Top

The Journal of Behavioral Health Services & Research

11-03-2024 | Opioids

Patterns of polydrug use among Black Americans who misuse opioids

Authors: Khary K. Rigg, PhD, Michael A. Weiner, BA, Ethan S. Kusiak, BS

Published in: The Journal of Behavioral Health Services & Research

Abstract

In the United States, opioid-related deaths involving polydrug use are now more prevalent than those involving only opioids. What often goes unnoticed is that deaths involving more than one substance are increasing more rapidly among Black Americans than Whites. Unfortunately, little research attention is paid to understanding opioid-related polydrug use patterns among Black Americans. As a result, less is known regarding which drug combinations are most common among this population and their reasons for co-using certain drugs. Therefore, the objective of this mixed methods study was to identify which substances were most commonly co-used with opioids among Black Americans, while also capturing their motives for combining opioids with other drugs. This study used data from the Florida Minority Health Study, a mixed-methods project that included online surveys (n = 303) and qualitative in-depth interviews (n = 30) of Black Americans who misuse opioids. Data collection was conducted from August 2021 to February 2022 throughout Southwest Florida. Analyses revealed that opioids were most commonly combined with alcohol, cocaine, and methamphetamine, respectively. Opioids were co-used with alcohol in an attempt to enhance the desired effect (i.e., intoxication), while stimulants and opioids were combined to counteract the undesirable side effects of the other. This study begins to answer the question of which/why substances are combined with opioids among Black Americans and should inform behavioral health interventions targeted at this population. Data on this topic are especially timely as the United States goes through the current fourth wave of the opioid crisis that is characterized by deaths due to polydrug use. These findings invite further study using nationally representative data to determine the extent to which polydrug using patterns differ across racial/ethnic groups.

Schuler MS, Schell TL, Wong EC. Racial/ethnic differences in prescription opioid misuse and heroin use among a national sample, 1999–2018. Drug and Alcohol Dependence. 2021;221:108588. Available at: https://doi.org/10.1016/j.drugalcdep.2021.108588. Accessed 6 September, 2023.

Han B, Volkow ND, Compton WM, et al. Reported heroin use, use disorder, and injection among adults in the United States, 2002–2018. JAMA. 2020;323(6):568–571. Available at: https://doi.org/10.1001/jama.2019.20844. Accessed 6 September, 2023.

Rigg KK, Nicholson HL. Prescription opioid misuse among African-American adults: A rural-urban comparison of prevalence and risk. Drug and Alcohol Dependence. 2019;197:191–196. Available at: https://doi.org/10.1016/j.drugalcdep.2019.01.023. Accessed 6 September, 2023.

Substance Abuse and Mental Health Services Administration. Results from the 2022 National Survey on Drug Use and Health: Key substance use and mental health indicators in the United States. Center for Behavioral Health Statistics and Quality. Publication Number PEP23-07-01-006, 2023. Available at https://www.samhsa.gov/data/sites/default/files/reports/rpt42731/2022-nsduh-nnr.pdf. Accessed 12 December, 2023.

Hsu DJ, McCarthy EP, Stevens JP, et al. Hospitalizations, costs and outcomes associated with heroin and prescription opioid overdoses in the United States 2001–12. Addiction. 2017;112(9):1558–1564. Available at: https://doi.org/10.1111/add.13795. Accessed 6 September, 2023.

Joint Economic Committee. The economic toll of the opioid crisis reached nearly $1.5 trillion in 2020. September, 2022. Available at: https://www.jec.senate.gov/public/index.cfm/democrats/issue-briefs?ID=CE55E977-B473-414F-8B88-53EB55EB7C7C. Accessed 6 September, 2023.

Langabeer JR, Stotts AL, Bobrow BJ, et al. Prevalence and charges of opioid-related visits to US emergency departments. Drug and Alcohol Dependence. 2021;221:108568. Available at: https://doi.org/10.1016/j.drugalcdep.2021.108568. Accessed 6 September, 2023.

Rigg KK, Rigg MS. Opioid-induced hearing loss and neonatal abstinence syndrome: Clinical considerations for audiologists and recommendations for future research. American Journal of Audiology. 2020;29(4):701–709. Available at: https://doi.org/10.1044/2020_AJA-20-00054. Accessed 6 September, 2023.

Chavez MN, Rigg KK. Nutritional implications of opioid use disorder: A guide for drug treatment providers. Psychology of Addictive Behaviors. 2020;34(6):699–707. Available at: https://doi.org/10.1037/adb0000575. Accessed 6 September, 2023.

10.

Szalavitz M, Rigg KK. The curious (dis) connection between the opioid epidemic and crime. Substance Use & Misuse. 2017;52(14):1927–1931. Available at: https://doi.org/10.1080/10826084.2017.1376685. Accessed 6 September, 2023.

11.

Mackesy-Amiti ME, Donenberg GR, Ouellet LJ. Prescription opioid misuse and mental health among young injection drug users. The American Journal of Drug and Alcohol Abuse. 2015;41(1):100–106. Available at: https://doi.org/10.3109/00952990.2014.940424. Accessed 6 September, 2023.

12.

Buttram ME, Kurtz SP, Surratt HL, et al. Health and social problems associated with prescription opioid misuse among a diverse sample of substance-using MSM. Substance Use & Misuse. 2014;49(3):277–284. Available at: https://doi.org/10.3109/10826084.2013.828754. Accessed 6 September, 2023.

13.

Rigg KK, DeCamp W. Explaining prescription opioid misuse among veterans: A theory-based analysis using structural equation modeling. Military Behavioral Health. 2014;2(2):210–216. Available at: https://doi.org/10.1080/21635781.2014.917011. Accessed 6 September, 2023.

14.

Surratt H, Kurtz SP, Cicero TJ. Alternate routes of administration and risk for HIV among prescription opioid abusers. Journal of Addictive Diseases. 2011;30(4):334–341. Available at: https://doi.org/10.1080/10550887.2011.609805. Accessed 6 September, 2023.

15.

Kariisa M, Davis NL, Kumar S, et al. Vital signs: Drug overdose deaths, by selected sociodemographic and social determinants of health characteristics—25 states and the District of Columbia, 2019–2020. Morbidity and Mortality Weekly Report. 2022;71(29):940. Available at: 10.15585%2Fmmwr.mm7129e2. Accessed 6 September, 2023.

16.

Glicksberg L, Dempsey SK, Casey BK. Heroin and fentanyl in Dallas County: A 5‐year retrospective review of toxicological, seized drug, and demographical data. Journal of Forensic Sciences. 2023;68(1):222–232. Available at: https://doi.org/10.1111/1556-4029.15155. Accessed 6 September, 2023.

17.

Bunting AM, Oser C, Staton M, et al. Polysubstance use patterns among justice-involved individuals who use opioids. Substance Use & Misuse. 2020;55(13):2165–2174. Available at: https://doi.org/10.1080/10826084.2020.1795683. Accessed 6 September, 2023.

18.

Lim JK, Earlywine JJ, Bagley SM, et al. Polysubstance involvement in opioid overdose deaths in adolescents and young adults, 1999–2018. JAMA pediatrics. 2021 Feb 1;175(2):194–6. Available at: https://doi.org/10.1001/jamapediatrics.2020.5035. Accessed 6 September, 2023.

19.

Centers for Disease Control and Prevention. US overdose deaths in 2021 increased half as much as in 2020—but are still up 15%. National Center for Health Statistics. 2022 May 11;16:2022. Available at: https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm. Accessed 6 September, 2023.

20.

Goodnough A. Overdose deaths have surged during the pandemic, C.D.C. Data shows. New York, NY: The New York Times, 2021. Available at: https://www.nytimes.com/2021/04/14/health/overdose-deaths-fentanyl-opiods-coronaviurs-pandemic.html. Accessed 6 September, 2023.

21.

Boileau-Falardeau M, Contreras G, Garipy G, et al. Patterns and motivations of polysubstance use: A rapid review of the qualitative evidence. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice. 2022;42(2):47–59. Available at: 10.24095%2Fhpcdp.42.2.01. Accessed 6 September, 2023.

22.

Moses T, Lundahl LH, Greenwald MK. Factors associated with sedative use and misuse among heroin users. Drug and Alcohol Dependence. 2018;185:10–16. Available at: https://doi.org/10.1016/j.drugalcdep.2017.11.035. Accessed 6 September, 2023.

23.

Food and Drug Administration. FDA Drug Safety Communications, FDA urges caution about withholding opioid addiction medications from patients taking benzodiazepines or CNS depressant: Careful medication management can reduce risks. Food and Drug Administration, August, 2016. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-warns-about-serious-risks-and-death-when-combining-opioid-pain-or. Accessed 6 September, 2023.

24.

Lamonica AK, Boeri M. An exploration of the relationship between the use of methamphetamine and prescription drugs. Journal of Ethnographic and Qualitative Research. 2012;6(3):160. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc3532935/. Accessed 6 September, 2023.

25.

Rigg KK, Sharp A. Nonmedical prescription drug use among African Americans who use MDMA (ecstasy/molly): Implications for risk reduction. Addictive Behaviors. 2018;79:159–165. Available at: https://doi.org/10.1016/j.addbeh.2017.12.024. Accessed 6 September, 2023.

26.

Lankenau SE, Teti M, Silva K, et al. Patterns of prescription drug misuse among young injection drug users. Journal of Urban Health. 2012;89:1004–1016. Available at: https://doi.org/10.1007/s11524-012-9691-9. Accessed 6 September, 2023.

27.

Rigg KK, Ibañez GE. Motivations for non-medical prescription drug use: A mixed methods analysis. Journal of Substance Abuse Treatment. 2010;39(3):236–247. Available at: https://doi.org/10.1016/j.jsat.2010.06.004. Accessed 6 September, 2023.

28.

Goodwin RD, Moeller SJ, Zhu J, et al. The potential role of cocaine and heroin co-use in the opioid epidemic in the United States. Addictive Behaviors. 2021;113:106680. Available at: https://doi.org/10.1016/j.addbeh.2020.106680Accessed 6 September, 2023.

29.

Valente PK, Bazzi AR, Childs E, et al. Patterns, contexts, and motivations for polysubstance use among people who inject drugs in non-urban settings in the US Northeast. International Journal of Drug Policy. 2020;85:102934. Available at: https://doi.org/10.1016/j.drugpo.2020.102934. Accessed 6 September, 2023.

30.

Rigg KK, Sharp A. Deaths related to MDMA (ecstasy/molly): Prevalence, root causes, and harm reduction interventions. Journal of Substance Use. 2018;23(4):345–352. Available at: https://doi.org/10.1080/14659891.2018.1436607. Accessed 6 September, 2023.

31.

Van Hout MC, Bingham T. “A costly turn on”: Patterns of use and perceived consequences of mephedrone based head shop products amongst Irish injectors. International Journal of Drug Policy. 2012;23(3):188–197. Available at: https://doi.org/10.1016/j.drugpo.2012.01.008. Accessed 6 September, 2023.

32.

Cooper ZD, Bedi G, Ramesh D, et al. Impact of co-administration of oxycodone and smoked cannabis on analgesia and abuse liability. Neuropsychopharmacology. 2018;43(10):2046–2055. Available at: https://doi.org/10.1038/s41386-018-0135-6. Accessed 6 September, 2023.

33.

Townsend T, Kline D, Rivera-Aguirre A, Bunting AM, Mauro PM, Marshall BD, Martins SS, Cerdá M. Racial/ethnic and geographic trends in combined stimulant/opioid overdoses, 2007–2019. American Journal of Epidemiology. 2022;191(4):599–612. Available at: https://doi.org/10.1093/aje/kwab290. Accessed 25 November, 2023.

34.

Friedman JR, Hansen H. Evaluation of increases in drug overdose mortality rates in the US by race and ethnicity before and during the COVID-19 pandemic. JAMA Psychiatry. 2022;79(4):379–381. Available at: https://doi.org/10.1001/jamapsychiatry.2022.0004. Accessed 6 September, 2023.

35.

Nicholson Jr HL. Socioeconomic status, fundamental cause theory, and prescription opioid use behaviors: a theoretical examination. Sociological Spectrum. 2020;40(1):1–32. Available at: https://doi.org/10.1080/02732173.2019.1707138. Accessed 25 November, 2023.

36.

Substance Abuse and Mental Health Services Administration. The opioid crisis and the Black/African American population: An urgent issue. Center for Behavioral Health Statistics and Quality. Publication Number PEP20–05- 02–001. 2020. Available at https://store.samhsa.gov/sites/default/files/pep20-05-02-001.pdf. Accessed 25 November, 2023.

37.

Santoro TN, Santoro JD. Racial bias in the US opioid epidemic: A review of the history of systemic bias and implications for care. Cureus. 2018;10(12). Available at: https://doi.org/10.7759/cureus.3733. Accessed 25 November, 2023.

38.

Compton WM, Valentino RJ, DuPont RL. Polysubstance use in the US opioid crisis. Molecular Psychiatry. 2021;26(1):41–50. Available at: https://doi.org/10.1038/s41380-020-00949-3. Accessed 6 September, 2023.

39.

Rigg KK, McLean K, Monnat SM, et al. Opioid misuse initiation: Implications for intervention. Journal of Addictive Diseases. 2018;37(3–4):111–122. Available at: https://doi.org/10.1080/10550887.2019.1609336. Accessed 6 September, 2023.

40.

Creswell JW. A concise introduction to mixed methods research. SAGE publications, 2021. Available at: https://books.google.com/books?id=xLU6EAAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false. Accessed 6 September, 2023

41.

Substance Abuse and Mental Health Services Administration. 2014 National survey on drug use and health: Methodological summary and definitions. Center for Behavioral Health Statistics and Quality. 2015. Available at: https://www.samhsa.gov/data/report/2014-national-survey-drug-use-and-health-methodological-summary-and-definitions. Accessed 6 September, 2023.

42.

Substance Abuse and Mental Health Services Administration. Reliability of key measures in the national survey on drug use and health. Office of Applied Studies. Publication Number SMA 09-4425, 2014. Available at: https://www.samhsa.gov/data/sites/default/files/2k6ReliabilityP/2k6ReliabilityP.pdf. Accessed 6 September, 2023.

43.

Hilal AH, Alabri SS. Using NVivo for data analysis in qualitative research. International Interdisciplinary Journal of Education. 2013 Jan;2(2):181–186. Accessed at: https://doi.org/10.13140/RG.2.2.20913.10082. Accessed 6 September, 2023.

44.

Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006 Jan 1;3(2):77–101. Available at: https://doi.org/10.1191/1478088706qp063oa. Accessed 6 September, 2023.

45.

Clarke V, Braun V, Hayfield N. Thematic analysis. Qualitative psychology: A practical guide to research methods. 2015 Jan 1;3:222–48. Available at: http://digital.casalini.it/9781473933415. Accessed 6 September, 2023.

46.

Fusch PI, Ness LR. Are we there yet? Data saturation in qualitative research. The Qualitative Report. 2015;20(9):1408–1416. Available at: https://doi.org/10.46743/2160-3715/2015.2281. Accessed 25 November, 2023.

47.

Ahmed S, Sarfraz Z, Sarfraz A. A changing epidemic and the rise of opioid-stimulant co-use. Frontiers in Psychiatry. 2022;13:918197. Available at: https://doi.org/10.3389/fpsyt.2022.918197. Accessed 25 November, 2023.

48.

Rigg KK, Menendez KM. Drug prevention programmes in schools: Selecting programme providers. Health Education Journal. 2018;77(5):586–597. Available at: https://doi.org/10.1177/0017896918763454. Accessed 9 February, 2024.

49.

Silva K, Kecojevic A, Lankenau SE. Perceived drug use functions and risk reduction practices among high-risk nonmedical users of prescription drugs. Journal of Drug Issues. 2013;43(4):483–496. Available at: https://doi.org/10.1177/0022042613491099. Accessed 6 September, 2023.

50.

Chastain G. Alcohol, neurotransmitter systems, and behavior. The Journal of General Psychology. 2006;133(4):329–335. Available at: https://doi.org/10.3200/GENP.133.4.329-335. Accessed 6 September, 2023.

51.

Laqueille X, Launay C, Dervaux A, et al. Abus d'alcool et de benzodiazépines lors des traitements de substitution chez l'héroïnomane : Une revue de la littérature [Abuse of alcohol and benzodiazepine during substitution therapy in heroin addicts: A review of the literature]. L'Encéphale. 2009 Jun 1;35(3):220–5. Available at: https://doi.org/10.1016/j.encep.2008.05.005. Accessed 6 September, 2023

52.

National Institute on Alcohol Abuse and Alcoholism. Alcohol’s effects on health: Research-based information on drinking and its impact. National Institute of Health. 2014. Available at: https://www.niaaa.nih.gov/alcohols-effects-health/alcohols-effects-body. Accessed 6 September, 2023.

53.

White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999 Jul;94(7):961–72. Available at: https://doi.org/10.1046/j.1360-0443.1999.9479612.x. Accessed 6 September, 2023.

54.

Ondocsin J, Holm N, Mars SG, et al. The motives and methods of methamphetamine and ‘heroin’ co-use in West Virginia. Harm Reduction Journal. 2023;20(1):1–9. Available at: https://doi.org/10.1186/s12954-023-00816-8. Accessed 6 September, 2023.

55.

Oliveira LG, Ponce JDC, Nappo SA. Crack cocaine use in Barcelona: A reason of worry. Substance Use & Misuse. 2010;45(13):2291–2300. Available at: https://doi.org/10.3109/10826081003682883. Accessed 6 September, 2023.

56.

Leri F, Bruneau J, Stewart J. Understanding polydrug use: Review of heroin and cocaine co‐use. Addiction. 2003;98(1):7–22. Available at: https://doi.org/10.1046/j.1360-0443.2003.00236.x. Accessed 6 September, 2023.

57.

Behzadi M, Joukar S, Beik A. Opioids and cardiac arrhythmia: a literature review. Medical Principles and Practice. 2018;27(5):401–414. Available at: https://doi.org/10.1159/000492616. Accessed 6 September, 2023.

58.

Hoffman RS. Treatment of patients with cocaine‐induced arrhythmias: Bringing the bench to the bedside. British Journal of Clinical Pharmacology. 2010 May;69(5):448–457. Available at: https://doi.org/10.1111/j.1365-2125.2010.03632.x. Accessed 6 September, 2023.

59.

Ciccarone D. The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Current Opinion in Psychiatry. 2021;34(4):344. Available at: 10.1097%2FYCO.0000000000000717. Accessed 25 November, 2023.

60.

Wang L, Min JE, Krebs E, et al. Polydrug use and its association with drug treatment outcomes among primary heroin, methamphetamine, and cocaine users. International Journal of Drug Policy. 2017;49:32–40. Available at: https://doi.org/10.1016/j.drugpo.2017.07.009. Accessed 25 November, 2023.

61.

Bovasso G, Cacciola J. The long-term outcomes of drug use by methadone maintenance patients. The Journal of Behavioral Health Services & Research. 2003;30:290–303. Available at: https://doi.org/10.1007/BF02287318. Accessed 25 November, 2023.

62.

Demaria PA, Sterling R, Weinstein SP. The effect of stimulant and sedative use on treatment outcome of patients admitted to methadone maintenance treatment. American Journal on Addictions. 2000;9(2):145–53. Available at: https://doi.org/10.1080/10550490050173217. Accessed 25 November, 2023.

63.

Baumeister M, Vogel M, Dürsteler-MacFarland KM, et al. Association between methadone dose and concomitant cocaine use in methadone maintenance treatment: A register-based study. Substance Abuse Treatment, Prevention, and Policy. 2014;9(1):1–8. Available at: https://doi.org/10.1186/1747-597X-9-46. Accessed 25 November, 2023.

64.

Peles E, Kreek MJ, Kellogg S, et al. High methadone dose significantly reduces cocaine use in methadone maintenance treatment (MMT) patients. Journal of Addictive Diseases. 2006;25(1):43–50. Available at: https://doi.org/10.1300/J069v25n01_07. Accessed 25 November, 2023.

65.

Szalavitz M, Rigg KK, Wakeman SE. Drug dependence is not addiction—and it matters. Annals of Medicine. 2021 Jan 1;53(1):1989–92. Available at: https://doi.org/10.1080/07853890.2021.1995623. Accessed 9 February, 2024.

66.

McCabe SE, Cranford JA, Morales M, et al. Simultaneous and concurrent polydrug use of alcohol and prescription drugs: Prevalence, correlates, and consequences. Journal of Studies on Alcohol. 2006;67(4):529–37. Available at: https://doi.org/10.15288/jsa.2006.67.529. Accessed 25 November, 2023.

67.

Bamsey, R. Polydrug use: Prevalence, predictors, pharmacology and psychopharmacology. Yale Review of Undergraduate Research in Psychology, 2017;7:20–47. Available at: https://www.researchgate.net/publication/318967256_Polydrug_Use_Prevalence_Predictors_Pharmacology_and_Psychopharmacology. Accessed 25 November, 2023.

68.

Smit F, Monshouwer K, Verdurmen J. Polydrug use among secondary school students: Combinations, prevalences and risk profiles. Drugs: Education, Prevention and Policy. 2002;9(4):355–65. Available at: https://doi.org/10.1080/09687630210155313. Accessed 25 November, 2023.

69.

Karjalainen K, Kuussaari K, Kataja K, et al. Measuring concurrent polydrug use in general populations: A critical assessment. European Addiction Research. 2017 Jul 7;23(3):163–9. Available at: https://doi.org/10.1159/000477802. Accessed 25 November, 2023.

70.

Silveira ML, Green VR, Iannaccone R, et al. Patterns and correlates of polysubstance use among US youth aged 15–17 years: Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Addiction. 2019;114(5):907–16. Available at: https://doi.org/10.1111/add.14547. Accessed 25 November, 2023.

Title: Patterns of polydrug use among Black Americans who misuse opioids
Authors: Khary K. Rigg, PhD
Michael A. Weiner, BA
Ethan S. Kusiak, BS
Publication date: 11-03-2024
Publisher: Springer US
Keywords: Opioids
Opioids
Published in: The Journal of Behavioral Health Services & Research
Print ISSN: 1094-3412
Electronic ISSN: 2168-6793
DOI: https://doi.org/10.1007/s11414-024-09878-3

At a glance: The STEP trials

Springer Medicine

Patterns of polydrug use among Black Americans who misuse opioids

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content