Men were significantly more vulnerable than women to overdose deaths involving opioid and stimulant drugs in 2020-2021, in line with a brand new study analyzing death records data from across the US. The study found that men had a 2–3 times greater rate of overdose mortality from opioids (like fentanyl and heroin) and psychostimulants (like methamphetamine and cocaine). While it has been known that men use drugs at higher rates than women, the researchers found that this alone doesn’t explain the gap in overdose deaths, noting that biological, behavioral, and social aspects likely combined to extend the mortality risk for men.

The study, published in Neuropsychopharmacology, was led by investigators on the Icahn School of Medicine at Mount Sinai in Recent York City and the National Institute on Drug Abuse (NIDA), a part of the National Institutes of Health.

Though men and ladies are being exposed to the trendy, fentanyl-contaminated drug supply, something is leading men to die at significantly higher rates. It could be that men use drugs more often or in greater doses, which could increase their risk of death, or there could also be protective aspects amongst women that reduce their risk of death in comparison with men.”

Nora Volkow, Study Co-Writer and Director, National Institute on Drug Abuse

“Understanding the biological, behavioral, and social aspects that impact drug use and our bodies’ responses is critical to develop tailored tools to guard people from fatal overdose and other harms of drug use.”

In 2021, nearly 107,000 people died of a drug overdose, largely driven by potent, illicit fentanyl which now contaminates the drug supply. Data have consistently shown that the speed of drug overdose deaths is significantly higher for men than women. As well as, data suggest that men are more likely than women to make use of almost every type of illicit drugs. Constructing on these data, researchers sought to find out the extent to which this known sex difference in overdose mortality varies by drug, state, and age, and to analyze whether the increased rate of overdose death amongst men held true when controlling for higher rates of drug misuse amongst men in comparison with women.

To accomplish that, researchers conducted a state-by-state evaluation of nationally representative epidemiological data on overdose mortality amongst people aged 15–74 from 2020-2021 within the U.S., using the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) platform. The scientists also used state-level, nationally representative data from the National Surveys on Drug Use and Health (NSDUH) to estimate and control for rates of drug misuse (popping up in a way not advisable by a health care provider) amongst men in comparison with women. The NSDUH is conducted annually by the Substance Abuse and Mental Health Services Administration.

For specific drugs, and after controlling for the sex-specific rate of drug misuse, the researchers found that the general rates of drug overdose death by sex from 2020-2021 were:

• Synthetic opioids (e.g., fentanyl): 29.0 deaths per 100,000 people for men, in comparison with 11.1 for ladies
• Heroin: 5.5 deaths per 100,000 people for men, in comparison with 2.0 for ladies
• Psychostimulants (e.g., methamphetamine): 13.0 deaths per 100,000 people for men, in comparison with 5.6 for ladies
• Cocaine: 10.6 deaths per 100,000 people for men, in comparison with 4.2 for ladies

The upper overdose death rate in men was observed across the lifespan (ages 15-74 overall) and was consistent across states, even after accounting for other demographic aspects akin to household net value. As well as, when the authors analyzed the info by 10-year age groups, they found that for overdose deaths involving synthetic opioids like fentanyl, men had greater rates than women across each group inside the complete 15-74 age range measured within the study. For the three other drug categories assessed, men also had greater overdose mortality rates in comparison with women across the lifespan, with few exceptions. Attributable to limited data, for heroin, the youngest and oldest age groups (age ranges 15-24 and 65-74) were excluded from evaluation; for psychostimulants and cocaine, the oldest age group (age range 65-74) was excluded from evaluation.

While researchers also found that men reported misusing drugs greater than women, the magnitude of difference recorded for overdose mortality between men and ladies was substantially greater than the difference of reported drug misuse. For instance, by comparing the info from CDC WONDER and NSDUH, the researchers found that men had a 2.8 greater rate of cocaine overdose mortality in comparison with women, though men only had a 1.9 greater rate of cocaine misuse in comparison with women.

The authors hypothesize that it’s a mixture of biological (e.g., men could have a greater vulnerability to the toxicity of medicine than women), behavioral (e.g. men may use these drugs in a riskier way than women), in addition to other social- and gender-related aspects.

“These data emphasize the importance of taking a look at the differences between men and ladies in a multilayered way,” said Eduardo R. Butelman Ph.D., assistant professor of psychiatry on the Icahn School of Medicine at Mount Sinai and a lead writer on the study. “Moving forward, it can be vital for researchers to proceed to analyze how biology, social aspects, and behaviors intersect with sex and gender aspects, and the way all of those can impact addictive drug misuse and overdose deaths.”