Opioid Overdose Risk and Resilience Among Older Black Men in Chicago: Findings from Community-Based Focus Groups

Background Older Black/African American men experience the highest opioid overdose mortality rates in the United States. Prior research highlights structural inequities and service barriers shaping these disparities, yet few studies center the perspectives of older Black men themselves. This study examined how older Black/African American men in Chicago understand and navigate overdose risk and resilience within the broader context of structural and life-course disadvantage. Methods Three focus groups were conducted in 2025 with Black/African American men aged 50 years and older who had current or past opioid use. Discussions included an overview of local overdose trends followed by questions about experiences with opioid use, perceptions of overdose risk, and views on prevention and treatment. An inductive thematic analysis guided interpretation of the transcripts, supported by team-based coding and analytic triangulation. An offline GPT-5 text-clustering utility was used as a secondary check for consistency across coded excerpts, with all AI-generated patterns manually reviewed to ensure interpretive accuracy. Results Participants described overdose vulnerability as emerging from the intersection of four mutually reinforcing conditions: (1) structural neglect, including decades of neighborhood disinvestment; (2) aging-related physical decline, chronic pain, and cumulative grief, which increased biological and emotional fragility; (3) deep mistrust of healthcare and treatment systems, shaped by lived and inherited experiences of medical harm; and (4) the belief that credible overdose prevention must be rooted in their own communities. Participants emphasized that formal overdose prevention efforts must address broader healthcare access and quality rather than relying solely on naloxone distribution or substance use treatment access. Conclusions Older Black/African American men conceptualize overdose risk as the product of structural abandonment, deteriorating health, and strained relationships with formal systems. Prevention strategies that are community-led, culturally grounded, and integrated with improved access to responsive, trustworthy healthcare services may be more credible and effective for this population. Findings highlight the urgency of interventions that acknowledge the generational histories, systemic harms, and community knowledge that shape overdose vulnerability among older Black/African American men.