Opioid Overdose Epidemic

Opioid Overdose Epidemic Made More Deadly by Polysubstance Use ​

Table of Contents

What is Polysubstance Abuse?

The opioid overdose epidemic has gotten worse by Polysubstance abuse, but what is Polysubstance abuse? Polysubstance abuse disorder occurs when multiple drugs or a combination of two or more substances are abused at the same time. Most often, it occurs between different prescription drugs, prescription drugs, and alcohol, or prescription drugs and illegal substances.

While polysubstance abuse can occur as the result of an accident when understanding how prescription medication should be taken, it can also be intentional. Sometimes, medication can lead to unpleasant side effects with regular use. Thus, polysubstance abuse becomes a way to treat and alleviate discomfort, although it can cause a new variety of dangerous side effects.Before 

Drugs Used in Polysubstance Abuse

Polysubstance abuse disorder can occur with any type of substance when used and mixed incorrectly. However, some of the most common drugs used include:







Dangers Associated with Polysubstance Abuse 

Polysubstance abuse disorder introduces more severe dangers because the body is not at risk for the side effects of just one substance but rather multiple substances. Mixing substances can also introduce new risks and side effects, including an increased risk for an overdose or even opioid death.

Polysubstance Use Driving Overdose Death

Since polysubstance use can cause substances to function and interact in ways separate from their prescribed use, there is an increased risk for overdoses. When multiple drugs are mixed with an opioid, it is more likely that opioid death may occur. Even mixing prescription medication with alcohol can increase the risk of overdose.

Cocaine and Meth in Opioid Overdose Deaths

Both cocaine and meth are psychostimulants, which makes them common in scenes such as parties where hyperactivity is favored. As a result, they are often mixed with other substances, including alcohol and both prescription and illegal opioids. Studies have shown that this mixing greatly increases the chances for overdose and thus opioid death as a result thereof.1

Other Common Combinations 

While polysubstance abuse can occur with any mixture or combination of substances, some combinations are more common than others. In many cases, these combinations can also cause the greatest side effects.

    • Cocaine and Alcohol Since both substances are typically used within a party environment, mixed usage is extremely common for cocaine and alcohol. Alcohol’s depressive and inhibitory aspects can escalate cocaine usage, making overdose more likely.
    • Opioids and Benzodiazepines One of the most common combinations is opioids and benzodiazepines. The two are often mixed accidentally through prescription medicine. Patients must alert each doctor they visit of current medications to reduce the risk of opioid overdose.
    • Prescription and Illegal DrugMixing prescription and illegal drugs is another common issue. Prescription medication should never be mixed with other substances, including alcohol. However, illegal drugs already pose a greater risk for overdose, and combining them with prescription medication increases the risk.
    • Psychedelics and Other Drugs Since psychedelics can produce long-lasting and unwanted effects, they are often mixed with other drugs to alleviate discomfort. This combination, however, increases the risk for negative side effects or overdose. 

Causes of Polysubstance Abuse

Substance use disorders, including polysubstance use disorders, can stem from many sources.
  • Biological: Things such as genetics and a family history of addiction or substance abuse can increase the likelihood of polysubstance abuse. However, biology can also play a role in how the body is affected by substances, which can alter the severity of side effects.2
  • Psychological: Studies have shown a high rate of comorbidity between mental illness such as anxiety and polysubstance abuse, a correlation discussed more further below.3
  • Sociocultural: Like genetics, one’s environment plays a large role in the development of polysubstance abuse disorder. Normalization in different regions can contribute to the spread of substances.

Signs of Polysubstance Abuse 

Substance use disorders, including polysubstance use disorders, can stem from many sources.

    • Tolerance One of the most common signs of polysubstance abuse is tolerance. When a substance regularly enters the body, it becomes less effective, requiring higher doses to feel the same effects as before tolerance developed. 
    • Loss of Control 

      Often, the substances misused in polysubstance abuse differ greatly in chemistry. This difference is because one substance is usually used to self-treat the side effects of another, which requires an opposite intended effect. However, with varying effects, polysubstance abuse can alter brain chemistry and worsen side effects.

      It can also make controlling usage more difficult, resulting in a loss of control.

    • Withdrawal As the body grows accustomed to the presence of polydrugs, it can develop what is known as polysubstance dependence. With this issue, the body has adapted to the altered chemistry within the body, and going without the substances can induce a withdrawal response. Withdrawal can look different for each type of substance. However, some signs that almost all forms of withdrawal share include:
      • Intense cravings for the substance
      • Lethargy
      • Appetite changes
      • Sleep changes
      • Headache
      • Aggression
      • Irritability
    • Inability to Stop Usage 

      The most predominant sign of a polysubstance use disorder is the inability to stop using the substances. Most often, this issue occurs because of withdrawal and its tendency to cause intense cravings.

Comorbidity of Mental Disorders

Polysubstance abuse occurs most commonly in patients with other mental disorders. This type of abuse is usually seen due to self-treatment of side effects that occur as a result of medication used in treatment.


Untreated depression can escalate the risk for the development of substance use disorders as a form of self-treatment for the symptoms of depression. In fact, studies have shown that depression is one of the leading causes of substance abuse.4 However, if substance abuse is not addressed at the same time that someone’s depression is treated, then that person may fall back into both disorders. 

Eating Disorder  

There are a variety of types of eating disorders, from binge eating to anorexia. However, while they differ in psychology, signs, and symptoms, they can share the aspect of harming mental health. As a result, opioid abuse is more common among those suffering from an eating disorder. 

Treatment for polysubstance abuse

With proper treatment, not only can most of the side effects associated with polysubstance abuse be reversed, but medical professionals will be able to treat the source of addiction and reduce the chance of relapse. From inpatient to outpatient programs, there are several different treatments options available for people with a polysubstance abuse disorder.


The first step in treatment is to undergo detox. When a substance or combination of substances is regularly administered to the body, the body will become accustomed to their presence. Over time, this presence develops into what is known as addiction or polysubstance dependence. 

To treat addiction, it is important to bring the body back to natural chemistry before the regular administration of a substance. One way of achieving this aspect is by ending the administration and allowing the body to eliminate it, which is a process known as detox. 

While effective, detox can also produce withdrawal symptoms, which is why it is often used in a combination with other treatments to help manage withdrawal symptoms and reduce the risk of relapse. 


CBT – Cognitive-Behavioral Therapy 

Cognitive-behavioral therapy – also known simply as CBT – is one of the most common psychotherapies utilized in the treatment of polysubstance use disorder.

CBT works to promote better mental health by identifying harmful thoughts or ideas and encouraging the patient to challenge these behaviors. It allows for a guided therapeutic experience while also teaching valuable self-help skills while also recognizing the connection between thoughts and behaviors in a guided setting.

    • Relapse Prevention Therapy Relapse prevention therapy is a form of CBT used to help treat polysubstance dependence as well as mental illnesses such as depression and obsessive-compulsive disorder. RPT’s focus is to identify potential high-risk situations and work through them on a cognitive and behavioral level to prevent future relapses.

Comprehensive Addiction Treatment 

In 2016, the United States passed what was known as the CARA, or the Comprehensive Addiction and Recovery Act. This act focused on addressing substance abuse and addiction in society to increase the likelihood and efficiency of individual treatment.

Comprehensive addiction treatment is rooted in providing holistic care addressing both the side effects and causes of polysubstance dependence. CARA has also created more prevention and education opportunities.

12-Step Programs 

12-Step programs, such as Alcoholics Anonymous and Narcotics Anonymous, are some of the most common outpatient therapies used in the treatment of substance abuse disorder, including polysubstance dependence. However, there are also several other 12-Step programs, including some conducted in-patient.

Commonly, 12-Step programs rely on a set of either religious or secular tenets and a focus on group settings.


  1. https://www.drugabuse.gov/drug-topics/opioids/opioid-overdose-crisis
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155832/
  3. https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/part-1-connection-between-substance-use-disorders-mental-illness
  4. https://pubmed.ncbi.nlm.nih.gov/29505419/#:~:text=Depression%20also%20seems%20to%20increase,among%20patients%20with%20chronic%20pain.

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