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Objective: This study was performed to explore the perceptions of treatment utilization patterns and the risk of overdose of both opioid users and their peer educators in Kolkata, India.Methods: This study used a qualitative approach for data collection between September and December 2023. In-depth interviews (IDIs) of 20 opioid users from two authorized opioid substitution therapy (OST) centers (10 registered clients) and their respective field practice areas (10 unregistered clients) in Kolkata were conducted. Key informant interviews (KIIs) of six peer educators were also conducted. Semi-structured interviews were conducted; audio was recorded, transcribed, and translated for coding and analysis. An inductive thematic analysis was performed.Results: Six broad themes (individual knowledge, logistics, legal/administrative, treatment effectiveness, self-confidence of treatment, and poor knowledge about the antidote of opioid poisoning, i.e., naloxone) emerged from the data analysis of IDIs. Four broad themes (high-risk behavior, raising awareness, the benefits of OST, and poor knowledge about naloxone) emerged from the data analysis of KIIs. Both opioid users and their peer educators were aware of the dangers of opioid overdose. However, they lacked sufficient knowledge in recognizing and offering immediate assistance in instances of opioid overdose, including the administration of naloxone.Conclusion: The findings recognize the necessity of drawing and retaining opioid users in an efficient healthcare facility, such as OST centers, and providing them adequate training to identify and provide immediate assistance in cases of overdose, including naloxone administration. Our findings will assist policymakers in designing programs to prevent and treat opioid overdoses.