The Dangers of Polysubstance Use

When addiction treatment professionals ask patients what substances they are using, they frequently get more than one answer. A considerable number of people who misuse substances typically consume more than one – taking them separately or combining them for a stronger high or a specific effect. Polydrug use often carries with it more risk than use of a single drug, due to an increase in side effects, and drug synergy. Futures Recovery Healthcare’s Medical Director, Dr. Gloria Dunkin, discusses her professional observations of polysubstance addiction in the below excerpt:

“In recent years the percentage of patients presenting with polysubstance addiction has increased dramatically.

Many patients augment their drug of choice with alcohol and/or a variety of prescription drugs, many of which were prescribed for legitimate reasons, the goal is to increase the intensity and duration of the primary drug’s effect. For example, patients might take an illegally obtained opioid in conjunction with muscle relaxers, benzodiazepines and gabapentin and top it off with alcohol.

Another dangerous practice is that of mixing cocaine with alcohol which initially enhances the euphoria derived from cocaine, this very dangerous practice leads to the production of cocaethelyne which builds up to toxic levels and can cause myocardial infarction, cerebral infarction or sudden death. Often a cocaine binge mixed with alcohol ends with the addition of heroin in attempts to balance off the negative effects from this dangerous combination.

The mixing of multiple substances means that on any given day a patient could inadvertently overdose, typically because their respiratory and or coughing reflexes are suppressed by a synergistic effect. Therefore the stakes are very high in these cases and intervention followed by proper treatment is truly a life saving process.

The complexity involved with both, the initial detoxification of patients who are withdrawing from multiple substances concomitantly and their initial road to recovery is such that intensive inpatient treatment is absolutely essential. People suffering from polysubstance addiction are not just addicted to a particular drug but rather to a lifestyle of being perpetually mentally and physically altered. It is a long road for them to attain a comfortable sobriety and they need expert guidance along the way.

Only after being free from the multiple substances for an extended period of time can these patients attain a baseline from which the reason behind their drive for polysubstance misuse is determinable. This should be the ultimate goal of treatment, for the patient to understand and accept who they are and take responsibility for choosing and living a drug free life.”

Increased Frequency

Polysubstance opioid overdose is increasingly common in the US, concluded a recent study led by Boston Medical Center’s Grayken Center for Addiction. It shows that opioid-related overdose deaths involving another substance are now the norm, not the exception.

Polydrug misuse has also had a significant impact on family life in America. Almost a fifth of respondents in a recent Gallup poll reported that both drinking alcohol and using drugs are a cause of trouble in the family. “Polysubstance use is common, particularly amongst some age groups and subcultures. It is also associated with an elevated risk of psychiatric and physical health problems,” reported Connor et al in a 2014 study. Using multiple addictive substances concurrently significantly increases the risk of overdose.

Common Combinations

Misusing alcoholic and opioid pain relievers (OPRs) concurrently is a risky endeavor. “When taken with OPRs or benzodiazepines, alcohol increases central nervous system depression and the risk for overdose,” warned the Centers for Disease Control and Prevention (CDC) in 2014.

The director of the National Institute on Drug Abuse, Nora Volkow, issued a similar warning. “Painkillers and booze are perhaps the worst to mix, because both slow breathing by different mechanisms and inhibit the coughing reflex, creating a ‘double-whammy’ effect, that can stop breathing altogether,” Dr. Volkow told Scientific American.

Alcohol also interacts with anti-anxiety drugs called benzodiazepines, antipsychotics, antidepressants, sleep medications, and muscle relaxants—intensifying the drugs’ sedative effects, causing drowsiness and dizziness, and making falls and accidents more likely.

The CDC also warns against using marijuana with other addictive substances. “Using alcohol and marijuana at the same time is likely to result in greater impairment than when using either one alone. Using marijuana and tobacco at the same time may also lead to increased exposure to harmful chemicals, causing greater risks to the lungs, and the cardiovascular system.”

Another popular concoction is the so-called “speedball,” a mixture of cocaine (or another stimulant) with an opioid such as heroin. Like other dangerous mixtures, speedballs are often more potent than just the sum of its parts due to drug synergy. Taking opioids and stimulants together is supposed to create a “push-pull” effect in the body and brain.

People with polydrug substance use disorder frequently combine cocaine and heroin to achieve an intense rush with a high that is supposed to combine the effects of both drugs while hoping to reduce the negative effects. Despite that intention, combining cocaine and heroin can have fatal consequences. Respiratory failure is particularly likely with speedballs because the effects of cocaine wear off far more quickly than the effects of heroin. Fatal slowing of the breathing can occur when the stimulating cocaine wears off and the full effects of the heroin are felt on their own.

As the preceding list of dangerous combinations shows, polysubstance abuse is especially life-threatening. Polydrug use makes increases the risks of overdose and death and makes addiction treatment more complicated. Detoxification is difficult when multiple drugs are present, and in most cases, polydrug use is an indication that addiction is more severe. Medication-assisted treatment with buprenorphine and naltrexone can help control cravings in the case of an opioid use disorder but the FDA-approved medications are contraindicated for addiction to stimulants such as cocaine or methamphetamine. The medications most often used to treat opioid use disorder do not work for stimulants, barbiturates, and other types of drugs.

Effectively treating people who use multiple substances requires expertise and a holistic approach. All substance use disorders pose challenges to clients and caregivers. Polysubstance addictions increase the importance of coordinated care that addresses underlying issues that contribute to the development of SUD and addiction.

Futures Recovery Healthcare offers coordinated medical detoxification, psychiatry, psychology, nutritional, and wellness services to address these complex conditions.