(83) Polysubstance Use Among New York Transition-Age Adults Who Use Opioids, 2018–2024

Background & Introduction: Substance use increases as adolescents enter transition-age (TA) adulthood. Biological, psychological, and social changes during this developmental period render 18- to 25-year-olds (i.e., TA adults) vulnerable to substance use disorders (SUDs). Polysubstance use , or using two or more illicit substances together or sequentially within a specific period, emerges during adolescence and increases into TA adulthood. Patterns of polysubstance use also differ between TA and older adults with some research suggesting rates decline with age. Compared to single illicit substance use, polysubstance use is associated with more drug-related harms and overall adversity, including overdose, early death, physical illness and injury, risk-taking, suicide, mental health problems, cognitive impairment, and poorer educational and occupational achievements.

Polysubstance use is more the rule than the exception among people who use opioids. For TA adults, polysubstance-involved opioid overdose deaths are more prevalent than those involving only opioids. Yet polysubstance use for TA adults who use opioids remains understudied. To address this gap in the literature, we examined the prevalence and likelihood of polysubstance use among TA adults who received treatment for opioid use through a New York State (NYS) Office of Addiction Services and Supports’ (OASAS) licensed program from 2018 to 2024.

Methods: We used the NYS OASAS SUD treatment registry data from 2018 to 2024. This data source provides information on all patients engaged in NYS SUD treatment programs that are certified or funded by OASAS regardless of patients’ payment source. All treatment episodes for 18- to 25-year-olds were included in analyses (N = 127,195). We first obtained the prevalence of polysubstance use (i.e., two or more problematic substances reported from separate SAMSHA-defined substance classes) versus single use for all treatment episodes regardless of the primary or secondary problematic substance reported.

We then selected all treatment episodes that included any opioid as a primary or secondary problematic substance (n = 44,870) to further examine the prevalence of polysubstance use among TA adults who use opioids. We assessed the overall rate of polysubstance use and the frequency of specific combinations of polysubstance use among TA adults who identified opioids as their primary or secondary problematic substance. Lastly, we calculated unadjusted risk ratios to test whether polysubstance use was more or less likely when an opioid was the primary problematic substance versus when alcohol, cannabis, a hallucinogen, inhalant, sedative/tranquilizer, stimulant, or other substance was identified as the primary problematic substance.

Results: Regardless of substance use reported, most treatment episodes for TA adults involved polysubstance use (65.1%). The risk of polysubstance use among opioid-related (i.e., primary or secondary opioid use) and non-opioid-related treatment episodes was 80.3% and 56.8% respectively . A minority of opioid-related treatment episodes (19.7% of the 44,870 treatment episodes that included an opioid as the primary or secondary problematic substance) identified an opioid as the only problematic substance. Opioid and stimulant use (16.1%) and opioid and cannabis use (15.5%) were the two most frequent combinations of polysubstance use within opioid-related treatment episodes. The third and fourth most frequent combinations were opioid, stimulant, and cannabis use (12.1%) and opioid and sedative/tranquilizer use (5.8%) respectively. A similar number of treatment episodes (~5%) involved a) opioid, cannabis, and sedative/tranquilizer use, b) opioid, alcohol, and stimulant use, c) opioid, sedative/tranquilizer, and stimulant use, and d) opioid, alcohol, and cannabis use. Opioid and alcohol use (3.52%) and opioid, alcohol, and sedative/tranquilizer use (2.27%) were the 9th and 10th most frequent combinations of polysubstance use among opioid-related treatment episodes.

When treatment episodes were defined by primary substance only (i.e., the primary problematic substance versus primary or secondary problematic substance reported at admission), polysubstance use was more likely for primary opioid versus primary alcohol (1.22, 95% CI [1.21, 1.24] and primary cannabis treatment episodes (1.65, 95% CI [1.63,1.67]). In contrast, polysubstance use was more likely for primary stimulant (0.97, 95% CI [0.96, 0.98]) and primary sedative/tranquilizer (0.88, 95% CI [0.87, 0.89]) than primary opioid treatment episodes.

Conclusion & Discussion: Consistent with prior research, polysubstance use is highly prevalent among TA adults who have received treatment in NYS facilities that were funded by OASAS between 2018 and 2024. Given the frequency with which TA adults who reported problematic opioid use also engaged in polysubstance use, it is important to assess for and treat polysubstance use among TA adults admitted to OASAS-funded NYS treatment programs. The prevalence of polysubstance use, especially opioid and stimulant co-use found in this TA adult sample points to a highly risky pattern of use. Deaths involving co-use of opioids and stimulants have increased since 2003. Additionally, opioid-related overdoses often involve stimulants and/or sedatives. Finally, purposeful non-fatal opioid-related overdoses involving polysubstance use have been linked to thoughts of self-harm and suicidal ideation.

This study has limitations: It examined episode rather than patient-level data. The results include individuals who have returned to treatment multiple times between 2018 and 2024. We also cannot discern from the data whether the polysubstance use reported at admission was concurrent or sequential. Our results highlighted the prevalence of polysubstance use among TA adults. Additional research is needed to better understand the antecedents and consequences of polysubstance use during this sensitive developmental period.

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