BOSTON (WHN) – Fatal overdoses involving fentanyl and stimulants have surged by an astonishing 9,000% among adults aged 65 and older over the past eight years, a trend that now mirrors rates seen in younger populations. This alarming increase, detailed in findings presented at the ANESTHESIOLOGY® 2025 annual meeting, highlights a growing crisis often overlooked in national overdose analyses.
The research, which drew upon extensive Centers for Disease Control and Prevention (CDC) data, is among the first to document the escalating impact of fentanyl-stimulant deaths on older adults. This demographic faces particular vulnerabilities. They often manage multiple chronic health conditions, are prescribed numerous medications, and experience age-related changes in drug metabolism, all of which can elevate overdose risks.
The opioid epidemic, as characterized by public health experts, has progressed through distinct phases. The 1990s saw a rise in prescription opioid-related deaths, followed by heroin in the early 2010s. Fentanyl’s prevalence began around 2013, and by 2015, the combination of fentanyl with stimulants emerged as a significant driver of fatalities.
“A common misconception is that opioid overdoses primarily affect younger people,” stated 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.”
Researchers analyzed 404,964 death certificates listing fentanyl as a cause of death between 1999 and 2023, utilizing data from the CDC’s Wide-ranging Online Data for Epidemiologic Research (WONDER) system. Of these, 17,040 deaths involved individuals 65 and older, while 387,924 were among adults aged 25 to 64.
Between 2015 and 2023, fentanyl-related fatalities among older adults increased from 264 to 4,144—a 1,470% rise. For younger adults, the increase was 660%, from 8,513 to 64,694 deaths. Crucially, within the older demographic, deaths involving both fentanyl and stimulants escalated from 8.7% (23 of 264 fentanyl deaths) in 2015 to 49.9% (2,070 of 4,144) in 2023. This represents the 9,000% increase cited. In comparison, fentanyl-stimulant deaths among younger adults saw a 2,115% rise over the same period, from 21.3% (1,812 of 8,513) to 59.3% (38,333 of 64,694).
The study specifically focused on 2015 and 2023. 2015 was selected as it marked the beginning of the epidemic’s fourth wave and represented the lowest point for fentanyl-stimulant deaths in older adults. 2023 provided the most current available CDC data.
The researchers observed a notable acceleration in fentanyl deaths involving stimulants among older adults beginning in 2020. During this period, deaths linked to other substances remained stable or declined. Cocaine and methamphetamines were identified as the most prevalent stimulants found in combination with fentanyl among the older adults studied, outnumbering alcohol, heroin, and benzodiazepines like Xanax and Valium.
“National data have shown rising fentanyl-stimulant use among all adults,” Mr. Pasia commented. “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 study’s authors suggested that anesthesiologists and other pain medicine specialists should consider these trends. Richard Wang, M.D., an anesthesiology resident at Rush University Medical Center, Chicago, and a co-author, emphasized the need for proactive measures. “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,” Dr. Wang advised. “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.”