When addiction treatment professionals ask their clients what drug they are using, they often get more than one answer. A significant number of people with addiction misuse more than one substance. They may take different drugs on separate occasions or combine them for a stronger high or a specific effect. Polydrug use poses a higher risk than use of a single illicit drug alone, due to an increase in side effects, and drug synergy.
A new study published in the Journal of Substance Abuse Treatment found that “polysubstance use is common in hospitalized patients with substance use disorders and identifying patterns of polysubstance use can guide clinical management. Hospital providers should prepare to manage polysubstance use during hospitalization and hospitals should broaden care beyond interventions for opioid use disorder.”
The researchers at Oregon Health & Science University found that among patients who participated in an in-hospital addiction medicine intervention at OHSU and who stated they used opioids, nearly 70 percent said they also used more than one substance in the previous 30 days, including alcohol (29.7 percent), cocaine (9.3 percent), or amphetamine (52.8 percent).
“There are many reasons why some people choose to use multiple rather than single substances, wrote Connor, Gullo, White, and Kelly in “Polysubstance Use: Diagnostic Challenges, Patterns of Use and Health” (2014). “It can be to enhance effects, by combining drugs with similar central nervous system (CNS) mechanisms such as alcohol and benzodiazepines or two or more anxiolytic-hypnotics. Drugs with different CNS actions may also be combined to accentuate the perceived benefits of each substance, for example, opioids and benzodiazepines, stimulants and opioids, and stimulants and hallucinogens.”
Multiple substances “are used simultaneously or sequentially to ameliorate the adverse effects of drug craving or withdrawal. For example, stimulants are used to overcome dysphoria, and CNS depressants, such as benzodiazepines, to manage withdrawal symptoms of anxiety and agitation.”
Polysubstance use is dangerous and can lead to addiction. Mixing opioids like heroin or prescription painkillers like oxycodone with alcoholic beverages—the most common combination according to the OHSU study—can also be lethal.
“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.”
Despite the danger, using multiple addictive substances concurrently is widespread as the argot of the drug milieu illustrates. Any imaginable combination of psychoactive substances has a cynical nickname. Heroin mixed with cocaine has long been known as a “speedball.” Marijuana mixed with heroin is called an “atom bomb,” and a “tipsy flip” consists of alcohol and MDMA (ecstasy). There are many more concoctions with similar nicknames.
“It is clear that individuals who use multiple substances are at elevated risk of developing comorbid psychiatric and other health conditions,” Connor, Gullo, et al. concluded their article on polysubstance use. “They also have more pervasive deficits in cognitive functioning that place them at elevated risk of poorer treatment outcomes. Prevention and treatment approaches for polysubstance use are underdeveloped by comparison with treatments for abuse of single substances.”
Evidence-based, comprehensive addiction treatment has to work on multiple biopsychosocial levels and address all the mental health needs of the patient that are playing a role in the substance use disorder. The longer the period of active addiction and the more substances involved in the substance use disorder, the greater the risk for the addicted individual.
Recovery is possible. At the Farley Center, patients work collaboratively with a multidisciplinary team of highly qualified and licensed professionals to design a treatment plan that is crafted for their specific needs. If you or a loved one is struggling with substance misuse but you are unsure what addiction treatment services are available during the COVID-19 pandemic, please contact the Farley Center at 800.582.6066 and find out about your options.