Conference Coverage

Study: Fentanyl-Stimulant Overdose Deaths Surge Among Older Adults

Anthony Calabro, MA

Key Highlights

  • Fentanyl-stimulant overdose deaths among adults ≥ 65 years increased 9000% from 2015 to 2023.
  • Overall fentanyl-related deaths in this age group rose 1470% during the same period.
  • Stimulants surpassed alcohol, heroin, and benzodiazepines as the most frequent co-involved substances.
  • Mortality trends in older adults now mirror those of younger populations.

From 2015 to 2023, fentanyl-related overdose deaths in adults aged 65 years and older increased from 264 to 4144,representing a 1470% rise,while deaths involving fentanyl-stimulant combinations surged 9000%, from 8.7% (23 of 264 deaths) to 49.9% (2070 of 4144 deaths), according to a new study presented at the ANESTHESIOLOGY annual meeting in San Antonio, TX.1

In this same period, stimulant co-involvement among adults aged 25 to 64 years increased from 21.3% to 59.3%. Among older adults, stimulants such as cocaine and methamphetamine became the most frequently co-involved substances, surpassing benzodiazepines, alcohol, and heroin.

The U.S. opioid epidemic has evolved through four distinct waves: prescription opioids in the 1990s, heroin around 2010, fentanyl in 2013, and the most recent phase, marked by fentanyl-stimulant combinations, beginning in 2015. While these trends have been well characterized in younger populations, their impact on older adults has been less clear. Older adults face unique risks, including polypharmacy, chronic pain, multiple comorbidities, and slower drug metabolism, as well as social isolation and limited access to harm-reduction strategies.2

“A common misconception is that opioid overdoses primarily affect younger people,” Lorenzo Gabriel Pasia, MA, lead author of the study and a medical student at the University of Nevada, Reno School of Medicine, said in an ASA press release.2 “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.”

In this retrospective, cross-sectional analysis, researchers examined CDC WONDER mortality data from 2000 to 2023. They compared age-adjusted and crude death rates between adults aged 65 years or older and those aged 25 to 64 years. Fentanyl-related overdose deaths were identified using ICD-10 code T40.4, and stimulant co-involvement was defined by T40.5 (cocaine) and/or T43.6 (psychostimulants). Joinpoint Regression was applied to identify inflection points in mortality trends, and analyses were conducted in RStudio.1

From 2015 to 2023, stimulant co-involvement in fentanyl-related deaths among older adults increased nearly six-fold, paralleling trends in younger populations. Co-involvement with prescription opioids also continues to rise, underscoring a unique vulnerability at the intersection of medical and non-medical opioid exposure. These findings call for continued vigilance in opioid prescribing, tailored pain management strategies, and age-appropriate harm-reduction interventions to mitigate overdose risk in this growing population.

In the ASA press release, the study authors emphasized that anesthesiologists and pain medicine specialists play a crucial role in mitigating overdose risk in older adults. They recommend that clinicians:

  • Recognize that polysubstance use can occur in all age groups, not only in young adults.
  • Be cautious when prescribing opioids to adults aged 65 years or older by carefully assessing medication history, closely monitoring for side effects, and considering non-opioid options when possible.
  • Use harm-reduction approaches such as involving caregivers in naloxone education, simplifying medication routines, providing clear labeling and safe storage instructions, and ensuring instructions are easy to follow for those with vision or memory challenges.
  • Screen older patients for a broad range of substance exposures beyond prescribed opioids to better anticipate complications and adjust perioperative planning.2

“National data have shown rising fentanyl-stimulant use among all adults,” Mr. Pasia said in the press release. “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.”2

References

  1. Pasia LG, Tang H, Baria D, et al. Fentanyl-stimulant co-involvement in older adults: trends in the fourth wave of the U.S. opioid crisis. Presented at: ASA Annual Meeting; 2025; San Antonio, TX. Available at: https://www.asahq.org/annualmeeting/attend.
  2. American Society of Anesthesiologists. Adults 65 years and older not immune to the opioid epidemic, new study finds: fentanyl-stimulants drive sharp increase in senior overdose deaths [Press Release]. October 11, 2025. Available at: https://www.asahq.org/annualmeeting/attend.