Polysubstance use patterns among individuals applying for opioid-use disorder treatment in the U.S.

ABSTRACT

Objective

The prevalence of polysubstance use is known to be high among individuals who use/misuse drugs. This study aims to extend existing research by (a) measuring polysubstance use through objective drug testing rather than fallible self-reports, (b) determining the most frequent three- and four-substance combinations instead of being limited to typical two-substance combinations, and (c) examining a comprehensive panel of substances beyond those commonly studied.

Method

Participants were a convenience sample of individuals applying for methadone maintenance treatment in 11 clinics across 7 states (n = 1098, 43.2% female). Participants voluntarily provided oral fluid and urine specimens for the study during clinic intake that were tested for 22 types of substances using liquid chromatography/tandem mass spectrometry (LC-MS-MS). 

Results

Polysubstance use was high (89.6%), with the mean number of substances used by participants = 3.3, up to a maximum of 11. There were 10 three-substance combinations with prevalences of 5% or greater, the most frequent being opiates, fentanyl, and cocaine (10.5%). There were nine four-substance combinations with prevalences of 2% or greater, the most frequent being opiates, fentanyl, cocaine, and cannabis (4.5%). Many of these combinations can produce serious and even life-threatening interactions and side effects. The combination with perhaps the most severe potential consequence of concurrent use is the combination of opiates, fentanyl, and tramadol (5.1%), which all have sedative or central nervous system (CNS) depressive effects.

Conclusion

Clinicians should consider that symptoms of substance use are likely due to diverse combinations of substances, not only problematic use of a single presenting “substance of choice.”

Highlights

• About 89.6% of participants tested positive for more than one substance

• The mean number of substances used by participants was 3.3

• Many of the combinations of substances used by participants have serious interactions when used together

KEYWORDS:

• Polysubstance use
• opioid crisis
• opioid misuse
• substance misuse

Acknowledgments

We gratefully acknowledge the invaluable assistance of the following organizations that made this study possible: Cherry Health – Muskegon Recovery Center, Cherry Health – Southside Health Center, Chilton County Treatment Center, Community Medical Services Columbus on Dublin, JSAS HealthCare, Inc, Maric Healthcare LLC, New Directions Treatment Services, Inc., Rightway Medical of Oklahoma City South (Oklahoma Treatment Services LLC), Shelby County Treatment Center, Tadiso Incorporated, Thomasville Treatment Associates (Treatment Centers LLC), Tulsa Rightway Medical (Oklahoma Treatment Services LLC), Stop Stigma Now (SSN), American Association for the Treatment of Opioid Dependence, Inc. (AATOD).

Mary E. Ramlow provided important administrative support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14659891.2024.2372093

Additional information

Funding

This work was supported by grant [5R01DA045733] from the National Institute on Drug Abuse (NIDA)