While biology does play a significant role in the development of addiction, it is the environment in which we grow and develop as children and ultimately exist as adults that determines whether or not an at-risk individual will subsequently develop opioid use disorder. Race (the outward manifestation of genetics) ethnicity (cultural factors such as nationality, regional culture, ancestry, and language), religion, gender, access to economic resources, and geography all influence risk to varying degrees. Within each community different cultures have different levels of propensity for developing opioid use disorder, and, in areas where there is more mixing of different races and cultures, a person’s risk for developing opioid addiction more closely reflects the risk of the community at large and not the genetic risk of the individual. In the past, social factors such as access to economic resources and peer or family support were thought to be somewhat protective and that a biologically at-risk individual in this setting would be less likely to develop opioid use disorder, but this has not turned out to be the case.