Overdose deaths amongst adults 65 and older from fentanyl mixed with stimulants have surged 9,000%, revealing a growing threat to seniors. Experts warn that age, medications, and health conditions make this group especially at risk.
Overdose deaths among people 65 and older linked to fentanyl mixed with stimulants such as cocaine and methamphetamines have skyrocketed by 9,000% in the past eight years, reaching levels similar to those seen in younger adults. The findings, presented at the ANESTHESIOLOGY 2025 annual meeting, highlight an alarming and often overlooked trend affecting older Americans.
This research is one of the first to use Centers for Disease Control and Prevention (CDC) data to demonstrate that older adults, a group rarely centered in overdose studies, are now deeply involved in the growing wave of fentanyl-stimulant fatalities. Those 65 and older are particularly at risk because they are more likely to have chronic health issues, take multiple medications, and process drugs more slowly as they age.
The Fourth Wave of the Opioid Epidemic
The opioid crisis has evolved through four distinct stages, each dominated by a different substance driving overdose deaths: prescription opioids in the 1990s, heroin around 2010, fentanyl beginning in 2013, and a combination of fentanyl and stimulants starting 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.”
Tracking the Deadly Trend in CDC Data
To examine the trend, researchers analyzed 404,964 death certificates listing fentanyl as a cause of death between 1999 and 2023, using data from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) system. Of these, 17,040 deaths were among people age 65 and older, while 387,924 were among those 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). The most striking finding was the rapid rise in deaths involving both fentanyl and stimulants. Among older adults, these cases grew from 8.7% (23 of 264 fentanyl deaths) in 2015 to 49.9% (2,070 of 4,144) in 2023—a 9,000% jump. For younger adults, the proportion rose from 21.3% (1,812 of 8,513) to 59.3% (38,333 of 64,694) over the same period, an increase of 2,115%.
Cocaine and Methamphetamine Drive the Surge
The researchers highlighted data from these individual years because 2015 marked the onset of the fourth wave of the opioid epidemic and was also the year fentanyl-stimulant deaths among older adults were at their lowest, and 2023 as it was 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.
Multi-Substance Overdoses and Prevention Strategies
“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 with older patients.”
The authors noted that 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.
A Call to Action for Clinicians and Caregivers
“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.”
Meeting: ANESTHESIOLOGY 2025 Annual Meeting
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