Oct. 16, 2025 – While drug overdose deaths overall have been falling recently, death rates for one surprising group continue to climb.
The number of fentanyl-related deaths among people ages 65 and older have jumped nearly 1,500% since 2015, a new study found. These deaths most often involved a combination of fentanyl (an opioid painkiller) and a stimulant like cocaine or methamphetamine. As the opioid epidemic has shifted from prescription drugs to illicit fentanyl, the new study highlights that older adults are not immune from this latest wave.
"We expected to see some rise in fentanyl-related deaths among older adults, but the magnitude of the change was striking," said lead investigator Gab Pasia, MA, a researcher at the University of Nevada, Reno School of Medicine.
This age group has unique medical and social risks, including chronic pain, taking multiple medications, slower processing of drugs in the body, and social isolation – things often overlooked in discussions about substance use, Pasia said.
The study, which has not been published yet and was presented Saturday at the annual meeting of the American Society of Anesthesiologists in San Antonio, Texas, is the latest in a growing body of evidence suggesting older Americans may be particularly vulnerable to opioid misuse. While adults ages 65 and older have a lower overall death rate than younger groups, they have seen massive increases in recent years. A 2022 study in the journal JAMA Network Open found opioid overdose deaths among adults ages 55 and up rose tenfold between 1999 and 2019, surging from less than 1 death per 100,000 people to more than 10. A 2024 CDC report showed that despite decreasing overdose death rates among people ages 15 to 54 in 2023, rates increased for those ages 55 and up.
Overall opioid deaths started to level off around 2010, likely due to health care-led efforts such as prescription drug monitoring programs, expanded naloxone access laws, and the 2010 reformulation of OxyContin that made the pill harder to crush and dissolve for inhalation or injection.
"However, this step forward was quickly followed by a steep rise in overall opioid-related deaths due to fentanyl and other illicit synthetic opioids," said Edward R. Mariano, MD, a professor and vice chair of anesthesiology, perioperative, and pain medicine at Stanford University School of Medicine. (Mariano was not affiliated with the new study.)
What We Know
Pasia and co-investigators studied nearly 405,000 death certificates – including 17,040 for people 65 and older and 387,924 for people 25 to 64 – between 1999 and 2023 that listed fentanyl as a cause of death.
- Fentanyl-related deaths among adults 65-plus increased 1,470% from 2015 (264 deaths) to 2023 (4,144). This was more than twice the 660% rise in fentanyl-related deaths among younger adults during the same period, which rose from 8,513 to 64,694.
- Deadly combinations like fentanyl mixed with stimulants account for a growing share of these deaths – rising in the older group from 8.7% in 2015 to 49.9% in 2023, and from 21.3% to 59.3% in the younger group.
- In the older group, the stimulants were most often illicit drugs, not prescription medications. The most common ones were cocaine and methamphetamines, surpassing alcohol, heroin, and benzodiazepines such as Xanax and Valium. The findings highlight illicit drug use – not just misuse of prescriptions – as a growing risk among older adults.
What We Don't Know
The cross-sectional study design did not allow researchers to look at why deaths increased. "One potential reason for the increased overdose deaths from illicit fentanyl could be drug contamination," Mariano said. Unlike fentanyl prescribed by doctors, illicit fentanyl has been found to include other substances like stimulants or carfentanil, an illicit synthetic opioid much more potent than fentanyl, he said. Illicit fentanyl and its analogs have been the main drivers of overdose deaths in the United States in recent years, according to the U.S. Government Accountability Office.
What to Do
Recognize the substance misuse warning signs of an older friend or relative at risk, said Richard Wang, MD, a study co-author and anesthesiology resident at Rush University Medical Center in Chicago. Look for changes in mood, alertness, or daily functioning, as well as confusion, drowsiness, or a hard time keeping track of medications. Keep in mind that some symptoms can be easy to mistake for normal signs of aging. Also know how to use the opioid reversal agent naloxone.
Families and caregivers should maintain an open dialogue about medications. Stigma often prevents people from seeking help or talking openly about their medications, Pasia said. "The best way to start a conversation is with empathy and curiosity, not judgment. Asking how someone is managing their pain, whether their medications feel effective, or if they have experienced side effects can make the discussion feel safe and supportive."
Communication among doctors, pharmacists, and caregivers is crucial to prevent unintentional drug interactions, Pasia said. Doctors and medical societies can also be part of the solution. "The goal is to normalize talking about medication safety as part of routine care, not as a sign of wrongdoing."
The American Society of Anesthesiologists highlights the importance of multimodal pain management, which means using non-opioid and non-drug therapies whenever possible, and prescribing opioids at the lowest effective dose for the shortest necessary duration when they are needed.
If you're concerned, get help from a doctor right away. You can also contact the Substance Abuse and Mental Health Services Administration's National Helpline at 800-662-HELP (800-662-4357).
