Polysubstance use patterns and novel synthetics: Acluster analysis from three U.S. cities.

Christopher Keith Haddock,Javier Cepeda,Luther Elliott,Stephanie Campos,Ellen Benoit

doi:10.1371/journal.pone.0225273

Abstract

The rapid emergence of novel psychoactive substances within the past decade has raised new concerns about the harms associated with unregulated drug use. Synthetic analogues—chemically related to established psychoactive substances like cannabis sativa and catha edulis—in particular have proliferated rapidly, allowing little opportunity for scientific research or the establishment of informal guidelines for safe use among consumers. To explore how synthetic substance use relates to other forms of use, this paper presents an analysis of polysubstance use among a sample of 676 people who use illicit substances in the United States. Participants were sampled from three greater metropolitan areas (Houston/Galveston, Texas; New York City; and New Orleans, Louisiana). Study researchers used cluster-type analyses to develop dendrogram visualizations of the interrelationships between substance types. Results suggest a considerable variation in substance and polysubstance use patterns across states in the U.S. Polysubstance use clustered around well-observed combinations like MDMA/cannabis and cocaine/heroin. Synthetic cannabinoids and cathinones showed no strong clustering with other substances. High rates of binge drinking among users of other substances further support the importance of interventions sensitive to the clinical challenges of polysubstance use.

Highlights

The use of multiple substances within a specified period of time, or “polysubstance use,[1]” is a common practice among people who use illicit drugs or misuse prescribed drugs [1,2,3]
Polysubstance use has emerged as a particular topic in recent years, due in part to the rapid development and distribution of novel psychoactive substances (NPS)—typically chemical analogues of established drugs—and the high rate of opioid-involved polysubstance overdose deaths
The present analysis focuses on 9 primary drugs of abuse included in this list: bath salts, molly, cocaine, crack, cannabis, synthetic cannabinoids, heroin, prescription drugs, and methamphetamine

Summary

Introduction

The use of multiple substances within a specified period of time, or “polysubstance use,[1]” is a common practice among people who use illicit drugs or misuse prescribed drugs [1,2,3]. Concurrent use of opioids with alcohol and other central nervous system depressants, such as benzodiazepine-class sedatives, are well known overdose risk factors [4], but many. Clusters of polysubstance use other less common drug combinations present grave health risks to their users. Alcohol combined with gamma-hydroxybutyrate (GHB) presents serious risk of respiratory depression [5,6,7,8] and inadvertent combinations of monoamine oxidase inhibitors (MAOIs)—an essential ingredient in ayahuasca preparations—can lead to coma or even death among those prescribed selective serotonin reuptake inhibitors (SSRIs) for depression [9] or among those using ecstasy/MDMA recreationally [10, 11]. Some other common substance combinations, such as alcohol and cocaine, may impact concurrent users over time. Cocaethylene, a metabolite of cocaine formed by liver enzymes when alcohol is present [12, 13], appears acutely toxic in mice at lower concentrations than cocaine alone [14], suggesting the importance of ongoing study in humans

Methods

Discussion

Conclusion