Polysubstance Use and Social Factors Associated with Opioid Overdose Deaths

Polysubstance opioid overdose is increasingly common in the US, concludes a new study led by Boston Medical Center's Grayken Center for Addiction. It shows that opioid-related overdose deaths involving another substance is now the norm, not the exception, in Massachusetts. 

The study found that “between 2014 and 2015, there were 2,244 opioid-related overdose deaths in Massachusetts that had accompanying toxicology results. Toxicology reports indicated that 17 percent had opioids only, 36 percent had opioids plus stimulants, and 46 percent had opioids plus another non-stimulant substance.”

The combination of opioids and stimulants together was more likely in several subgroups, representing particular social factors.

“Persons older than 24 years, non-rural residents, those with comorbid mental illness, non-Hispanic black residents, and persons with recent homelessness were more likely than their counterparts to die with opioids and stimulants than opioids alone.”

The findings indicate a pressing need to address the social factors affecting patients with substance use disorder who are using multiple substances, such as homelessness, mental health issues, and addiction treatment in prison, in order to reduce polysubstance misuse and subsequent overdose deaths.

Taking multiple psychoactive substances without medical supervision is extremely dangerous. Combining illicit drug use with alcohol consumption is fairly common since alcoholic beverages are legally available.  “Prescription drugs and alcohol can be a dangerous combination,” the director of the National Institute on Drug Abuse, Nora Volkow, told Scientific American. “Painkillers and booze are perhaps the worst to mix, because both slow breathing by different mechanisms and inhibit the coughing reflex, creating a ‘double-whammy’ effect, that can stop breathing altogether,” Dr Volkow said. 

Another “double-whammy” is the combination of benzodiazepines and alcohol. “Benzos” and alcohol are both depressants, and combining them increases the risk of coma or fatal overdose.

Benzos and alcohol severely compromise the human central nervous and immune systems, and misuse—over longer periods of time—may lead to organ failure and death. Combining the two substances increases the user’s chances of addiction to both substances, making an eventual detox and recovery more complicated. 

The study shows that mental health issues are often correlated with polysubstance use. Many patients engage in polysubstance abuse because they are struggling with severe mental health conditions. Others are trying to cope with traumatic life experiences. Addiction treatment needs to consider all relevant co-occurring circumstances or it is likely to fail.  

Drug and alcohol misuse has to be seen in the context of social setting, personal history, substance dosage and number of substances misused, psychological profile, and many other personal, biological, and cultural variables. Mental health issues such as anxiety, depression, and trauma are often the driving force behind the substance abuse. 

Consequently, each case of addiction has to be carefully assessed in order to be able to treat it effectively. With so many important factors at play, neglecting one or more aspects of the condition can lead to treatment failure. 

The evaluation at the Farley Center occurs over a four-day period with participants onsite during the thorough assessment. While each evaluation may differ slightly, it will typically include a comprehensive history, a physical examination, an addiction medicine evaluation, a psychiatric evaluation, a series of comprehensive psychological tests, and a biopsychosocial assessment. Based on the findings, the Farley team—together with the patient—will be able to design the appropriate treatment schedule.  

If you or someone you know is struggling with substance use and could benefit from addiction treatment services, please contact The Farley Center at 800.582.6066 or fill out our admissions request form.