Overdose mortality rates for opioids and stimulant drugs are substantially higher in men than in women: state-level analysis

Hot Off the Press – June 22, 2023

A new collaborative study coauthored by investigators from Mount Sinai School of Medicine, NIDA-IRP, and NIDA-HQ showed that fatal overdoses on opioids or psychostimulants are 2-3 times more common in men than in women. This sex difference is far larger than those seen in most health-related behaviors. It is not accounted for by smaller sex differences in rates of use or misuse of those drug classes, and it is similar in all US states, suggesting that it reflects a fundamental difference in the way men and woman are using or responding to the drugs.

Publication Information

Butelman, Eduardo R; Huang, Yuefeng; Epstein, David H; Shaham, Yavin; Goldstein, Rita Z; Volkow, Nora D; Alia-Klein, Nelly

Overdose mortality rates for opioids and stimulant drugs are substantially higher in men than in women: state-level analysis Journal Article

In: Neuropsychopharmacology, 2023.

Abstract | Links

@article{Butelman2023,

title = {Overdose mortality rates for opioids and stimulant drugs are substantially higher in men than in women: state-level analysis},

author = {Eduardo R Butelman and Yuefeng Huang and David H Epstein and Yavin Shaham and Rita Z Goldstein and Nora D Volkow and Nelly Alia-Klein},

url = {https://pubmed.ncbi.nlm.nih.gov/37316576/},

doi = {10.1038/s41386-023-01601-8},

year  = {2023},

date = {2023-06-15},

urldate = {2023-06-15},

journal = {Neuropsychopharmacology},

abstract = {Drug overdoses from opioids and stimulants are a major cause of mortality in the United States. It is unclear if there are stable sex differences in overdose mortality for these drugs across states, whether these differ across the lifespan, and if so, whether they can be accounted for by different levels of drug misuse. This was a state-level analysis of epidemiological data on overdose mortality, across 10-year age bins (age range: 15-74), using the CDC WONDER platform for decedents in the United States in 2020-1. The outcome measure was rate of overdose death (per 100,000) for: synthetic opioids (e.g., fentanyl), heroin, psychostimulants with potential for misuse (e.g., methamphetamine), and cocaine. Multiple linear regressions controlled for ethnic-cultural background, household net worth, and sex-specific rate of misuse (from NSDUH, 2018-9). For all these drug categories, males had greater overall overdose mortality than females, after controlling for rates of drug misuse. The mean male/female sex ratio of mortality rate was relatively stable across jurisdictions: synthetic opioids (2.5 [95% CI, 2.4-7]), heroin, (2.9 [95% CI, 2.7-3.1], psychostimulants (2.4 [95% CI, 2.3-5]), and cocaine (2.8 [95% CI, 2.6-9]). With data stratified in 10-year age bins, the sex difference generally survived adjustment (especially in the 25-64 age range). Results indicate that males are significantly more vulnerable than females to overdose deaths caused by opioid and stimulant drugs, taking into account differing state-level environmental conditions and drug misuse levels. These results call for research into diverse biological, behavioral, and social factors that underlie sex differences in human vulnerability to drug overdose.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}