Heroin overdose

Men Die of Drug Overdose at 2 to 3 Times Greater Rate Than Women

From 2020 to 2021, men had a rate of overdose mortality from opioids and psychostimulants that was 2 to 3 times greater than the overdose mortality rate for women, according to a recent study.

Findings were published in the journal Neuropsychopharmacology. The study was led by investigators from the Icahn School of Medicine at Mount Sinai in New York City and the National Institute on Drug Abuse (NIDA).

The discrepancy in overdose deaths between men and women could be attributed to a combination of biological, behavioral, and social factors.

“Though men and women are being exposed to the modern, fentanyl-contaminated drug supply, something is leading men to die at significantly higher rates,” NIDA Director Nora Volkow, MD, said in a news release. “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.

“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.”  

Researchers conducted a state-by-state analysis of nationally representative epidemiological data on overdose deaths among Americans between the ages of 15 and 74. Data was compiled from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) platform, as well as state-level, nationally representative data from the National Survey on Drug Use and Health (NSDUH) to estimate rates for drug misuse.

After controlling for sex-specific rates of drug misuse, researchers found that overdose death rates by sex for the following drugs were:

  • Synthetic opioids, such as fentanyl: 29.0 deaths per 100,000 people for men, 11.1 for women;
  • Heroin: 5.5 deaths per 100,000 people for men, 2.0 for women;
  • Psychostimulants, such as methamphetamine: 13.0 deaths per 100,000 people for men, 5.6 for women; and
  • Cocaine: 10.6 deaths per 100,000 people for men, 4.2 for women.

Higher overdose death rates for men were consistent across states, even when accounting for other demographic factors. Due to limited data, for heroin, the youngest and oldest age groups—15 to 24 and 65 to 74—were excluded from analysis. For psychostimulants and cocaine, the oldest age group—ages 65 to 74—was excluded from analysis.

The magnitude of difference of overdose mortality between men and women was significantly greater than the difference in reported drug misuse between men and women. For example, men were found to have a 2.8 greater rate of cocaine overdose mortality than women, while having just a 1.9 greater rate of cocaine misuse.

The study’s authors hypothesized that several factors could be causing the discrepancy. For example, men could have a greater vulnerability to the toxicity of drugs than women. Men may also engage in riskier drug-using behaviors.

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

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