Concomitant use of opioids and depressant drugs, such as benzodiazepines, is also common and is associated with increased risk of fatal and non-fatal overdose due to synergistic respiratory depression ( Barocas et al., 2019 Jones, Mack, & Paulozzi, 2013 Park, 2017 Park, Saitz, Ganoczy, Ilgen, & Bohnert, 2015 Pizzicato, Johnson, & Viner, 2019). Concurrent use of stimulants and opioids result in both cardiovascular strain and respiratory depression, thus increasing overdose risk and mortality ( Glick et al., 2018 Turner et al., 2018). methamphetamine and prescription stimulants ) increased three- and five-fold, respectively ( Hedegaard, Miniño, & Warner, 2020).
Between 20, overdose deaths involving cocaine and other psychostimulants with abuse potential (e.g. Although the majority of recent overdose-related deaths have been attributed to opioids, nearly two-thirds (62.6%) of fatal opioid overdoses have also involved other classes of drugs such as cocaine (34%), benzodiazepines (32.5%), and methamphetamine (12%) ( Gladden, O'Donnell, Mattson, & Seth, 2019). In the United States, unintentional drug overdoses caused 554,711 deaths between 19 ( Centers for Disease Control and Prevention, 2019a). Polysubstance use was perceived to increase overdose risks and to be a barrier to accessing healthcare and drug treatment services.
Inadequately managed cravings and withdrawal symptoms prompted concomitant use of heroin and medications for opioid use disorder, including among individuals reporting cocaine or crack as their primary “issue” drugs.
Polysubstance use to self-medicate poorly managed physical and mental health conditions (e.g., chronic pain, anxiety, and depression) was also reported. Reasons for polysubstance use included obtaining synergistic psychoactive effects as a result of mixing drugs (i.e., using drugs to potentiate effects of other drugs) and managing undesirable effects of particular drugs (e.g., offsetting the depressant effects of opioids with stimulants or vice-versa). Polysubstance use often followed long personal drug use histories (i.e., years or decades of occasional drug use). All participants reported recent polysubstance use, with most using five or more classes of substances in the past three months.
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