Fentanyl overdoses among seniors rise by 9,000% – a hidden crisis that few expected

This research is one of the first to use Centers for Disease Control and Prevention (CDC) data to reveal that older adults — often excluded from overdose analyzes — make up a growing portion of the national increase in deaths from fentanyl stimulants. People in this age group face a greater risk of overdose because many have chronic diseases, take multiple medications, and metabolize medications more slowly as they age.

Experts describe the opioid epidemic as unfolding in four different “waves,” each associated with a different drug that leads to fatal overdoses: prescription opioids in the 1990s, heroin that began around 2010, fentanyl that took hold in 2013, and a combination of fentanyl and stimulants that emerged in 2015.

“A common misconception is that opioid overdoses primarily affect young adults,” said Jabe Basia, lead author of the study and a medical student at the University of Nevada, Reno College of Medicine. “Our analysis shows that older adults are also affected by fentanyl-related deaths and that stimulant involvement is becoming more common in this group. This suggests that older adults are being affected by the current fourth wave of the opioid crisis, following similar patterns seen in younger populations.”

To conduct the study, researchers examined 404,964 death certificates listing fentanyl as a cause of death from 1999 to 2023, using data from the Centers for Disease Control and Prevention’s Wide Online Data System for Epidemiological Research (WONDER). Of those deaths, 17,040 were people 65 or older, while 387,924 were among adults ages 25 to 64.

Between 2015 and 2023, fentanyl-related deaths rose from 264 to 4,144 among older adults (an increase of 1,470%) and from 8,513 to 64,694 among younger adults (an increase of 660%). Among older adults, deaths from both fentanyl and stimulants rose from 8.7% (23 of 264 fentanyl deaths) in 2015 to 49.9% (2,070 of 4,144) in 2023 — a staggering 9,000% rise. In comparison, among younger adults, deaths due to fentanyl stimulants rose from 21.3% (1,812 of 8,513) to 59.3% (38,333 of 64,694) over the same period, an increase of 2,115%.

The researchers chose to highlight the years 2015 and 2023 in their analysis because 2015 marked the beginning of the fourth wave of the epidemic, when deaths from fentanyl stimulants among older adults were lowest, and 2023 represented the most recent year available for Centers for Disease Control and Prevention data.

The rise in stimulant-related fentanyl deaths in older adults began to rise sharply in 2020, while deaths associated with other substances remained the same or decreased, the researchers noted. Cocaine and methamphetamine were the most common stimulants paired with fentanyl among older adults studied, surpassing alcohol, heroin, and benzodiazepines such as Xanax and Valium.

“National data has shown a rise in the use of fentanyl stimulants among all adults,” Mr. Basia said. “Because our analysis was a national, cross-sectional study, we were only able to describe patterns over time—and not identify underlying causes of their occurrence. However, the results underscore that fentanyl overdoses in older adults are often multi-substance deaths—not due to fentanyl alone—and the importance of sharing substance abuse prevention strategies for older patients.”

The authors note that anesthesiologists and other pain specialists should:

• You should realize that polysubstance use can occur in all age groups, not just young people.
• Use caution when prescribing opioids to adults 65 years of age or older by carefully evaluating medication history, closely monitoring patients prescribed opioids who may have a history of using stimulants for potential side effects, and considering non-opioid options when possible.
• Use harm reduction techniques, such as involving caregivers in teaching naloxone, simplifying medication procedures, using clear labels and safe storage instructions, and making sure instructions are easy to understand for those with memory or vision challenges.
• Screen older patients for a wider range of substance exposures, beyond prescribed opioids, to better anticipate complications and adjust perioperative planning.

“Older adults who are prescribed opioids, or their caregivers, should ask their doctors about overdose prevention strategies, such as availability of naloxone and knowing the signs of overdose,” said Richard Wang, MD, an anesthesiologist resident at Rush University Medical Center, Chicago, and co-author of the study. “With these trends in mind, it is more important than ever to reduce opioid use in this vulnerable group and use other methods of pain control when appropriate. Proper patient education and regular review of medication lists can help flatten this terrible trend.”