing the voices of African Americans who use drugs.

Assessing Feasibility and Barriers to Implementing a Family-Based Intervention in Opioid Treatment Programs.

Families Facing the Future (FFF) is an intervention designed specifically for families with a parent in methadone treatment. FFF is unique because it addresses prevention for children and recovery for parents in a single intervention. The primary goals of the program are to prevent parents' relapse, help them cope with relapse if it occurs, and teach parenting skills in order to reduce the likelihood of substance use among their children. FFF has been implemented as an adjunct to treatment in several Opioid Treatment Programs, but has not been widely adopted due to various implementation barriers. The aims of this study, therefore, were to (1) assess the perceived feasibility of implementing FFF and (2) identify/describe barriers to implementing FFF. An online survey was used to assess implementation feasibility, while individual qualitative interviews were conducted to explore specific barriers to implementation. Data collection from a total of 40 participants (20 patients and 20 providers) was conducted from August 2022 to October 2022 at two Opioid Treatment Programs in Florida. Analyses revealed high feasibility scores, indicating that FFF was viewed by both patients and providers as a practical intervention to implement. Despite strong perceived feasibility of the intervention, qualitative findings identified several implementation barriers with respect to difficulty attending parent training sessions, aversion to in-home visits, and lack of funding (inability to provide patient incentives/bill insurance). This study provides evidence that while patients and providers view FFF as having high feasibility, significant implementation barriers exist. This paper fills a void in the literature by informing if and which modifications might be necessary to facilitate wider adoption of FFF in real-world Opioid Treatment Program settings.

Perceptions of fentanyl among African Americans who misuse opioids: implications for risk reduction.

BACKGROUND: Fentanyl is a powerful synthetic opioid that is 50 times more powerful than heroin and has become ubiquitous in the illicit drug supply in the USA. Studies show that among people who use drugs, fentanyl is sometimes viewed as a desirable substance due to its high potency and low cost, while others have an unfavorable perception because of its association with overdose. Unfortunately, studies on the perceptions of fentanyl are relatively rare and existing studies tend to rely on samples with little African American representation. The objective of this study, therefore, was to identify and describe perceptions of fentanyl among African Americans who misuse opioids, while capturing their motivations for seeking out or avoiding fentanyl. METHODS: In-depth interviews (n = 30) were conducted with a sample of African American adults who misuse opioids in Southwest Florida between August 2021 and February 2022. Audiotapes of interviews were transcribed, coded, and thematically analyzed. RESULTS: Analyses revealed the presence of three subtypes of fentanyl-related perceptions: (1) fentanyl as an avoided adulterant, (2) fentanyl as a tolerated adulterant, and (3) fentanyl as a drug of choice. CONCLUSIONS: These findings show that African Americans' perceptions of fentanyl are not monolithic and suggest the distribution of fentanyl test strips and naloxone may be an effective risk reduction strategy. Given that most studies on fentanyl rely on quantitative data from drug seizures and death certificates, this study uniquely contributes to the literature by capturing the voices of African Americans who use drugs.

Barriers to Adequate Pain Control and Opioid Use Among Cancer Survivors: Implications for Nursing Practice.

BACKGROUND: Cancer survivors can experience long-term negative effects from cancer and its treatment. Pain is one of the most common and distressing symptoms that cancer survivors experience. Opioids are often prescribed for pain; however, cancer survivors who have completed active treatment may have unique challenges with regard to pain management. OBJECTIVE: The aim of this study was to explore barriers to pain management and perceptions of opioid use among cancer survivors. METHODS: This research was an exploratory pilot study using in-depth qualitative interviews with adult cancer survivors who were recruited from community-based survivorship organizations. Data were analyzed using applied thematic analysis techniques. RESULTS: Participants (n = 25) were mostly women (96%), diagnosed with breast cancer (88%) and stages I to III disease (84%), with a mean age of 56.2 years. Three themes on barriers to adequate pain control emerged: (1) taking just enough to take the edge off: self-medicating behaviors and nonadherence to prescribed regimen; (2) lack of insurance coverage and costly alternative pain treatment options; and (3) chronicity of cancer-related pain not adequately addressed and often mismanaged. CONCLUSIONS: Discussions with cancer survivors unveiled personal accounts of unmanaged pain resulting from limited pain management/opioid education, fear of opioid addiction, negative perceptions/experiences with opioids, lack of insurance coverage for alternative pain therapies, and regulatory policies limiting access to opioids. IMPLICATIONS FOR PRACTICE: There is a clear need for improved access to multimodal pain management options and nonopioid alternatives for cancer survivors. Oncology nurses should endeavor to support policies and procedures aimed at opioid education, training, and legislation.

Attitudes toward methadone treatment among Black/African Americans: Implications for engagement and retention.

Despite its ability to lower the risk of opioid misuse, methadone is viewed by patients with a certain degree of ambivalence. Research has documented a variety of patient attitudes toward methadone, but the majority of these studies have relied on samples with little Black/African American representation. The primary goal of this study, therefore, was to identify and explain the attitudes of Black/African Americans toward methadone treatment. Surveys were used to identify which attitudes were most prevalent while interview data are presented to help explain and provide context to these attitudes. Data were drawn from the Florida Minority Health Survey, a mixed-methods project that included online surveys (n = 303) and in-depth interviews (n = 30). Only persons 18 years old or over who identified as Black/African American and reported past 90-day opioid misuse were eligible to participate. Analyses revealed that negative attitudes largely revolved around methadone's perceived helpfulness and side effects. The most strongly held attitudes were (a) methadone in a treatment program gets you high just like heroin, (b) the sooner a person stops taking methadone, the better, and (c) methadone is a "crutch." These findings contribute to the literature by improving our understanding of why some Black/African Americans may be ambivalent about methadone. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Building capacity to create community change (BC4): A model to support successful program planning and implementation.

Community-based interventions (CBIs) are increasingly used to address health problems and are usually implemented by organizations outside and/or inside the community. CBIs are complex and organizations need to have, or be able to build the capacity needed to implement CBIs effectively. The importance of organizational capacity building is well established in the literature, but less attention is focused on how to build capacity, particularly for prevention-focused and mental health CBIs. As part of the longitudinal process evaluation of a national initiative to promote the mental health and wellbeing of men and boys in the United States, this study developed a capacity-building model to identify areas and associated factors that were integral to grantee organizations' ability to build capacity to create change in their communities. The findings identified five domains used to comprise the Building Capacity to Create Community Change model, which contributed to organizational capacity building and as a result, implementation progress: Administrative Support, Leadership, Vision and Mission, Partnership Development, and Community Engagement. Strength in each domain increased grantees' capacity to impact the lives of participants and progress towards the goal of creating community change.

Racial/Ethnic Differences in the Effects of Adverse Childhood Experiences on Substance Misuse among Justice-Involved Children.

Background: Adverse childhood experiences (ACEs) are linked to substance use (SU) and substance use disorders (SUD). However, this relationship has yet to be tested among justice-involved children (JIC), and it is unclear if racial/ethnic differences exist. This study aimed to determine: (1) whether ACEs are associated with increased risk of SU and SUD among JIC; and (2) if the effects of ACEs on SU and SUD are moderated by race/ethnicity. Methods: Bivariate and multivariate logistic regression analyses were employed to examine a statewide dataset of 79,960 JIC from the Florida Department of Juvenile Justice. Marginal odds were estimated to examine how race moderates the relationship between ACEs and SU and SUD. Results: Results showed higher ACEs scores were linked to SU and SUD. Black JIC were 2.46 times more likely, and Latinx JIC were 1.40 times more likely to report SU than white JIC. Specifically, Black and Latinx JIC with a higher average ACEs score were more likely to report SU but less likely to have ever been diagnosed with a SUD when compared to white JIC with equivalent ACEs. Conclusions: Study results highlight the need to develop trauma-informed and culturally appropriate interventions for SU and SUD among JIC.

Acceptability and Usability of a Reward-Based Mobile App for Opioid Treatment Settings: Mixed Methods Pilot Study.

BACKGROUND: Contingency management is an evidence-based yet underutilized approach for opioid use disorder (OUD). Reasons for limited adoption in real-world practice include ethical, moral, and philosophical concerns regarding use of monetary incentives, and lack of technological innovation. In light of surging opioid overdose deaths, there is a need for development of technology-enabled solutions leveraging the power of contingency management in a way that is viewed by both patients and providers as acceptable and feasible. OBJECTIVE: This mixed methods pilot study sought to determine the perceived acceptability and usability of PROCare Recovery, a reward-based, technology-enabled recovery monitoring smartphone app designed to automate contingency management by immediately delivering micropayments to patients for achieving recovery goals via smart debit card with blocking capabilities. METHODS: Participants included patients receiving buprenorphine for OUD (n=10) and licensed prescribers (n=5). Qualitative interviews were conducted by 2 PhD-level researchers via video conferencing to explore a priori hypotheses. Thematic analysis of interviews was conducted and synthesized into major themes. RESULTS: Participants were overwhelmingly in favor of microrewards (eg, US $1) to incentivize treatment participation (up to US $150 monthly). Participants reported high acceptability of the planned debit card spending restrictions (blocking cash withdrawals and purchases at bars or liquor stores, casinos or online gambling). Quantitative data revealed a high level of perceived usability of the PROCare Recovery app. CONCLUSIONS: Patients and providers alike appear receptive to microfinancial incentives in standard OUD treatment practices. Further pilot testing of PROCare is underway to determine acceptability, feasibility, and preliminary effectiveness in a rigorous randomized controlled trial.

Preventing Adolescent Opioid Misuse: Racial/Ethnic Differences in the Protective Effects of Extracurricular Activities.

OBJECTIVE: Participation in extracurricular activities has been largely shown to be protective against adolescent substance use. However, research has yet to examine whether extracurricular activities are specifically protective against adolescent opioid misuse and if these protective effects vary by race/ethnicity. This study focuses on a high-risk population for drug use (i.e., justice-involved adolescents [JIAs]) that is not often captured in population-based surveys. The goals of the current study were twofold: (a) determine the prevalence of opioid misuse for White, Black, and Latinx JIAs and (b) assess the influence of participation in extracurricular activities on opioid misuse risk among White, Black, and Latinx JIAs. METHOD: Using data from the Florida Department of Juvenile Justice (n = 65,248), multivariate logistic regression models were estimated to determine which racial/ethnic groups experienced protective effects from participation in extracurricular activities. RESULTS: Results show that 2.3% of the sample met criteria for past-30-day opioid misuse and participation in extracurricular activities lowered the risk for opioid misuse by 36%. However, although involvement in extracurricular activities was protective for White and Latinx youth, Black youth received no such protective effect. CONCLUSIONS: This study provides evidence of a fairly strong protective effect (36% risk reduction) for extracurricular activities against opioid misuse, but our results caution against assuming that youth from all racial/ethnic backgrounds benefit similarly from extracurricular activities because Black adolescents may not experience the same protective benefit that White and Latinx youth receive. Programs should be aware that the protection extracurricular activities offer varies across racial/ethnic lines and tailoring may be warranted to see protective effects for Black youth.

'They say you can get addicted': Exploring factors that fuel the fear of addiction to prescription opioids among cancer survivors.

OBJECTIVES: To explore misconceptions regarding addiction potential of prescription opioids among cancer survivors. METHODS: A qualitative study using semi-structured interviews were conducted with a purposive sample of cancer survivors (N = 25) treated with prescription opioids for pain management. Interviews were audio recorded, transcribed and coded using Atlas.ti version 8. Inductive applied thematic analysis techniques were employed to identify emergent themes. RESULTS: The majority of participants were breast cancer survivors (88%) who underwent a combination of surgery, chemotherapy and radiation (72%). Thematic analysis revealed that (1) cancer survivors view opioids as an illicit drug, (2) media narrative of the opioid epidemic increased negative perception of opioid use for cancer-related pain, (3) perceptions of opioids were also informed by experiences of friends and family with an opioid use disorder, (4) poor understanding of terminology resulted in misconceptions of opioid use and addiction and (5) fear of opioid addiction resulted in unrelieved cancer pain and poor quality of life. CONCLUSION: Our findings support previously identified concerns among cancer patients about fear of addiction to opioids, a barrier to effective pain management. It highlights the importance for health care providers caring for cancer survivors to continue to address misconceptions about prescribed opioids.

Framing Cancer Survivors' Access to and Use and Disposal of Prescribed Opioids Within the Opioid Epidemic.

PURPOSE: To explore cancer survivors' access to and use and disposal of opioids in the context of the opioid epidemic. PARTICIPANTS & SETTING: Community-based recruitment strategies were employed for individuals aged 18 years or older who were previously diagnosed with cancer, completed cancer treatment within the past five years, or were cancer free, and who were prescribed opioids for cancer-related pain. METHODOLOGIC APPROACH: This qualitative study used semistructured interviews. Data were analyzed using applied thematic analysis techniques. FINDINGS: Themes included the following: (a) restrictive policies affecting opioid access and supply, (b) decreased opioid use because of concerns of addiction and other opioid-related side effects, and (c) lack of clarity on safeguarding and disposal of opioids. IMPLICATIONS FOR NURSING: Cancer survivors may encounter barriers to opioid access, alter medication-taking behavior over fear of addiction and side effects, and face inadequate education regarding proper disposal of opioids. Nurses can advocate for appropriate access to prescribed opioids, assess opioid-taking behavior, provide education regarding storage and disposal, and implement educational interventions accordingly.

Drug dependence is not addiction-and it matters.

Accurately identifying persons with addiction is critically important for effectively targeting treatment and harm reduction interventions. Misdiagnosis of addictive disorders can lead to a cascade of negative outcomes, including stigma, discontinuation of needed medications, undue scrutiny of both patients and physicians, and even criminal consequences. A recent study raises significant concerns about the accuracy of diagnosis code data, likely rooted in confusingly-worded International Classification of Diseases (ICD)-9 and ICD-10 codes and a general misunderstanding of the difference between addiction and physiologic dependence. It is hardly surprising that physicians frequently mislabel patients when the ICD terms used to code for addiction are themselves misleading. ICD codes have not been updated to reflect current understanding of addiction, unlike those in the DSM-5. To explore this issue further, this commentary briefly discusses new information regarding coding data inaccuracies, how coding inaccuracies can lead to misdiagnosis, and the dangers of conflating "addiction" with "dependence." The commentary concludes with a call for the ICD to update their codes to reflect current understanding of addiction.Key messagesIt is not surprising that physicians frequently conflate patients with "addiction" and "dependence" when the ICD terms used to code for addiction are themselves misleading.ICD codes have not been updated to reflect what we know about the nature of addiction, unlike those in the DSM-5.This commentary calls for the ICD to update their codes to reflect current understanding of addiction.

Perceptions of prescription opioid medication within the context of cancer survivorship and the opioid epidemic.

PURPOSE: Prescription opioid medication can be of great benefit for cancer patients and survivors who suffer from cancer-related pain throughout their cancer care trajectory. However, the current opioid epidemic has influenced how such medications are perceived. The purpose of this study was to explore the perceptions of opioid use and misuse in cancer survivorship within the context of the opioid epidemic. METHODS: pt?>A qualitative study using a semi-structured interview was conducted with a purposive sample of health care professionals (n = 24), community-level stakeholders (n = 6), and cancer survivors (n = 25) using applied thematic analysis techniques. RESULTS: Crosscutting themes include (1) fear of addiction and living with poorly managed pain, (2) the importance of good patient/provider communication and the need for education around the use/handling/disposal of prescription opioid medication, (3) preference for nonopioid alternatives for pain management, (4) cancer survivors perceived to be low risk for developing opioid use disorder (include inconsistent screening), and (5) impact of policies aimed at curbing the opioid epidemic on cancer survivors. CONCLUSION: This study illustrates the intersecting and sometimes conflicting assumptions surrounding the use of opioids analgesics in the management of cancer pain among survivors embedded within the national discourse of the opioid epidemic. IMPLICATIONS FOR CANCER SURVIVORS: A system of integrated cancer care using psychosocial screening, opioid risk mitigation tools, opioid treatment agreements, and specialist expertise that cancer care providers can rely on to monitor POM use in conjunction with patient-centered communication to empower patients informed decision making in managing their cancer pain could address this critical gap in survivorship care.

Understanding Cancer Survivors' Educational Needs About Prescription Opioid Medications: Implications for Cancer Education and Health Literacy.

Cancer survivors' perceptions of prescription opioid medication (POM) and the health communications they receive about POM's safety and effectiveness are embedded within the national discourse of the opioid epidemic. Using qualitative methods, this community-based study explored the health communication and the educational needs of diverse cancer survivors who received opioid agonist treatment to manage cancer pain. Our community-based sample consisted of 25 cancer survivors, 24 healthcare providers, and six community-level stakeholders. Over half of the cancer survivors interviewed were from underrepresented minority groups (52% African American and 12% Hispanic/Latino). The data were analyzed using applied thematic analysis techniques. The over-arching themes include the need to (1) provide clear, consistent, and comprehensive education and information about POM to ensure safe use; (2) discuss the risks, benefits, and proper use of POM in the treatment of cancer-related pain; (3) communicate realistic expectations and address common misconceptions about pain; and (4) address cancer survivor beliefs and concerns surrounding fear of addiction. Our findings highlight the need for effective cancer education and communication about opioid agonist treatment and POM in plain simple language that is easy to understand, relevant, and culturally appropriate. Recommendations for cancer education and suggestions for future research are discussed.

Opioid-Induced Hearing Loss and Neonatal Abstinence Syndrome: Clinical Considerations for Audiologists and Recommendations for Future Research.

Purpose Over the last two decades, the number of Americans misusing opioids has reached epidemic levels. With such drastic increases in opioid misuse, audiologists are more likely to have patients with opioid-induced hearing loss or neonatal abstinence syndrome (NAS) than in previous years. More attention is needed on how these increases might influence clinical practice and such a discussion could be useful for audiologists. The goal of this article, therefore, is to summarize what is currently known regarding the relationship between opioid misuse and audiology to help guide hearing health care providers (with a particular focus on opioid-induced hearing loss and NAS). This article (a) summarizes the overlap in opioid misuse and hearing loss populations, (b) describes the evidence linking opioid misuse to hearing loss, (c) discusses clinical implications that opioid-induced hearing loss and NAS have for practicing audiologists, and (d) recommends directions for future audiological research on opioid-induced hearing loss and NAS. Conclusions There is considerable overlap between populations at-risk for hearing loss and opioid misuse. Additionally, compelling evidence exists linking opioid misuse to hearing loss, but the specific causal mechanisms remain unclear, indicating a need for additional research. This article attempts to fill a gap in the audiological literature and has the potential to serve as a guide for hearing health care providers to make more informed clinical decisions regarding patients with opioid-induced hearing loss and NAS. Clinicians may wish to consider the concerns raised in this article before intervening with such concerns, especially in the absence of best practice protocols.

Sexual Risk Behaviors among African Americans Who Use MDMA (Molly/Ecstasy): Implications for HIV Prevention.

Numerous studies have linked sexual risk taking to recreational use of MDMA. Questions remain, however, regarding the extent and type of sexual risk behaviors that occur among MDMA users, especially African Americans who use the drug. Because the MDMA literature has historically relied on samples with little minority representation, little is known about Black MDMA users and their sexual risk taking. The primary goal of this study, therefore, was to describe patterns of sexual risk behaviors among African Americans who use MDMA. This study used survey data to identify (a) which sexual risk behaviors occurred among Black MDMA users and (b) the prevalence of each behavior. Qualitative interview data are also presented to contextualize the role that MDMA and the club/nightlife environment might play in contributing to these behaviors. Results show that sexual risk taking (e.g., sex without a condom, "hooking up," sex on MDMA, and group sex) was prevalent and that the mind-set and context in which MDMA was consumed are contributing factors. The current study adds to the limited amount of data on African Americans who use MDMA and is a step toward better understanding the link between MDMA and sexual risk taking. These data can be used to inform social workers in their efforts to prevent HIV in this population.