Not all risks are perceived equally: racial and ethnic differences in drug risk perceptions and use among US adults

Background Illicit drug use has remained a critical public health issue in the United States (U.S.) over the past few decades. Individuals’ perceptions of drug-related risks may affect their likelihood of use. Given the persistent racial and ethnic disparities in the U.S., this study examined how race and ethnicity are associated with both perceived risk of illicit drug use and actual consumption behaviors.Methods We analyzed data from three waves of the National Survey on Drug Use and Health (NSDUH, 2021–2023), focusing on adult participants aged 18 and older (unweighted n = 135,497). The Heckman two-step selection model was used to address potential selection bias. The first step examined participants’ perceptions of drug use risk, while the second step assessed actual use of six illicit substances.Results Racial and ethnic minority participants, including Black, Hispanic, Asian, and other non-White groups, were significantly less likely than White participants to perceive illicit drug use as a ‘lower risk.’ Most racial and ethnic minority groups were generally less likely to report using these substances; however, Black participants had higher odds of reporting crack use.Conclusions These findings emphasize the importance of incorporating racial and ethnic perspectives into substance use prevention and education strategies.