Healthcare Access, Trust, and Opioid Overdose Risk Among Older African American Adults

Background and Purpose: Older African American adults experience disproportionately high rates of fatalities from opioid overdose relative to other racial groups, a disparity that cannot be explained solely by differences in opioid use or opioid use disorder prevalence. Structural inequities in healthcare access, quality, and trust may contribute to these disparities. Men and women may also experience distinct risk factors and pathways to substance use and overdose, highlighting the need for gender-specific analysis. This study aimed to examine participants’ perspectives on factors driving overdose risk among older African American adults, with particular attention to healthcare systems and access to care.

Methods: Four focus groups (two men’s and two women’s; N = 22) were conducted on the South Side of Chicago with African American men and women aged 50 and older. Participants were recruited through a community-based substance use treatment organization and a senior housing building program. Focus groups followed a semi-structured guide exploring perceptions of overdose risk, treatment experiences, and prevention strategies. Discussions were audio-recorded, transcribed, and analyzed using thematic analysis. An inductive approach was used to identify recurring patterns and themes across groups, with attention to gender differences.

Results: Participants identified structural barriers to healthcare as central drivers of overdose risk, including limited access to mental health services, substance use treatment, and long-term recovery support. Men emphasized the absence of mental health infrastructure and gaps in continuity of care, particularly following treatment initiation, as well as patterns of disengagement from healthcare services. Women described complex pathways into substance use that were often shaped by interactions with healthcare systems, alongside experiences of depression, trauma, caregiving burdens, and social isolation. Distrust of healthcare providers emerged as a salient theme, with participants expressing concerns about provider motivations and lack of transparency, while also highlighting the importance of trusted providers in supporting recovery. Participants additionally noted the increasing toxicity and unpredictability of the drug supply, particularly fentanyl, as well as homelessness and poverty, as contributing factors that compound existing barriers to care. Together, these dynamics contributed to delayed care, unmet needs, and increased vulnerability to overdose.

Conclusions and Implications: Findings suggest that opioid overdose risk among older African American adults is deeply embedded in inequities in healthcare access, quality, and trust, which shape both pathways into substance use and opportunities for recovery. While broader factors such as drug supply toxicity and social conditions contribute to risk, participants consistently emphasized healthcare system gaps as central to unmet needs and delayed care. Addressing these disparities requires expanding culturally responsive treatment services, improving continuity of care, and strengthening patient-provider relationships. Social work practice can play a critical role in facilitating engagement with care, addressing trauma and psychosocial needs, and bridging gaps between communities and healthcare systems. Policy efforts should prioritize investment in community-based healthcare infrastructure and integrated care models that reflect the needs of aging African American populations.