Opioid overdose risk and resilience among older Black men in Chicago: findings from community-based focus groups

Abstract 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 investigator triangulation and an iterative AI-assisted analytic review of de-identified transcripts. Following investigator-led coding, ChatGPT-5 was used to critique emerging themes, identify overlooked concepts, and suggest alternative interpretations. All AI-generated observations were independently reviewed by the research team, and final coding and interpretation remained investigator-driven. Results Participants described overdose vulnerability as emerging from the intersection of five mutually reinforcing conditions: (1) structural neglect; (2) aging, chronic pain, health conditions, and grief; (3) institutional mistrust and medical avoidance; (4) isolation and stigma; and (5) community-led prevention and peer support. Participants emphasized that formal overdose prevention efforts must address broader healthcare access and quality rather than relying solely on naloxone distribution or expanding substance use treatment. 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.