Men are more likely to die of overdoses, but it's not clear why that's the case

Nora Volkow, director of the National Institute for Drug Abuse, says something is leading men to die of overdoses at much higher rates than women. (Image credit: Mary Noble Ours/NIH)

Men are two to three more times likely than women to suffer a fatal overdose, researchers have found.

Even with men using illegal drugs more than women, the increased likelihood of fatal overdoses among men is far greater. And the gap in deaths is wider than the differences in usage of drugs by gender.

Researchers from the Icahn School of Medicine at Mount Sinai in New York City and the National Institute on Drug Abuse, part of the National Institutes of Health, led the study. The findings were published June 15 in the journal Neuropsychopharmacology.

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Many of the deaths are tied to fentanyl, and both men and women are being exposed to drugs contaminated with fentanyl.

Nora Volkow, M.D., director of the National Institute for Drug Abuse and a co-author of the study, said in a statement that, “Something is leading men to die at significantly higher rates.”

“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,” Volkow said in the statement.

Researchers analyzed fatal overdoses in 2020-2021. Nearly 107,000 Americans died in overdoses in 2021, and many deaths are attributed to fentanyl.

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The gender gap in fatalities is evident across those using several different narcotics.

Opioids, such as fentanyl: 29.0 deaths per 100,000 people for men, compared to 11.1 for women

Heroin: 5.5 deaths per 100,000 people for men, 2.0 for women

Psychostimulants (e.g. methamphetamine): 13.0 deaths per 100,000 people for men, 5.6 for women

Cocaine: 10.6 deaths per 100,000 people for men, 4.2 for women

As for why men are more likely to die of overdoses, researchers say it’s a topic that requires additional study, but they do suggest some possibilities.

The answer could be simply biology. “Sex-specific biological vulnerability to the direct toxic effects of the drugs, for example, cannot be ruled out,” the researchers wrote.

The authors also suggest that men are more willing to make dangerous choices with drugs, including how much they consume.

“​​Males, compared to females, have been shown to have a greater propensity for other risky behaviors, with associated morbidity and mortality,” they wrote.

Eduardo R. Butelman, assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai and a lead author on the study, said it’s important to examine the issue “in a multi-layered way.”

“Moving forward, it will be important for researchers to continue to investigate how biology, social factors, and behaviors intersect with sex and gender factors, and how all of these can impact addictive drug misuse and overdose deaths,” Butelman said in a statement.

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