Structural racism has long been a part of systems and structures in the United States, including substance use treatment and prevention services. The historical and ongoing impacts of implicit and explicit discrimination in national and local policies, practices, programs, leadership, and access to resources have had a profound and harmful effect on people who use drugs, particularly Black, Indigenous, Latinx, and other historically and structurally excluded people. This study highlights how communities of color counter structural racism and oppression by creating culturally effective community-based programming that promotes equitable outcomes for people who use drugs. Our research shows that substance use service models led by people of color are relatively small, underfunded, and often unrecognized by public and private health care payers, despite their potential to dismantle structural racism related to substance use in communities of color.

To examine the ways programs and organizations support and provide services that interrupt structural racism for people who use drugs, we conducted key informant interviews with nine organizations. From these discussions, we identified six key recommendations to mitigate structural and institutional racism in the substance use treatment and prevention paradigm:

• Provide holistic care using a racial justice frame.
• Support client-centered, antiracist care.
• Choose and support staff with high emotional intelligence.
• Build trust with clients through culturally effective care including alternative therapies.
• Form participant advisory boards.
• Encourage community-based programs to build in-house research capabilities.

In addition, we also identified three key recommendations for funders who support organizations that are working to dismantle structural racism that harms people who use substances:

• Focus on racial justice work, including the need to support efforts that break the link between health and the criminal legal system for people who use drugs.
• Focus on community, including the need to prioritize grantees’ community-based research agendas.
• Focus on external factors, including the need to influence policymakers and government research agendas to bring antiracist services and health care for people who use drugs to scale.

Overall, we sought to identify and elevate the work, concerns, and recommendations of these organizations to help changemakers and policymakers think about how and why they should fund such efforts. By partnering with these leaders and others like them in the field, we can work to dismantle structural racism and promote equitable outcomes for people who use drugs.