Men Up to 3 Times More Likely to Die From an Overdose

Can differences in drug use between the genders explain differences in overdose deaths?

Drug overdoses claimed 107,000 lives in the U.S. in 2021, mostly driven by the contamination of illicit drug supplies by the highly potent opioid fentanyl.^[1] The rate of overdose deaths is consistently higher among men than women.^[2] However, researchers haven’t known whether that’s simply a factor of men’s higher rates of drug consumption or could also be a result of other genetic, behavioral, and social factors.^[3]

“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 Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA) and co-author of a new study examining the gender gap in overdose deaths.

The research, published in the journal Neuropsychopharmacology last month, examined sex differences in overdose mortality across age groups and states to determine if they can be explained solely by differential drug use between men and women.^[4]

Even with sex-specific rates of drug abuse controlled for, male overdose rates are significantly higher

In the study, researchers at the Icahn School of Medicine at Mount Sinai used the CDC’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) platform to analyze state-by-state overdose mortality among people aged 15 to 74 from 2020 to 2021.

They also drew on state-level data from the annual National Surveys on Drug Use and Health (NSDUH) to estimate and control for rates of drug misuse among men compared to women.

The study revealed that even when gender disparities for drug use were controlled for, men are still dying of overdoses at a rate two to three times that of women, across age groups and states.

For synthetic opioids including fentanyl, overdose mortality among men was 29.0 deaths per 100,000 people, nearly three times that among women (11.1). 

Psychostimulants, including methamphetamine, caused 13 deaths per 100,000 people among men, compared to 5.6 among women. 

Among men, cocaine overdoses caused 10.6 deaths per 100,000 people, compared to 5.6 for women. Overall, men were 2.8 times as likely to die of cocaine overdoses but only 1.9 times as likely to use the substance.

Meanwhile, heroin overdoses were responsible for 5.5 deaths per 100,000 people among men, compared to 2.0 for women.^[4]

This disparity in overdose mortality between genders was observed across age cohorts and states and also remained when other demographic factors, such as household income, were accounted for. That suggests a different explanation for men’s vulnerability to overdose death, beyond higher rates of drug use, the researchers said.

Men's vulnerability to overdose death could have other causes

The study’s authors suggest that a combination of biological, behavioral, and social factors may make men uniquely vulnerable to dying of drug overdoses.

For instance, while the difference in rates of substance use disorders (SUDs) between men and women (9.8% of males vs 7.4% of females) isn't enough to account for the difference in overdose mortality, the authors hypothesized that men may be more likely to take risks in their drug use, for instance injecting opioids alone, taking large doses, and using untrusted supplies. However, they noted that epidemiological data alone can’t directly point to the explanation and further research is needed.^[4]

“These data emphasize the importance of looking at the differences between men and women in a multilayered way,” said Eduardo R. Butelman, assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai and a lead author 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.”^[2]