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  • How Polysubstance Use Complicates The Opioid Epidemic

    various colorful pills and alcohol whiskey on a table

    The ongoing opioid epidemic has kept the focus mainly on the misuse of opioids/opiates, such as heroin, fentanyl, and prescription pain medications. Changes in treatment approaches have led to some success with reducing opioid overdose deaths in recent years. 

    However, something is flying under the radar. Polysubstance use, which is using more than one substance at once, paints a different picture in our understanding of this crisis. 

    Acknowledging polysubstance use can not only lead to better treatment outcomes for opioid addiction, but also improve our understanding of the opioid epidemic overall.

    Three Waves Of The Opioid Crisis

    Opioid overdose deaths over the past couple of decades have prompted changes in the way opioid addiction is treated. 

    The three waves of the opioid epidemic refer to the main type of opioid substance responsible for a large number of overdose deaths in a given time.

    First Wave

    This started with opioid prescriptions during the 1990s. Many overdose fatalities occurring during this time involved the use of natural and semi-synthetic opioid substances that were prescribed for pain relief.

    Second Wave

    The second wave started around 2010. It’s attributed to opioid seekers turning to the illicit drug heroin as a cheaper and more available alternative. This wave mainly included overdose deaths that involved heroin use.

    Third Wave

    This started around 2013 and mainly included fatal overdoses involving the use of fentanyl or other synthetic opioids. Fentanyl use has grown to include potentially deadly combinations in cocaine, heroin, or counterfeit pills.

    The Opioid Epidemic’s Fourth Wave: Polysubstance Use

    Polysubstance use among those who abuse opioids has been on the rise in recent years and is considered the fourth wave in the opioid overdose epidemic.

    A 2019 review found that: 

    • out of 2,244 fatal opioid-related overdoses in Massachusetts in 2014 and 2015, only 17 percent involved opioids alone
    • roughly 46 percent of these deaths involved the use of opioids and a non-stimulant substance 
    • around 36 percent involved the use of opioids and a stimulant substance like amphetamine or cocaine

    This review also found other trends among opioid-related overdose deaths, including a higher number of individuals among certain populations who used both opioids and stimulants: 

    • individuals older than 24 years of age
    • non-hispanic black residents
    • those living in non-rural areas
    • those with a co-occurring mental health disorder
    • those who were recently homeless

    Another study from 2019 published by the Centers for Disease Control & Prevention found:

    • overdose deaths involving fentanyl and non-opioid substances increased in 25 states
    • among overdose deaths involving fentanyl, 63 percent included other substances, such as cocaine, methamphetamine, or benzodiazepines like Xanax
    • out of these deaths, 34 percent involved cocaine, 33 percent involved benzodiazepines, and 12 percent involved methamphetamine

    Why Treating Opioid Addiction Alone Is A Problem

    The main problem with only treating opioid addiction is that this approach leaves out needed treatment for other addictions, which must be addressed in the same rehab program. 

    Leaving out treatment for other addictions, like alcohol use disorder or methamphetamine addiction, can make it harder for someone with opioid addiction to fully recover; treatment programs must factor in polysubstance use for a whole-person approach.

    Being in a medication-assisted treatment program, for example, offers a way to overcome opioid addiction with the use of buprenorphine or a similar medication like methadone. However, this does not address the issue of misusing more than one type of substance. 

    This singular approach isn’t designed to include treatment for other addictions because it is specifically designed for opioid use disorder alone.

    Treating Opioid Addiction & Polysubstance Use

    As growing evidence shows that polysubstance use is on the rise, this trend should become a factor in determining a treatment plan for opioid addiction. 

    Social factors, such as age or income level, which are shown to be associated with higher incidences of polysubstance use, should also be taken into consideration when creating individualized treatment plans. 

    Considering these factors, and the increase in polysubstance use overall, can result in more effective treatment measures while also reducing the risk of potentially fatal overdoses.

    To learn more about our individualized treatment programs, please connect with us today.

    Written by Ark Behavioral Health Editorial Team
    ©2024 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.
    Medically Reviewed by
    Kimberly Langdon M.D.
    on August 22, 2022
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