Opioid overdoses in Chicago, other cities have been killing the same generation of Black men for decades

James Stewart got hooked on heroin in 1987.

Life was a party then. He was in his early 20s, playing basketball and hustling drugs on the West Side. He experimented with cough syrup and other drugs. And he tried heroin.

His body started to change. He was addicted. Soon, the party was over. And people he knew kept overdosing.

“They’ve been dying along the way,” says Stewart, who’s 60.

Stewart says he was using heroin to keep from feeling sick — even as he held down a job loading freight trains. He says he was a “functional addict.”

He’s sober now, working at the Haymarket Center for addiction treatment after graduating from a Cook County drug court that offered him a deal he couldn't refuse: Quit heroin, and you won't go to jail for drug possession.

He’s one of the lucky ones. In Chicago and other U.S. cities, Black men in Stewart’s generation, born from 1951 through 1970, have been dying of opioid poisoning at a greater rate than any other segment of society. And that's been true for decades. This group has been at the highest risk of dying as a result of overdoses even when they were in their 20s, 30s and 40s.

That’s true in Chicago. And it's also the case in other cities including Baltimore, Washington, San Francisco, Milwaukee and Newark, N.J., according to a data analysis by The Baltimore Banner, which collaborated with the Chicago Sun-Times, The New York Times, Big Local News at Stanford University and other news organizations to investigate this particular generation of Black men's sky-high vulnerability to opioid deaths.

The partnership identified dozens of U.S. counties where this generation of Black men have died of overdose at astronomical rates in the last five years. Among them, Cook County was ranked fourth highest, with Black men from this group dying at rates nearly 10 times higher than the county average and nearly 15 times higher than the national average.

And this year in Cook County through Nov. 10, Black men born from 1951 through 1970 accounted for nearly one in four of all opioid overdose deaths, the Sun-Times found. Nearly all overdosed on super-potent fentanyl — often in a cocktail of other drugs, such as heroin or cocaine.

Despite this longstanding risk to this group, government and private agencies in Chicago, in the rest of Cook County and across Illinois have done little to target these particular men for help, the Sun-Times found.

Instead, prevention efforts in Chicago have been aimed more broadly at five neighborhoods with the worst problems. None of these programs specifically targets this vulnerable group because government and private agencies largely haven't recognized the need. All aim to serve adults of every age, race and gender.

Medical experts say Black men with opioid addictions tend to receive less care than the general population. They are half as likely to be offered medications to treat their addictions as white patients are. When they do get prescriptions, they typically are for lower doses of those medications. And, health experts say, they often feel disrespected by health care providers, so they frequently don't seek help to begin with.

Across the country, billions of dollars are pouring in to state governments from lawsuits they've filed against pharmaceutical giants including Johnson & Johnson and retailers like Walgreens, accusing them of contributing to America's opioid crisis. Illinois expects to collect more than $1.3 billion from settlements of those lawsuits. Most of the money is supposed to pay for what's termed "remediation" of the opioid crisis.

But health care professionals watching how the money is doled out in Illinois say they haven’t seen any proposals that focus on older Black men who use opioids.

"I know they're working to make sure that, in every application, we discuss how we're reaching groups that are underserved, with Black men being an underserved group," says Dr. Tanya Sorrell, director of Rush University Medical Center’s Substance Use Disorder/Center of Excellence. "I haven't seen a specific, targeted group for Black men."

At a recent meeting of the West Side Heroin and Opioid Task Force, Jim Wilkerson, the statewide opioid settlement administrator for Illinois, encouraged the group to come up with ideas to address the lack of services targeting people hardest hit by the opioid crisis.

Fanya Burford-Berry, the task force's director, told members they need to find a way to address the needs of Black men.

"It seems like there's a blind spot when it comes to prioritizing Black men — older Black men — and drug usage," Burford-Berry says.

According to the Illinois Opioid Settlements Initiative, which oversees the money, telehealth services and prisoners have been among the early targets of the spending.

‘You can see the impact of racism’

Why have these older Black men always died of overdoses more often than anyone else? In part, this stems from their having been born during the racial tumult of the 1950s, 1960s and early 1970s.

Cook County Board President Toni Preckwinkle says she tells her staff that some of society’s worst inequities, from overdoses to low school achievement, are concentrated in the same areas of Chicago and the south suburbs — places that are home largely to Black and Brown people.

“It’s one of the most physical ways in which you can see the impact of racism in our communities,” Preckwinkle says.

In Chicago, as in many other U.S. cities, Black people were segregated from the white population — literally, with expressways walling off neighborhoods from each other.

The riots that followed the 1968 assassination of the Rev. Martin Luther King Jr. left big swaths of the West Side burned out. And jobs were harder to get after the closings of the Sears catalog center on the West Side — where Stewart's mother worked for more than 20 years — and the steel mills on the South Side in the 1980s and 1990s.

Heroin, increasingly plentiful in those low-income communities through what health-care experts call "predatory marketing," offered people a temporary escape from those problems. But the drug also became one of the greatest problems in those communities.

Austin and West Garfield Park on the West Side together now account for the most deaths of older Black men in Chicago from opioid poisoning.

Chatham, once a middle-class African American bastion, also has been hit this year with a cluster of overdose deaths. For years, Chatham was viewed by some as being immune from many of the problems associated with poverty. This year through September, though, Chatham was No. 5 in Chicago in the number of overdose deaths among Black men in this older age group. At least eight of them died in Chatham of overdoses.

The South Side neighborhood could be seeing the impact of drug sales in nearby areas, including Auburn Gresham, Grand Crossing and along Cottage Grove Avenue, health care workers say.

The high incidence of opioid deaths is just one of the factors contributing to a large disparity in life expectancy for all Black Chicagoans. Homicides, infant and maternal mortality and chronic and infectious diseases also contribute to the life expectancy gap between Black and non-Black Chicagoans now standing at 11.4 years.

“Black Chicagoans are not having the same type of health outcomes as other parts of the city,” says Dr. Olusimbo "Simbo" Ige, the city’s health commissioner. “Every single other population seems to be improving in health outcomes — except for Black Chicago.”

Black patients are half as likely as their white counterparts to be offered medications to treat opioid addictions while in an emergency room, and that's the case even if they have private health insurance or Medicaid, Rush's Sorrell says.

And when they are prescribed those medications, studies show they get lower doses, which might not be enough to cover opioid symptoms, she says.

“Most people who may finally succumb to an overdose death have had about four to six emergency department overdose visits before they finally pass from an opioid overdose,” Sorrell says. “So we have opportunities to reach them, get them treatment, get them on buprenorphine and get them into care before an overdose happens.”

Buprenorphine is a medication used to treat opioid addiction and is an ingredient in the treatment drug Suboxone.

But one challenge with using that drug is that some people, like James Stewart, are leery of it.

“I always went cold turkey,” Stewart says. “I’ve seen people get on Suboxone for years, decades. Even now, in my mind, it’s like transferring your addiction.”

Stewart says many Black opioid users in his older age group often experience a fear of getting sober and facing other underlying health conditions.

“I had high blood pressure because I hadn't checked on my health," he says.

Michael Huyck, a nurse practitioner at the Mile Square Health Center on the Near West Side, says mistrust is also an issue among older Black opioid users.

“It takes me, as a white male, a while to build up a rapport and trust because they've been mistreated and marginalized in the health care system," Huyck says. "A lot of people maybe are not taking advantage of the resources just because they don't want to come in here and be disrespected.”

Huyck and Tondalaya Henry, an addiction counselor at the center, say they try to remove hurdles to getting treatment. For example, the clinic provides free bus passes to patients.

Stewart says many of his acquaintances are unwilling to stop using drugs but thinks they could benefit from guidance from those who’ve been addicted.

Stewart and former heroin user James “Jo Jo” Russell, 56, both say they’d be interested in doing outreach in jails.

“We can't save everybody,” Russell says. “But I bet you one or two or three people may get the understanding.”

Employing former drug users is part of the strategy for Community Outreach Intervention Projects, which sends mobile units around the city to provide Suboxone to people in Chicago.

“I think that's the best model,” says Albert Murphy, who works for the organization. “It just seems like the bureaucracy is challenging just to get people in those spaces to do that type of work. I just think that maybe they need some special funding.”

Younger generation was scared of heroin

Stewart has a theory about why people his age have always been at a high risk of dying from opioid poisoning: a lack of fear about using heroin. He says he wasn’t scared of fooling with heroin when he was in his 20s. Neither were many of his friends.

But the generations who grew up after him generally were more leery of getting hooked on heroin. They stuck with other things like marijuana, cocaine and pills. The rampant use of crack cocaine in the 1980s and 1990s and the prescription-pill crisis that began in the 1990s took a huge toll in Chicago, too.

The number of opioid deaths peaked during the COVID-19 pandemic and has declined this year in Cook County and across the country. Through the end of September, there were more than 800 opioid-related deaths in Cook County this year, compared with more than 1,300 over the same period of 2023.

City officials say one reason for the decline is their expanded outreach to drug users.

Also, U.S. Drug Enforcement Administration officials say they’ve seized lower quantities of fentanyl this year. That could mean less of the deadly drug is available for gangs to mix with heroin, cocaine and other drugs in Chicago.

To get a better idea of what's contributed to the deaths, the Sun-Times reviewed those of 90 Black men 54 to 73 years old who have overdosed from opioids this year in Cook County through mid-April. Autopsy reports showed some common things, factors that might help policymakers target help for this particular age group of drug users:

• Almost every autopsy found fentanyl among the drugs that contributed to the man’s death. Perhaps surprisingly, heroin was a factor in fewer than one-quarter of the deaths, and cocaine was a factor in more than half of the deaths. A few cases involved both heroin and cocaine. And Xylazine, an animal tranquilizer that can’t be reversed by Narcan and is considered particularly lethal, was listed in 13 of the 90 autopsy reports.
  
• Nearly all of the men suffered from heart disease and other ailments, including hypertension and diabetes.
  
• Most died where they overdosed: Fewer than one-third were taken to a hospital. 
  
• In only four cases, a friend or family member had given the dying man naloxone, commonly known by the brand name Narcan, which reverses the immediate effects of opioids.
  
• Usually, the men were found unresponsive in an apartment where they were staying with a friend or relative, though some were living on their own. 
  
• Only three of the autopsy reports explicitly said the men were unhoused, including a man found in a tent, a man living in an apartment hallway and a man in a homeless shelter. One man was found unresponsive on a CTA Red Line L train and one at a CTA bus stop in Bronzeville, but their housing status was not mentioned.
  
• Another man overdosed in a south suburban nursing home. His relatives told investigators they suspected the nursing staff covered up evidence of drugs in his room. No Narcan was administered because the man was on a "do not resuscitate" list.

Increasing access to Narcan, the overdose-reversal drug, is at the center of efforts these days to keep opioid users from dying.

On a recent Saturday, eight outreach workers from the West Side Heroin and Opioid Task Force loaded into a small white bus carrying navy tote bags each filled with two doses of Narcan.

“Let’s save lives,” they cheered.

They were guided by a city map showing blocks with a high number of 911 calls for opioid-related overdoses.

One of the stops was the 4800 block of West Congress Parkway, less than half a mile from the Eisenhower Expressway in Austin. Single-family homes and apartment buildings line the block that leads to bustling Cicero Avenue.

“Can I talk to you for a second?” Latricia Walker-West asked an older Black man standing outside a house in that block. “We’re providing everyone with Narcan.”

The man said he never uses opioids but pointed down the street to people who do.

“I have a girlfriend who overdosed, I didn’t know what to do,” the man said, adding that a neighbor overdosed, and another man overdosed in a car in that same block.

Walker-West and the other outreach workers have memorized a speech they give outlining steps to take after seeing signs of an overdose: Call 911, administer the first dose of Narcan, and then give the second dose if the person doesn’t regain consciousness. By then, an ambulance should be arriving to treat the person.

After she breezed through her spiel, a group of skeptical men decided to take totes from Walker-West. A man walking by said he had Narcan in his pocket and grabbed a tote without stopping.

The Austin-based West Side Heroin and Opioid Task Force was created in 2016 by state Rep. La Shawn Ford, D-Chicago. That was after research had shown that Narcan wasn’t getting to the people who needed it most.

Each month now, the task force goes through about 100 cases of Narcan, which is sprayed into the nostril.

“Typically for Black drug users, we don’t do syringes,” says Burford-Berry, the task force director. “It is not our choice of delivery for usage. It's snorting or smoking. So, for us to even have syringes, it would have been something we wouldn’t have used even if it was saving our lives."

Targeting 5 worst areas for overdoses

Some treatment programs target people in the criminal justice system.

For instance, there’s the Cook County drug court that Stewart sees as having been his salvation. Many participants in the program are Black men around his age or older, though it's open to adults of any age.

And every Chicago police district allows most people arrested with a small amount of drugs to enter treatment instead of going to jail. More than 3,000 people have participated since that program started in 2018. The average age for Black men in the program is 40, meaning many are Stewart's age or older, a Better Government Association analysis found. But the program is also open to adults of any age, gender and race.

The Chicago Department of Public Health has been targeting the five neighborhoods that have the most opioid-related emergency responses: Austin, East Garfield Park, Humboldt Park, North Lawndale and West Garfield Park. They're the same places where many of Chicago's older Black men suffer fatal overdoses, though the city's response doesn't specifically target that group.

Last summer, the department says, it tested the drug supply for adulterants, distributed naloxone as well as fentanyl and xylazine test strips, coordinated overdose education and connected people to medication-assisted recovery through the MAR NOW telemedicine hotline.

The city agency also is aiming to address long-term needs, such as stable housing.

Ige, the city health commissioner, points to city initiatives such as The Haven on Lincoln, a 40-unit housing facility in Lincoln Square where people with substance-use disorder can live while receiving health care and social services.

“People need jobs, people need homes, people need food,” she says.

‘Some of us have to die for others to live’

Algie Woods, 53, was born in 1971. He says he was raised by his mother after his father died as a result of gang violence. He says he still managed to have a normal childhood but got “pulled into negativity” as an adult.

“I did all the right things coming up,” he says. “But I went to a party, and I just never left.”

He faced the first of a long string of drug-related arrests in 1986. He remembers his mother visiting him in jail. He thought of the singer Sade’s lyrics: “Like the scar of age written all over your face.”

Not only was his mother worrying about the crimes Woods was committing because of his heroin habit, but she was struggling with her own substance abuse.

“I remember thinking, ‘Why do I keep putting this garbage in my system knowing I’m going to go through that metamorphosis,’ you know? Like, I’m sick, and I see people see it in me, but I kept doing it.”

Woods says he’s been drug-free after going through treatment. He did that, he says, because he realized, “I could be a productive citizen, leaving this behind me.”

Still, some people don't seem to be able to be saved from their addictions to opioids, James Stewart says.

Stewart says about four years ago he gave heroin to a friend who had never taken it before but later wound up addicted. He quit. But, during a period of withdrawal, Stewart says he begged and begged him for heroin. Stewart says he caved in. He gave the man the drugs — and he died. His death inspired Stewart to change his life.

“It’s sad but true,” Stewart says. “Some of us gotta die for others to live.”

Among those who have died of opioid overdoses this year in the Chicago area was a 70-year-old Black man who had used heroin for decades before he was found unresponsive inside his unit in an Avalon Park senior building, his daughter says.

The Cook County medical examiner’s office determined that fentanyl and xylazine killed him.

His daughter agreed to talk about what happened only on the condition that the Sun-Times not publish her name or her father’s because his substance disorder remains a stigma in her family.

She says no one ever told her that her father used heroin, and she never saw him consuming it. Still, she always knew her father was using heroin regularly, even as he worked as a valet downtown and then for years as a packer at the United Parcel Service.

He lived most of his life with her grandmother.

“He was always content no matter where he was, in what situation,” she says. “I know, at one point, he was squatting in a building, and he was OK. He was still content.”

When her grandmother died, the Chicago-area woman became her father’s primary caregiver. By then, it seemed to her like he was more likely to die if he stopped using heroin since it had become a form of medication.

That meant ensuring doctors knew about his heroin usage when he underwent two surgeries to make sure he would heal without going through withdrawals.

She thinks her father started using heroin as a teenager — before she was born — and isn’t sure whether he started using the substance on his own or got it from his brother, who returned from military service using heroin.

The woman looks at her father’s school photo from 1969, about when he was in eighth grade. She also sees others in the photo who struggled with addiction like her father.

"Addiction almost seems like the only way out from the hell of life that they have to live, living in this neighborhood,” she says.

In the photo, he stands in the back of the group, wearing a white button-up shirt and a tie, showing off a slight smile. A small mustache is visible, like the one he kept into adulthood.

She doesn’t think her father’s story is reflected in the ways that most people think about the opioid crisis. She says it's typically associated with younger white people.

She sees it as yet another example of how Black men are marginalized and made to feel like the addiction is their fault, rather than looking into the source of why they became addicted to the opioids.

“It’s very, very easy to make them invisible and not matter but they do,” she says. “We shouldn’t have ignored it in the '60s. We shouldn’t have ignored it in the '70s. And now that these guys are older, we’re still ignoring them.

"We are just waiting for them to not be our burden. The same way that he was my burden. It feels like everybody is waiting to be unburdened by this population. And I don’t think that should be the case.”