A deadly new wave of fentanyl-stimulant overdoses is claiming the lives of older adults at unprecedented rates.
https://www.sciencedaily.com/releases/2025/10/251012054606.htm
Summary:Overdose deaths from fentanyl mixed with stimulants have skyrocketed among seniors, increasing 9,000% in just eight years. Once thought to affect mainly the young, the opioid epidemic’s fourth wave now engulfs older adults too. Cocaine and methamphetamine are the leading culprits, and experts warn that multi-drug use makes these overdoses especially lethal. Doctors are urged to educate patients and caregivers on prevention and safer pain management.
Fatal overdoses among adults 65 and older involving fentanyl mixed with stimulants such as cocaine and methamphetamines have risen dramatically, climbing 9,000% in the past eight years. The rate now mirrors that seen in younger adults, according to findings presented at the ANESTHESIOLOGY® 2025 annual meeting.
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.”
Filed under: General Problems
I can tell you exactly why this 4th wave has happened. Often chronic pain patient “seniors” are cut back on QoL giving opioids strictly due to their age. These people are suffering and going to the streets. Think about it….they are tired from untreated pain and are willing to risk their lives for some relief, no matter the outcome. I fully blame the gov’t for overreach in the sick, twisted, control of RX opioids. Along with the medical boards and anti-opioid groups such as PROP.
I’m 63 as of this writing. I had to retire early at age 56 due to illness. All of my disability pay is taxable because I get a pension – how fair is that? I am continuing to decline, though being treated, I have conditions that are progressive and do not get better. Just the tip of the iceberg is DDD, DJD, and spinal stenosis. In 2 years, if this new plan to start tapering those 65 and older off benzos (if fortunate to even have an RX; I get 6 pills per MONTH and have severe anxiety; used to have an RX for 3 xanax per DAY.) and opioids. I will be in a world of literal hurt. I barely get by on the pain relief I do receive and for it to be cut would be damning me to an intolerable way to live the rest of my life. I’m not at risk for OD – opioids only take the edge off the pain of a mangled back. I still can only stand for 20-30 minutes at a time w/o having to sit down. I know that day is coming and what am I supposed to do? I and millions of others are considered expendable and a drain to society.
I have always believed in judging a country in how they treat the young, disabled, and elderly. The US is no longer a first world for those in the categories listed. Possibly for healthy young people.
I read a lot of medical sites, targeting doctors. All they seem to be pushing now is opioid-sparing surgeries and treatments. I have been exposed to opioids all throughout my life. Am I an addict? No. Am I dependent? Yes, as a diabetic is dependent upon insulin. No one except those doctors in the know and educated pain patients seem to believe that exposure to opioids ONLY leads to addiction in a fraction of 1% of patients.
Peace and better days to all of those who made it this far through my rant. I wish protection from the DEA/DoJ for doctors who prescribe and proper pain care for those suffering.
Well said, Lisa! I was diagnosed 16 years ago with an incurable and rare blood cancer. My cancer specialists all reassured me that I would never have to worry about the new restrictions on opioids as I was a cancer patient and thereby exempt from the unconscionable CDC “recommendations”. So much for that prognosis, huh docs!?
Thank you Steve. I appreciate your article and agree.
We are definitely the target.
The OD surge is due to illicit fentanyl in illegal drugs, so if course their response is to tell Drs to be even more paranoid about prescribing safe, effective pain meds. Brilliant! There’s clearly a stupidity epidemic.
Yes, but its a SPECIAL kind of stupidity, doncha think?!
I see this study detrimental to seniors as the underlying reason why wasn’t stated. Seniors are being forced to the streets seeking pain medication because of the ongoing abandonment of those in chronic pain. Now for the 8.5% who represent the most severe pain conditions I’d bet they represent a very high number of those who’ve overdosed. They try doctoring themselves and that’s dangerous and in advisable. To bad the study doesn’t elucidate on the why.
SIMPLE TO SEE FROM HERE: EVERYONE HAS ABANDONED SENIORS, THE MOST COMMON OF THE CHRONICALLY IN DIRE PAIN. THEY ARE NOT EVEN TRYING TO BE HUMAINE ABOUT IT.
THE MILITARY, WHOSE NUMBERS INCLUDE COMBAT RELATED INJURIES LEARNED LAST MONTH THAT IN A FEW YEARS THE VA WILL BE OPIOID FREE. NOTE- NOT PAIN-FREE. TAKE INTO ACCOUNT ALLERGIES TO MEDICINES AND THAT LEAVES NOTHING TO OUR BRAVE MILITARY.
SENIORS WITH SEVERE ALLERGIES, UNABLE TO TAKE ANYTHING ELSE.. INSTEAD OD DENYING PAIN MANAGEMENT, EDUCATE THOSE AND ALLOW THEM PAIN CONTROL. I’VE NOT SLEPT AT ALL TONIGHT FOR PAIN. EVEN WITH PRESCRIPTIONS, I TAKE CARE TO USE MINIMAL EVEN WHEN I’M IN ACTIVE, PROGRESSIVE PAIN.
FOR THOSE UNEDUCATED, NON- DOCTORS WHO SAY AN ASPIRIN IS ENOUGH, I HOPE YOU HAVE A CATASTROPHIC AND VERY PAINFUL ILLNESS SO WE CAN SEE HOW BRAVE YOU ARE.
WHEN YOU CHANGE YOUR WORDING FROM “IT’S ALL GOING AWAY” TO “WHERE POSSIBLE(!!!) WE WILL REDUCE USIGE PEOPLE WILL BEGIN TO TAKE YOU SERIOUSLY,