AbstractPurposes/Aims: The aim of this study was to explore Black women's explanatory models of their opioid use, including their conceptions of addiction, views of the causes, ways of dealing with its consequences, how social context (e.g., family or the community) relates to their addiction trajectories, and how they decided to engage in rehabilitation. Background: In 2021, 9.2 million people reported opioid misuse in past year. Increased public health efforts have aimed to reduce opioid use disorders since 2015, yet many people are still not receiving appropriate rehabilitation care. More importantly, in 2021, roughly 1.2 million Blacks reported opioid use. Compared to all other populations, Blacks had the highest mortality rate involving the use of heroin, fentanyl, or fentanyl analogs. Despite increased rates of opioid use among Blacks, and increased attention and treatment for people with opioid use disorders, Black women remain understudied. National surveillance provides opioid use pattern rates but data on the intersection of gender, race, and geography are missing. Thus, there is a gap in knowledge about Black women and their experiences with opioid use rehabilitation services. Methods: This social constructivist grounded theory study interviewed Black women ages 18 and older with opioid use rehabilitation experiences, within the United States. Researchers using the social constructivist grounded theory approach often engage in intensive interviewing, constant comparison, theoretical sampling, memo writing, and substantive theory generation. The interview guide was developed with open-ended questions centered around the following a-priori thematic domains (a) experiences of Black women’s opioid addiction experiences, (b) coping with addiction consequences, (c) successors to and barriers to rehabilitation, and (e) how race, gender, and social class relate to Black women’s accounts of their recovery experiences. Participants were recruited via a university hosted recruitment site. Participants (N=30) completed in-depth individual interviews via Zoom between January 2023 and April 2023. Audio was transcribed verbatim by a transcription service. Analysis began with open coding of each interview transcript as it became available. Open coding was followed by axial coding. All study procedures were approved by the University IRB. Results: Black women aged 18-30 years responded to the study call. Women report oral opioid use, heroin use, and multi-use histories. Participants acknowledged the emotional and physical traumas which influenced initiating use, and multiple overlapping experiences of societal backlash from within Black communities. Participants described backlash for opioid use, saying “we don’t do those kind of drugs;” and backlash for seeking help “Blacks don’t need that kind of help;” and backlash within rehab programs (“Blacks are supposed to be strong, so you don’t need help”). Implications for translation to practice/further research: Black women might be more attracted to complete rehab if the rehab programs focus on fostering community and connections versus invalidating Black women’s experiences. The societal message and internalized need to be a Strong Black Woman are hurting Black women’s health behaviors and biasing the clinicians involved with substance use rehabilitation care.