Tom Valentino, Digital Managing Editor
From 2020 to 2021, men had a rate of overdose mortality from opioids and psychostimulants that was 2 to 3 times greater than the overdose mortality rate for women, according to a recent study.
Findings were published in the journal Neuropsychopharmacology. The study was led by investigators from the Icahn School of Medicine at Mount Sinai in New York City and the National Institute on Drug Abuse (NIDA).
The discrepancy in overdose deaths between men and women could be attributed to a combination of biological, behavioral, and social factors.
“Though men and women are being exposed to the modern, fentanyl-contaminated drug supply, something is leading men to die at significantly higher rates,” NIDA Director Nora Volkow, MD, said in a news 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.
“Understanding the biological, behavioral, and social factors that impact drug use and our bodies’ responses is critical to develop tailored tools to protect people from fatal overdose and other harms of drug use.”
Researchers conducted a state-by-state analysis of nationally representative epidemiological data on overdose deaths among Americans between the ages of 15 and 74. Data was compiled from the Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) platform, as well as state-level, nationally representative data from the National Survey on Drug Use and Health (NSDUH) to estimate rates for drug misuse.
After controlling for sex-specific rates of drug misuse, researchers found that overdose death rates by sex for the following drugs were:
The magnitude of difference of overdose mortality between men and women was significantly greater than the difference in reported drug misuse between men and women. For example, men were found to have a 2.8 greater rate of cocaine overdose mortality than women, while having just a 1.9 greater rate of cocaine misuse.
The study’s authors hypothesized that several factors could be causing the discrepancy. For example, men could have a greater vulnerability to the toxicity of drugs than women. Men may also engage in riskier drug-using behaviors.
“These data emphasize the importance of looking at the differences between men and women in a multilayered way,” Eduardo R. Butelman PhD, assistant professor of psychiatry at the Icahn School of Medicine at Mount Sinai and a lead author on the study, said in the release. “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.”
Men died of overdose at 2-3 times greater a rate than women in the US in 2020-2021. News release. National Institute on Drug Abuse. June 14, 2023. Accessed June 20, 2023.
Biden-Harris Administration Designates Fentanyl Combined with Xylazine as an Emerging Threat to the United States
Xylazine’s growing role in overdose deaths nationwide prompts Administration to make this designation for the first time in U.S. history
ATLANTA, GA – Today, Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy (ONDCP), has officially designated fentanyl adulterated or associated with xylazine as an emerging threat to the United States. Xylazine is a non-opioid tranquilizer approved by the Food and Drug Administration (FDA) for veterinary use but not human use. This designation comes after careful review of the impact of xylazine on the opioid crisis, including its growing role in overdose deaths in every region of the United States.
“As a physician, I am deeply troubled about the devastating impact of the fentanyl-xylazine combination, and as President Biden’s drug policy advisor, I am immensely concerned about what this threat means for the Nation,” said Dr. Gupta. “That’s why the Biden-Harris Administration is using this designation authority for the first time since it passed Congress in 2018. By declaring xylazine combined with fentanyl as an emerging threat, we are being proactive in our approach to save lives and creating new tools for public health and public safety officials and communities across the Nation. To parents, loved ones, community leaders, and those affected by xylazine use: I want you to know that help is on the way.”
ONDCP is required to monitor novel and evolving patterns of substance use, establish criteria for determining when a substance or combination of substances should be designated an emerging threat, and declare emerging threats when the Director deems appropriate based on the criteria. These criteria were published earlier this year, and focus on geographic presence of an emerging threat, as well as impact measured by metrics such as overdoses in the course of a year.
Director Gupta is making this designation because xylazine combined with fentanyl is being sold illicitly and is associated with significant and rapidly worsening negative health consequences, including fatal overdoses and severe morbidity.
The Drug Enforcement Administration (DEA) reports that:
These levels of geographic distribution and rapid increase in negative health outcomes meet the Emerging Threats Criteria used by ONDCP to judge when the novel use of a substance should be considered as an emerging threat to the nation. While national overdose death numbers have flattened or decreased for seven straight months, xylazine is complicating efforts to reverse opioid overdoses with Naloxone and threatens progress being made to save lives and address the opioid crisis.
Following today’s public declaration, the Administration will take steps to publish a whole-of-government response that includes evidence-based prevention, treatment, and supply reduction.
ONDCP is convening an interagency working group to inform the development of the national response plan. The response will include work on xylazine testing, treatment and supportive care protocols, comprehensive data systems (including information on drug sourcing and supply), strategies to reduce illicit supply of xylazine, and rapid research (such as work on the interactions between xylazine and fentanyl).
President Biden has made combatting the opioid crisis a key part of his Unity Agenda for America and has taken several actions to reduce both the supply of fentanyl and negative health outcomes associated with illicit fentanyl and other illicit substances. Fentanyl was dangerous before and it is even more dangerous now due to its combination with xylazine. Addressing the fentanyl crisis also requires addressing the drugs—in particular xylazine—with which fentanyl is being combined. Saving lives is the Administration’s North Star and drives the President’s drug policy.
Read about the Biden-Harris Administration’s efforts to crack down on illicit fentanyl supply chains HERE.
Read the Biden-Harris Administration’s National Drug Control Strategy HERE.
Read about the Emerging Threat Committee’s last meeting regarding xylazine HERE.