New Research Reveals Men Die of Overdose at Two-to-Three Times Greater a Rate Than Women in the United States

UNDER EMBARGO UNTIL
WEDNESDAY, JUNE 14 at 8:00 PM EST

New York, NY (June 13) Men were significantly more vulnerable than women to overdose deaths involving opioid and stimulant drugs in 2020-2021, according to a new study analyzing data from across the United States. The study found that men had a two–three times greater rate of overdose mortality from opioids (like fentanyl and heroin) and psychostimulants (like methamphetamine and cocaine). While it is known that men use drugs at higher rates than women, the researchers found that this alone does not explain the gap in overdose deaths, noting that biological, behavioral, and social factors likely combined to increase the mortality risk for men.

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

“These data emphasize the importance of looking at the differences between men and women in a multilayered way,” said Eduardo R. Butelman PhD, Assistant Professor of Psychiatry at Icahn Mount Sinai and a lead author on 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.”

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 rate of drug overdose deaths is significantly higher for men than women. In addition, data suggest that men are more likely than women to use almost all types of illicit drugs. Building on these data, researchers sought to determine the extent to which this sex difference in overdose mortality varies by drug, state, and age, and to investigate whether the increased rate of overdose death among men held true when controlling for higher rates of drug misuse among men compared to women. 

To do so, researchers conducted a state-by-state analysis of nationally representative data on overdose death among people aged 15–74 from 2020-2021 in the United States, 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 (taking drugs in a way not recommended by a health care provider) among men compared to 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 overall rates of drug overdose death by sex from 2020-2021 were:

• 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 in men was observed across the lifespan (ages 15-74 overall) and was consistent across states, even after accounting for other demographic factors, such as household net worth. In addition, when the authors analyzed the data 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 within the entire 15-74 age range measured in the study. For the three other drug categories assessed, men also had greater overdose mortality rates compared to women across the lifespan, with few exceptions. Due to limited data, for heroin, the youngest and oldest age groups (age ranges 15-24 and 65-74) were excluded from analysis; for psychostimulants and cocaine, the oldest age group (age range 65-74) was excluded from analysis.

While researchers also found that men reported misusing drugs more than women, the magnitude of difference recorded for overdose mortality between men and women was substantially greater than the difference of reported drug misuse. For example, by comparing the data from CDC WONDER and NSDUH, the researchers found that men had a 2.8 greater rate of cocaine overdose mortality compared to women, though men only had a 1.9 greater rate of cocaine misuse compared to women.

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

“Future research that investigates the interactive biological, behavioral and social mechanisms that underlie differential risks of overdose mortality in men versus women could eventually point to personalized strategies to mitigate the progression or severity of substance use disorders, and thereby decrease the public health crisis caused by overdose mortality,” said Dr. Butelman.

About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, over 400 outpatient practices, nearly 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advanced health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. 

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,300 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report‘s Best Hospitals, receiving high “Honor Roll” status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children’s Hospital among the country’s best in several pediatric specialties.

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