Men Die of Overdose 2-3 Times More Than Women

Higher rates of use do not entirely account for the increase in mortality risk for men

By Deborah Jeanne Sergeant

Men died of opioid and stimulant drugs at a rate two to three times higher than women between 2020 and 2021, according to a recent study. The data looked at fentanyl, heroin, methamphetamine and cocaine.

The study said that men’s higher rates of use do not entirely account for the increase in mortality risk.

The study was published by Neuropsychopharmacology and 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,” said physician Nora Volkow, director of NIDA and one of the co-authors on the study in a press 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.”

The study indicated that further research must be done to determine why more men die from stimulant and opioid overdoses than women.

“We’re still trying to understand the underlying major mechanisms and modified risk factors that could explain this differential,” said physician Hemant Kalia, managing director at Invision Health in the great Rochester region. “Some things that come to light are maybe some cultural-bound differences where there is a propensity towards risky behavior that can lead to overdose and associated mortality. We’ve seen similar differences in a study that found males are three to four times more likely for motor vehicle collisions. That also goes with that risky behavior propensity. We cannot exclude other biological, behavior, and social factors.”

At Delphi Rise in Rochester, Clinical Director Carla Leaks said that her facility sees 70% men and 30% women; however, many of these are referrals from the legal system as identified with a substance use disorder.

“Thirty-two percent of the men in admission status with our clinic on June 30, 2023, had a primary diagnosis of opioid use disorder, moderate or severe,” she said.

One the same date, “20% of the women in admission status had a primary diagnosis of moderate or severe opioid use. This would suggest that men are using opioids more than women are.”

Leaks thinks that socially constructed beliefs about gender are driving behavioral differences that result in higher overdose rates, with men eager to take risks and look “macho.” There’s also the factor of men eschewing healthy ways of dealing with trauma and stress and turning to drugs.

Leaks said that metabolic differences between men and women may also present a factor.

Evan Frost, assistant director of communications and public information at the NYS Office of Addiction Services and Supports (NYS OASAS) in Albany, said that more than 70% of treatment admissions are male.

“A higher prevalence of substance use disorder in men is not new and has been a steady trend in both New York state and the rest of the country for years,” he said.

As to why more men are dying — especially since they’re entering treatment programs at higher rates — it’s not entirely clear.

Most of the programs OASAS offers are oriented toward men or are men-only, including programs on parenting, relationships in early recovery, anger management, and specialized services for those involved in the criminal justice system.

“In general, we are also addressing opioid overdoses by increasing access to care through low threshold access to medications for opioid use disorder, providing overdose prevention education and naloxone, and providing fentanyl and xylazine test strips so people who use drugs can be informed about what is in their supply,” Frost added.