The Emerging Threat of Polysubstance Use in the US

The US is grappling with a severe opioid crisis, marked by a significant increase in opioid use and a high fatality rate due to opioid and heroin overdoses. Several factors have contributed to this epidemic, including the expansion of opioid prescriptions, the availability of potent synthetic opioids like fentanyl, and deteriorating mental health conditions. In a study published in Addictive Behaviors, researchers believe one aspect that has received less attention but is increasingly relevant is the dangers of polysubstance use.

According to researchers, polysubstance use is on the rise. It is often more dangerous than using a single drug in isolation, as it is associated with higher mortality rates in overdose cases. One alarming combination is "speedballing," involving the simultaneous use of cocaine and opioids/heroin. The stimulant effects of cocaine can mask the signs of an impending opioid overdose, making it a lethal combination. Understanding the prevalence of cocaine and heroin use, separately and together, is crucial for public health approaches to prevention and intervention.

This study analyzed data from the National Survey on Drug Use and Health (NSDUH) between 2002 and 2017 to investigate trends in cocaine and heroin use, individually and in combination. The findings revealed that cocaine use without the incorporation of heroin (adjusted odds ratio [AOR] = 0.971, 95% CI (0.963, 0.979) declined over this period, while the co-use of heroin and cocaine increased (AOR = 1.062 (1.027, 1.099). Heroin use without the incorporation of cocaine also showed an upward trend (AOR = 1.101 (1.070, 1.133). Notably, cocaine use saw an increase from 2011 to 2017.

The increase in co-use of heroin and cocaine is concerning, especially considering the rising number of overdose fatalities involving both substances. This underscores the need for increased attention to screening and early intervention strategies in short-term and long-term treatments to mitigate the risks associated with overdoses. Education on the specific risks associated with various patterns of drug co-use is crucial for preventing adverse outcomes and effectively addressing this public health issue.

"In light of the current findings and other evidence of increasing trends in co-use of heroin and cocaine, and the elevated risk of fatal outcomes of overdoses involving more than one substance, increased attention should be focused on screening and early intervention in terms of short- and long-term treatment to prevent adverse outcomes associated with overdose," said researchers.

Reference

Goodwin RD, Moeller SJ, Zhu J, Yarden J, Ganzhorn S, Williams JM. The potential role of cocaine and heroin co-use in the opioid epidemic in the United States. Addictive Behaviors. 2021;113:106680. doi:10.1016/j.addbeh.2020.106680