Different Patterns of Polysubstance Use Predict Relapse for People in Treatment for Opioid Use Disorders

Addiction Science Made Easy
January 2023
CTN Dissemination Library & Northwest ATTC

What’s the Question?

Recent estimates suggest that most people with opioid use disorder (OUD) use multiple substances (“polysubstance use”). Rates of polysubstance use among people in treatment for OUD range between 65-85%. 

Some combinations, like opioids taken with benzodiazepines, are more common and likely contribute to overdose events. Less is known, however, about other combinations, like opioids with cannabis or opioids with alcohol, and their impact on treatment response. 

Figuring out which substances are commonly used together and whether specific patterns of use impact treatment outcomes could help clinicians better tailor interventions to help those seeking care for their substance use.
 

How Was This Study Conducted?

This study used data from 2,637 participants in 3 large OUD treatment trials in the National Drug Abuse Treatment Clinical Trials Network (CTN).

In all three trials, study participants had filled out surveys asking about their substance use history in the 28 days prior to treatment initiation. 

Researchers used that data to analyze specific patterns and substances of use and then compared those patterns to reports of relapse from study participants later in the trials. 
 

What Did Researchers Find Out?

The analysis revealed some interesting correlations:

• Polysubstance use was common among participants in the 3 trials
• Use of specific drugs (benzodiazepines, cocaine, and cannabis) were more likely to lead to heroin use
• A combination of cocaine, cannabis, and heavy drinking with prescription opioids seemed to be correlated with lower risk for relapse – suggesting that a polysubstance “binge” does not automatically result in relapse to regular opioid use 
• People who had been taking higher doses of opioids before starting treatment were at higher risk for relapse – even if they decreased their use of opioids before entering care
• People who used heroin, cocaine, and cannabis were more likely to have a worse outcome than people using other combinations of substances

What Are the Implications for the Workforce?

Knowing which patterns of polysubstance use might lead to higher risk for relapse can help clinicians better tailor interventions for their patients, increasing the chances for successful treatment for opioid use disorder. Future studies are needed to replicate these results in larger sample sizes and different treatment contexts.