Fentanyl in Focus: Perspectives on Polysubstance Use in 2022

Abstract: Fentanyl positivity grew by nearly 150% nationally from 2019 to 2022 and is now the most frequently detected drug in those analyzed with substance use disorder. Furthermore, a recent study suggested that about half (52%) of individuals entering treatment for opioid use disorder who were positive for fentanyl reportedly preferred fentanyl alone or mixed with heroin. Polysubstance use involving fentanyl among groups of individuals who are positive for other drugs (e.g., heroin, methamphetamine, cocaine) has also increased remarkably since 2015. Given that fentanyl was the most detected drug in 2022 and “fentanyl use,” itself often represents some inherent form of polysubstance use, a more detailed analysis of trends in polysubstance use among individuals who use fentanyl is warranted. Here, we start with the fentanyl-positive population and ask how many of those individuals are also using other drugs. Not only do these findings provide a glimpse into the national picture of polysubstance use in the fentanyl positive population, but they reveal geographic variations in polysubstance use that most likely create unique treatment challenges in different areas that may change over time. Together, the findings suggest that a one-size-fits-all approach to the fentanyl problem is unlikely to achieve broad success and highlights the importance of maintaining knowledge of current trends in polysubstance use to inform comprehensive, patient centered clinical decision making to improve treatment outcomes and support long-term recovery. Access to real-time data can inform intervention efforts and even serve as an early warning for changes in the drug use landscape.Short Description: This current analysis examines polysubstance use trends in the fentanyl positive population with the goal of providing a more nuanced understanding of their implications for treatment, community-response efforts, and policy decisions. The findings presented here generally show most individuals who were positive for fentanyl were also positive for other substances and that these patterns of polysubstance use continue to shift over time and by geographic region.Name of Sponsoring Organization(s): Millennium Health