Fentanyl overdoses among seniors surge 9,000% — A hidden crisis few saw coming

This research is one of the first to use Centers for Disease Control and Prevention (CDC) data to reveal that older adults -- often left out of overdose analyses -- are increasingly part of the national surge in fentanyl-stimulant deaths. People in this age group face higher risks of overdose because many manage chronic illnesses, take multiple medications, and metabolize drugs more slowly as they age.

Experts describe the opioid epidemic as unfolding in four distinct "waves," each tied to a different drug driving fatal overdoses: prescription opioids in the 1990s, heroin beginning around 2010, fentanyl taking hold in 2013, and a combination of fentanyl and stimulants emerging in 2015.

"A common misconception is that opioid overdoses primarily affect younger people," said Gab Pasia, M.A., lead author of the study and a medical student at the University of Nevada, Reno School of Medicine. "Our analysis shows that older adults are also impacted by fentanyl-related deaths and that stimulant involvement has become much more common in this group. This suggests older adults are 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 CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) system. Of those deaths, 17,040 involved adults 65 and older, while 387,924 were among adults aged 25 to 64.

Between 2015 and 2023, fentanyl-related deaths rose from 264 to 4,144 among older adults (a 1,470% increase) and from 8,513 to 64,694 among younger adults (a 660% increase). Within the older population, deaths involving both fentanyl and stimulants grew 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, fentanyl-stimulant deaths rose from 21.3% (1,812 of 8,513) to 59.3% (38,333 of 64,694) over the same period, a 2,115% increase.

Researchers chose to highlight 2015 and 2023 in their analysis because 2015 marked the beginning of the epidemic's fourth wave, when fentanyl-stimulant deaths among older adults were at their lowest, and 2023 represented the most recent year of CDC data available.

The researchers noted that the rise in fentanyl deaths involving stimulants in older adults began to sharply rise in 2020, while deaths linked to other substances stayed the same or declined. Cocaine and methamphetamines were the most common stimulants paired with fentanyl among the older adults studied, surpassing alcohol, heroin, and benzodiazepines such as Xanax and Valium.

"National data have shown rising fentanyl-stimulant use among all adults," said Mr. Pasia. "Because our analysis was a national, cross-sectional study, we were only able to describe patterns over time -- not determine the underlying reasons why they are occurring. However, the findings underscore that fentanyl overdoses in older adults are often multi-substance deaths -- not due to fentanyl alone -- and the importance of sharing drug misuse prevention strategies to older patients."

The authors noted anesthesiologists and other pain medicine specialists should:

• Recognize that polysubstance use can occur in all age groups, not only in young adults.
• Be cautious when prescribing opioids to adults 65 or older by carefully assessing medication history, closely monitoring patients prescribed opioids who may have a history of stimulant use for potential side effects, and considering non-opioid options when possible.
• Use harm-reduction approaches such as involving caregivers in naloxone education, simplifying medication routines, using clear labeling and safe storage instructions and making sure instructions are easy to understand for those with memory or vision challenges.
• Screen older patients for a broad 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 clinicians about overdose prevention strategies, such as having naloxone available and knowing the signs of an overdose," said Richard Wang, M.D., an anesthesiology 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 minimize opioid use in this vulnerable group and use other pain control methods when appropriate. Proper patient education and regularly reviewing medication lists could help to flatten this terrible trend."