Journal of substance use · 2024
Polysubstance use patterns among individuals applying for opioid use disorder treatment in the U.S.
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Lee-Easton Miranda, Magura Stephen, Abu-Obaid Ruqayyah, Reed Pete, Allgaier Brandi, Fish Emily, Maletta Abigail L, Amaratunga Piyadarsha, Lorenz-Lemberg Bridget, Levitas Matthew, Achtyes Eric D
Аннотация
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 to the study during clinic intake that were tested for 22 types of substances by 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 ten 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."
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 to the study during clinic intake that were tested for 22 types of substances by 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 ten 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."