Fatal overdoses involving fentanyl mixed with stimulants among adults aged 65 and older have increased by 9,000% over the past eight years, according to new research. This trend mirrors patterns in younger adults and highlights the opioid crisis's fourth wave affecting older populations. The findings, presented at the ANESTHESIOLOGY® 2025 annual meeting, urge better prevention and education for seniors.
The opioid epidemic has evolved through four waves: prescription opioids in the 1990s, heroin around 2010, fentanyl from 2013, and fentanyl combined with stimulants since 2015. New analysis reveals that older adults are now deeply impacted by this latest phase.
Researchers examined 404,964 death certificates listing fentanyl as a cause from 1999 to 2023, using CDC's WONDER data. Among these, 17,040 involved adults 65 and older, compared to 387,924 for those aged 25 to 64.
From 2015 to 2023, fentanyl-related deaths in older adults rose from 264 to 4,144—a 1,470% increase. Within this group, deaths involving both fentanyl and stimulants jumped from 8.7% (23 of 264) to 49.9% (2,070 of 4,144), marking a 9,000% rise. For younger adults, the proportion increased from 21.3% to 59.3%, a 2,115% rise, with overall fentanyl deaths climbing from 8,513 to 64,694 (660% increase).
The sharp increase in older adults began in 2020, with cocaine and methamphetamines as the most common stimulants paired with fentanyl, outpacing alcohol, heroin, and benzodiazepines.
"A common misconception is that opioid overdoses primarily affect younger people," said Gab Pasia, M.A., lead author and 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."
Experts attribute higher risks in seniors to chronic illnesses, multiple medications, and slower drug metabolism. They recommend anesthesiologists and pain specialists recognize polysubstance use across ages, assess medication histories carefully, monitor for side effects, and prioritize non-opioid pain options.
Harm-reduction strategies include educating patients and caregivers on naloxone, simplifying medication routines, and screening for broader substance exposures.
"Older adults who are prescribed opioids, or their caregivers, should ask their clinicians about overdose prevention strategies," said Richard Wang, M.D., co-author and anesthesiology resident at Rush University Medical Center. "With these trends in mind, it is more important than ever to minimize opioid use in this vulnerable group."