Men died of overdose at 2-3 times greater a rate than women in the U.S. in 2020-2021

National data show need for more research into the factors underlying differences in sex-based vulnerability to drug use

Men were significantly more vulnerable than women to overdose deaths involving opioid and stimulant drugs in 2020-2021, according to a new study analyzing death records data from across the United States. 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 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 in New York City and the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

“Though men and women are being exposed to the modern, fentanyl-contaminated drug supply, something is leading men to die at significantly higher rates. 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,” said Nora Volkow, M.D., director of NIDA and one of the co-authors on the study. “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.”

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 known 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. 

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