Co-Occurring Polysubstance Use and Physical Disease of Persons with Mental Disorders in Residential Treatment Program

The purpose of this study was to describe the prevalence of co-occurring polysubstance use and to examine the differences in physical disease between polysubstance users and single/no substance users with mental disorders. This retrospective cross-sectional study included 1949 clinical records of psychiatric patients from 11 residential treatment programs between 2007 and 2011. Demographic variables, psychiatric diagnoses, and data on substance use and physical disease were obtained from the clinical records. Chi-square analyses were used to examine substance use difference in the prevalence of each physical disease category. This study found that the prevalence of co-occurring polysubstance use was 53.5%. Chi-square analyses identified that co-occurring polysubstance users reported more respiratory, digestive, musculoskeletal, and HIV/AIDS diseases but less endocrine diseases than single/no substance users. Therefore, integrated treatment programs for treating patients with co-occurring substance use and physical disease should be developed and expanded for this high-risk group.

Polysubstance Use and Overdose Visualized via Maps: Amphetamines and Cocaine

Abuse of drug substances and resultant overdose deaths are no longer very straightforward—viz., attributable to a single chemical entity of known purity. The reality is that most overdose deaths involve polysubstance use (i.e., the use of combinations of substances). Further, the combinations are often of unknown purity, and even of unknown composition. Overdose deaths are at all-time highs. The depressing statistics are monitored and reported by several international and governmental organizations such as the WHO (World Health Organization), CDC (Centers for Disease Control and Prevention), several Institutes of the NIH (National Institutes of Health), Regulators, and Enforcement Agencies (e.g., DEA). The information is disseminated for free for review and use. But it is our observation that although numeric presentation is helpful and adequate for professionals, the non-expert and the visual learner often find a visual representation clearer and compelling. With this in mind, we present the “gestalt” of polysubstance use and overdose using available maps of the data. The previous article in the series considered the opioids. This one considers amphetamines and cocaine, and places the rise in opioid-associated overdose deaths in the context of other abused drugs.

Commentary: “Ockham’s Razor” Doesn’t Apply to “Opioid” Overdose Death

Polysubstance Abuse (PSA) greatly complicates an attempt to implicate a single drug as sole cause of an overdose death. Since PSA now occurs in the majority of cases of drug overdoses, many or most overdose deaths are polysubstance overdose deaths. And since many of the substances involved in a polysubstance Overdose Death (POD) are Central Nervous System (CNS) depressants, many of which can cause overdose death themselves, or synergistically with opioids, it is somewhat puzzling that prescription opioids have been singled out as the cause of these deaths—without reference to PSA. This is particularly puzzling in light of the fact that the issues of PSA and POD have been recognized and discussed in the literature since at least the 1960’s and before. We therefore here consider the question: are we facing an “opioid” crisis or, instead, a “polysubstance crisis”? And we wonder if the issue has been over-simplified, to the detriment of the individuals affected, and to society more broadly. There is a need for an “agnostic” respiratory stimulant that can reverse polysubstance-induced respiratory depression.