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Polysubstance abuse associated with more frequent opioid use among patients in rural primary care settings

David L. Albright, PhD, Justin McDaniel, PhD, Kirsten Laha-Walsh, MSW, Beth Morrison, MS, Shanna McIntosh, MS


Objective: Opioid use is a continuing problem for the United States. Individuals who use opioids have a high risk of misuse, especially with prescription opioids. Substances that are often used in combination with opioids include methamphetamines, sedatives, and benzodiazepines, as well as tobacco, alcohol, and marijuana, but not in a medical setting. We sought to determine (a) the relationship between various drugs (eg, methamphetamine, benzodiazepines) and opioid use, as well as (b) the relationship between polysubstance use and opioid use.

Design: We created a screening instrument that requested the patients seeking medical care at Federally Qualified Health Centers (FQHC) and Veterans Affairs (VA) hospitals in West Alabama self-report their substance usage.

Setting: This study took place in outpatient primary care settings (FQHCs and VA hospitals) in west Alabama.

Participants: De-identified electronic health records for 346 adults were obtained from consenting medical facilities. Missing data were found in 33 of the records obtained. The final usable sample for this study was 311.

Main Outcome Measure: The screening tool was comprised of five sections: demographics, tobacco use, alcohol abuse, drug use, and mental health. The primary outcome measure of this study was the number of days of opioid use in the past 30 days.

Results: Thirteen individuals (4.18 percent) reported opioid use in the last 30 days. While polysubstance or dual substance use was not in the majority of the participant responses, the significant substances that were used in conjunction with opioids were methamphetamine, hallucinogens, and benzodiazepines.

Conclusions: Individuals who are polysubstance users have a higher likelihood of opioid use. Interventions that target opioid use would serve the population stronger by including screenings and potential treatments for polysubstance use additionally.


opioid, polysubstance, rural, SBIRT

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