Comparisons of injection and non-injection opioid use among Black people in methadone treatment: A pilot in Detroit

•Opioid injection group were younger and less educated than non-injection group.•Injection group more likely to receive mental health diagnoses and adult treatment.•Non-injection group reported more symptoms of needle phobia.•Non-injection group had stronger agreement on perception of police mistreatment.•Non-injection group had stronger agreement on control, risk, and family items. Rates of injection drug use (IDU) of opioids have been consistently lower among Black people relative to Non-Hispanic White people despite rising IDU estimates. While explanations have been proposed, no study has explored differences within a clinical sample of Black people in treatment who prefer IDU to non-IDU opioid administration. The purpose of this pilot study was to explore these differences guided by a seminal framework (e.g., market force, social network, and risk-taking characteristics), along with mental health symptoms, needle phobia, and injection perception variables. A purposive sample of 50 Black participants (58.0% male) were recruited from an opioid treatment program in Detroit by their preference for IDU (n = 16) versus non-IDU. The IDU group was younger, less educated, and younger at first treatment episode. They were more likely to report having been told they had bipolar disorder, PTSD, or anxiety, receiving mental health services as adults, and have a spouse/partner and close friends who injected opioids. The non-IDU group endorsed more symptoms of needle phobia. The non-IDU group also agreed more with statements that family and friends believe police mistreat people who inject drugs, and that people who inject opioids have a harder time quitting, are more likely to die from overdose, and have a harder time hiding it from family. These initial findings provide a rationale for a larger study with sex-specific analysis on factors associated with IDU among Black people to inform harm reduction efforts.