Men had higher death rates than women as opioid crisis claimed lives in 2020 and 2021

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Men have been more vulnerable to overdose deaths than women as the opioid crisis raged in 2020 and 2021.

A new study found men had an overdose mortality rate up to three times that of women. Although it has been known that men use more drugs than women, researchers said that difference alone does not explain the difference in mortality rates.

“Though men and women are being exposed to the modern, fentanyl-contaminated drug supply, something is leading men to die at significantly higher rates,” National Institute on Drug Abuse Director Nora Volkow, MD, said in a news release. Volkow is a coauthor of the study, which was published in Neuropsychopharmacology.

“It may be that men use drugs more frequently or in greater doses, which could increase their risk of death, or there may be protective factors among women that reduce their risk of death compared to men,” Volkow said. “Understanding the biological, behavioral, and social factors that impact drug use and our bodies’ responses is critical to develop tailored tools to protect people from fatal overdose and other harms of drug use.”

Figures and findings

In 2021, fentanyl contaminating drug supplies contributed to almost 107,000 people dying of overdose. The researchers said data have shown men have higher rates of overdose deaths, and data suggest men are more likely than women to use almost all types of illicit drugs.

Researchers analyzed state data on mortality among people aged 15 to 74 years. Figures came from sources including the Wide-ranging Online Data for Epidemiologic Research of the U.S. Centers for Disease Control and Prevention (CDC WONDER), and the National Surveys on Drug Use and Health of the U.S. Substance Abuse and Mental Health Services Administration.

Among the findings, by drug and death rates:

• Synthetic opioids (e.g., fentanyl): 0 deaths per 100,000 people for men, compared to 11.1 for women
• Heroin: 5 deaths per 100,000 people for men, compared to 2.0 for women
• Psychostimulants (e.g., methamphetamine): 0 deaths per 100,000 people for men, compared to 5.6 for women
• Cocaine: 6 deaths per 100,000 people for men, compared to 4.2 for women

The higher overdose death rate for men was observed across the lifespan and across states, and was unaffected by other demographic factors, such as household net worth. By 10-year age groups, men had greater overdose death rates involving synthetic opioids including fentanyl, than women, across the entire age range

“The authors hypothesize that it is a combination of biological (e.g., men may have a greater vulnerability to the toxicity of drugs than women), behavioral (e.g. men may use these drugs in a riskier way than women), as well as other social- and gender-related factors,” the news release said.

“These data emphasize the importance of looking at the differences between men and women in a multilayered way,” lead author Eduardo R. Butelman, PhD, said in the news release. Butelman is assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai, co-investigator of the study.

“Moving forward, it will be important for researchers to continue to investigate how biology, social factors, and behaviors intersect with sex and gender factors, and how all of these can impact addictive drug misuse and overdose deaths,” Butelman said.

Doctors respond

The NIDA study was published a day after the American Medical Association (AMA) announced its members adopted new policies on substance use during their annual meeting this week.

Regarding overdoses, AMA is encouraging states and communities to allow teachers, students, and schools access to the overdose reversal medication naloxone

“We are facing a national opioid crisis and it’s affecting our young people at an alarming rate. Just as students carry prescription inhalers to treat an asthma attack, we must destigmatize substance use disorders and treat naloxone as a lifesaving tool,” Bobby Mukkamala, MD, said in a news release. Mukkamala is chair of the AMA Substance Use and Pain Care Task Force.

“Fortunately, an overdose tragedy can be reversed if quick action is taken with these safe and effective medications like naloxone,” Mukkamala said. “Allowing teachers and students to carry these medications is a commonsense decision and will no doubt result in young lives saved.”

For other policies, AMA members also voted to support amending state and federal child protection laws so pregnant people may seek treatment for substance use disorder with threat of incarceration or immediate loss of child custody.

AMA membership also voted to support the U.S. Food and Drug Administration (FDA) in ensuring safety of medication options. AMA will advocate against use of any psychedelics or entactogenic agents to treat psychiatric disorders, unless approved by the FDA or prescribed in approved studies.