Polysubstance Use: A Broader Understanding of Substance Use During the Opioid Crisis

Abstract

Objectives. To understand important changes in co-occurring opioid and nonopioid drug use (i.e., polysubstance use) within the opioid epidemic in the United States.Methods. We analyzed survey data on the past month co-use of prescription and illicit opioids and 12 nonopioid psychoactive drug classes from a national sample of 15 741 persons entering treatment of opioid use disorder.Results. Past-month illicit opioid use increased from 44.8% in 2011 to 70.1% in 2018, while the use of prescription opioids alone dropped from 55.2% to 29.9%, yet overall remained high (94.5% to 85.2%). Past-month use of at least 1 nonopioid drug occurred in nearly all participants (> 90%), with significant increases in methamphetamine (+85%) and decreases across nonopioid prescription drug classes (range: -40% to -68%).Conclusions. Viewing opioid trends in a "silo" ignores the fact not only that polysubstance use is ubiquitous among those with opioid use disorder but also that significant changes in polysubstance use should be monitored alongside opioid trends.Public Health Implications. Treatment, prevention, and policymaking must address not only the supply and demand of a singular drug class but also the global nature of substance use overall.

FIGURE 1—

Percentage of Survey of Key Informants’ Patients (SKIP) Sample Who Indicated Past-Month Use “to Get High” of (a) Any Prescription Opioid and Heroin or Nonprescription Fentanyl, and (b) Prescription Opioids Exclusively, Prescription and Illicit Opioids, or Illicit Opioids Exclusively: United States, Second Half of 2011 to First Half of 2018 Note. q = quarter; Rx = prescription. ^aDoes not include nonprescription fentanyl.

FIGURE 2—

The Prevalence Rates of Past-Month Use of Nonopioid Drugs Among the Survey of Key Informants’ Patients Sample in the First Analysis Period (Second Half of 2011) and the Final Analysis Period (First Half of 2018): United States Note. q = quarter; Rx = prescription. Trend lines indicate the prevalence rates across the entire study period. ^aData first made available in 2015q1,2.

FIGURE 3—

The Percent Change in Past-Month Use of Nonopioid Drugs Among the Survey of Key Informants’ Patients Sample From the Initial Analysis Period (Second Half of 2011) to the Final Analysis Period (First Half of 2018): United States Note. Rx = prescription. ^aData first made available in 2015q1,2.

FIGURE 4—

Past-Month Opioid Use Showing the Relative Frequency of Nonopioid Polysubstance Use Among Each Opioid Subgroup at Each Time Point by (a) Line Chart and (b) Bubble Chart: United States, 2011–2018 Note. Rx = prescription. Past-month opioid use included prescription poioids exclusively, prescription and illicit opioids, or illicit opioids exclusively. In part a, the trend line represents the mean number of unique, nonopioid drugs used at each time point, with standard error shown in shaded region. In part b, the size of the bubble corresponds to the relative proportion during each time period.