Comparisons of Cocaine-Only, Opioid-Only, and Users of Both Substances in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Abstract

Background Cocaine and opioid co-use is a notable public health concern, but little is known about correlates of this behavior. Most prior findings come from treatment samples and concern cocaine and heroin. Findings from a nationally-representative sample involving primarily prescription opioid misuse would expand knowledge. Methods Past-12-month cocaine and/or opioid users in Wave 1 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) formed the sample (N=839). Cocaine-only, opioid-only and cocaine/opioid co-users were compared regarding sociodemographics, other substance involvement, psychiatric and medical conditions/events. Results Opioid-only users were the largest group (n=622), followed by cocaine-only (n=144) and co-users (n=73). The vast majority of opioid misuse was of prescription opioids (1.4% with past-12-month use of heroin). Notably, co-users did not differ from single drug users in frequency of use of either drug. Co-users did not have significantly greater incidence of any psychiatric conditions, medial conditions or events. In preliminary analyses, co-users were more likely than either single use group to report several classes of other drug use. However, for most comparisons, opioid use did not add substantial risk beyond cocaine use. Differences on multiple sociodemographic variables suggested opioid-only users were at lowest risk of negative outcomes. These results may relate to a finding that opioid-only users were less likely to have sought treatment. Conclusions/Importance This sample of past-12-month cocaine and/or opioid users had greater involvement with other substances, more psychiatric and medical conditions compared to the general population. Co-users had greater involvement with other substances than opioid-only users in particular.

The Cholinergic System as a Treatment Target for Opioid Use Disorder

“…In addition, multiple genetic variations have been associated with the risk of developing OUD [20–22]. OUD is highly comorbid with many psychiatric and medical problems including depression, anxiety disorders, PTSD, chronic pain, and infections including the human immunodeficiency virus and Hepatitis C Virus [23–25]. …”

A latent class analysis of the past-30-day substance use patterns among lifetime cocaine users: Findings from a community sample in North Central Florida

“…Previous studies have shown that cocaine users concurrently use other substances frequently, including alcohol ( Blow et al, 2011 ; Borders & Booth, 2013 ; Evans-Polce, Lanza, & Maggs, 2016 ; Hedden, Malcolm, & Latimer, 2009 ; Liu, Williamson, Setlow, Cottler, & Knackstedt, 2018 ), tobacco ( Winhusen et al, 2013 ), marijuana ( Gonçalves & Nappo, 2015 ; Liu et al, 2018 ), heroin ( Leeman, Sun, Bogart, Beseler, & Sofuoglu, 2016 ; Ojha, Sigdel, Meyer-Thompson, Oechsler, & Verthein, 2014 ; Oviedo-Joekes et al, 2015 ), and prescription medications ( Al-Tayyib, Rice, Rhoades, & Riggs, 2014 ; Chen et al, 2014 ; Evans-Polce et al, 2016 ; Herman-Stahl, Krebs, Kroutil, & Heller, 2006 ; Winhusen et al, 2013 ). Polysubstance users have been found to have a higher risk of overdose, emergency department (ED) visits, violence, accidental injury ( Macdonald et al, 2014 ), traffic accidents ( De Boni et al, 2014 ), and lower addiction treatment effectiveness ( Evans et al, 2015 ; Hou, Zhan, Zheng, Zhan, & Zheng, 2014 ; Liu et al, 2018 ) compared to mono-substance users.…”

“…Polysubstance users have been found to have a higher risk of overdose, emergency department (ED) visits, violence, accidental injury ( Macdonald et al, 2014 ), traffic accidents ( De Boni et al, 2014 ), and lower addiction treatment effectiveness ( Evans et al, 2015 ; Hou, Zhan, Zheng, Zhan, & Zheng, 2014 ; Liu et al, 2018 ) compared to mono-substance users. Polysubstance use has also been associated with worse physical health ( Quek et al, 2013 ; White et al, 2013 ), lower quality of life ( Kelly et al, 2017 ) and higher rates of mental health conditions, such as anxiety, depression, social phobia, and personality disorders ( Agrawal, Lynskey, Madden, Bucholz, & Heath, 2007 ; Chen et al, 2014 ; Evans et al, 2015 ; Kelly et al, 2017 ; Leeman et al, 2016 ; Quek et al, 2013 ; White et al, 2013 ). Studies examining cocaine-polysubstance use mainly focus on the comparison between individuals who used cocaine only and individuals who used cocaine plus one other substance.…”

“…Studies examining cocaine-polysubstance use mainly focus on the comparison between individuals who used cocaine only and individuals who used cocaine plus one other substance. However, patterns of polysubstance with more than two substances are typically ignored ( Gonçalves & Nappo, 2015 ; Hedden et al, 2009 ; Leeman et al, 2016 ; Winhusen et al, 2013 ). It is crucial to understand more about the complex patterns of polysubstance use, because a high degree of complexity is inherent in polysubstance use and we need to begin to account for its complexity in research.…”

Medications for substance use disorders (SUD): emerging approaches

“…There are no medications currently approved for persons who have poly-drug diagnoses, although this group may be at special risk [31,32]. …”