View source for Polysubstance use

{{also|List of polysubstance combinations}}
{{distinguish|Polysubstance abuse|Polysubstance dependence}}
{{Short description|Use of multiple psychoactive substances}}
{{Infobox medical condition (new)
| name            = Polysubstance use
| synonyms        = 
| image           = File:Photo of an empty bottle of Buckfast Tonic Wine.JPG
| caption         = In certain parts of Scotland, the [[caffeinated alcoholic beverage]] [[Buckfast Tonic Wine]] is associated with drinkers who are prone to committing [[anti-social behaviour]] when drunk.<ref name="telegraph">{{cite news| url=https://www.telegraph.co.uk/food-and-drink/news/england-gets-taste-buckfast-fortified-wine-linked-crime/|title=England gets a taste for Buckfast, the fortified wine that's linked to crime |newspaper=[[The Daily Telegraph]]|date=17 July 2017}}</ref>
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| field           = [[Psychiatry]]<ref name="Sher 2017">{{cite book |author1-last=Anthony |author1-first=James |author2-last=Barondess |author2-first=David A. |author3-last=Radovanovic |author3-first=Mirjana |author4-last=Lopez-Quintero |author4-first=Catalina |year=2017 |chapter=Part 1: Psychiatric Comorbidity – Polydrug Use: Research Topics and Issues |chapter-url=https://books.google.com/books?id=_MySDAAAQBAJ&pg=PA27 |editor-last=Sher |editor-first=Kenneth J. |title=The Oxford Handbook of Substance Use and Substance Use Disorders: Volume 2 |location=[[Oxford]] and [[New York City|New York]] |publisher=[[Oxford University Press]] |series=Oxford Library of Psychology |pages=27–59 |doi=10.1093/oxfordhb/9780199381708.013.006 |isbn=9780199381708 |lccn=2016020729}}</ref>
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| complications   = [[Combined drug intoxication]], [[drug overdose]]<ref name="Sher 2017"/>
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{{for|combination of pharmaceuticals|Combination drug|Polypharmacy}}
[[File:aya-preparation.jpg|thumb|[[Ayahuasca]] being prepared in the [[Napo Province|Napo]] region of [[Ecuador]]]]
[[File:Coughsyrup-promethcode.jpg|thumb|A spoonful of [[promethazine]]/{{zwsp}}[[codeine]] [[cough syrup]] showing the characteristic purple color that gave rise to the name [[purple drank]].|alt=Close-up photo of a metal spoon filled with a viscous, clear purple fluid]]

'''Polysubstance use''' or '''poly drug use''' refers to the use of combined [[psychoactive substance]]s. Polysubstance use may be used for [[entheogenic]], [[Recreational drug use|recreational]], or [[Indication_(medicine)#Label_indications_vs._off-label_indications|off-label indications]], with both legal and [[illegal substance]]s. In many cases one drug is used as a base or primary drug, with additional drugs to leaven or compensate for the [[side effect]]s, or [[drug tolerance|tolerance]], of the primary drug and make the experience more enjoyable with [[drug synergy]] effects, or to supplement for primary drug when supply is low.<ref>{{cite web|url=https://www.emcdda.europa.eu/html.cfm/index34913EN.html|title=Polydrug use &#124; www.emcdda.europa.eu|website=www.emcdda.europa.eu}}</ref>

==Combination drugs==
{{also|Combination drug#Common combination drugs}}

Some common combinations that are used recreationally include
* [[Dimenhydrinate]] ([[8-chlorotheophylline]]/[[diphenhydramine]]) – used to treat [[motion sickness]] and [[nausea]]
* [[Adderall]] ([[dextroamphetamine]] sulfate/[[amphetamine]] sulfate/dextroamphetamine saccharate/amphetamine aspartate monohydrate) – treatment of [[attention deficit hyperactivity disorder]] (ADHD) and [[narcolepsy]].

==Drug synergy==

===Ayahuasca===
Some substances, such as the powerful [[psychedelic drug]] [[N,N-Dimethyltryptamine|DMT]], are not psychoactive when ingested alone. [[Ayahuasca]], or [[pharmahuasca]], notably consists of DMT combined with [[Monoamine oxidase inhibitor|MAOIs]] that interfere with the action of the MAO enzyme and stop the breakdown in the stomach of chemical compounds, which make the DMT psychoactive. The MAOIs are also psychoactive and thus produce a polysubstance effect with the DMT. However, the MAOIs may cause [[#Combined drug intoxication|combined drug intoxication]] with the majority of all psychoactive substances and are therefore usually only combined with DMT.

===TOMSO===
[[TOMSO]] is a lesser-known psychedelic drug and a substituted amphetamine. TOMSO is inactive on its own; it is activated with the consumption of alcohol.

==Proprietary blends==

===Pre-workout===
{{main|Pre-workout}}

Some ingredients such as [[caffeine]], [[creatine]] and [[β-alanine]] are found in nearly all [[pre-workout]] blends, but each branded product is a "proprietary blend" with an average of 18 different ingredients, the exact composition and proportions of which can vary widely between different products.<ref>{{cite journal | vauthors = Harty PS, Zabriskie HA, Erickson JL, Molling PE, Kerksick CM, Jagim AR | title = Multi-ingredient pre-workout supplements, safety implications, and performance outcomes: a brief review | journal = Journal of the International Society of Sports Nutrition | volume = 15 | issue = 1 | pages = 41 | date = August 2018 | pmid = 30089501 | doi = 10.1186/s12970-018-0247-6 | pmc = 6083567 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Jagim AR, Harty PS, Camic CL | title = Common Ingredient Profiles of Multi-Ingredient Pre-Workout Supplements | journal = Nutrients | volume = 11 | issue = 2 | date = January 2019 | page = 254 | pmid = 30678328 | doi = 10.3390/nu11020254 | pmc = 6413194 | doi-access = free }}</ref> Additionally legal psychoactive substances occasionally used in these proprietary blends that are typically legal include [[5-HTP]], [[tyrosine]], and [[yohimbine]]. Although these products are not banned, the [[Food and Drug Administration|Food and Drug Administration (FDA)]] warns consumers to be cautious when consuming pre-workout.<ref name=":6">{{Cite journal | author = Office of the Commissioner |date=2019-02-09|title=FDA 101: Dietary Supplements|url=https://www.fda.gov/consumers/consumer-updates/fda-101-dietary-supplements|journal=FDA|language=en}}</ref>

==Combined drug intoxication==

[[Combined drug intoxication]] use often carries with it more risk than use of a single drug, due to an increase in side effects, and drug synergy. The potentiating effect of one drug on another is sometimes considerable and here the licit drugs and medicines – such as [[Alcohol (drug)|alcohol]], [[nicotine]] and [[antidepressant]]s – have to be considered in conjunction with the controlled psychoactive substances. The risk level will depend on the dosage level of both substances. If the drugs taken are illegal, they have a chance of being mixed (also known as "cutting") with other substances which dealers are reported to do to increase the perceived quantity when selling to others to increase their returns. This is particularly common with powdered drugs such as [[cocaine]] or [[MDMA]] which can be mixed with relative ease by adding another white powdery substance  to the drug. This cumulative effect can lead to further unintended harm to health dependent on what is being covertly added.

===Common combinations of drug classes===
* [[Alcohol (drug)|Alcohol]] combined with [[Cannabis (drug)|cannabis]] – known as ''cross-fading''; may easily cause [[spins]] in people who are drunk and use potent cannabis.
* [[Caffeinated alcoholic drink]]s
* [[Nicotini]]: Alcohol combined with [[nicotine]].

===Dangerous combinations of drug classes===
[[File:Sekakaytto2.JPG|thumb|Tranquillizers, sleeping pills, opiates and alcohol. [[Opioid epidemic|Opioid-related deaths]] often involve alcohol.]]

Concerns exist about a number of pharmacological pairings, especially:

* Antidepressants
** [[MAOI]]s combined with most drug classes, especially stimulants.
** [[SSRI]]s combined with MAOIs, or opioids.
* [[Depressant]]s combined with depressant. For example:
** [[Benzodiazepines]] can cause death when mixed with other [[CNS depressant]]s such as [[opioids]], alcohol, or [[barbiturate]]s.<ref>{{cite journal |vauthors=Serfaty M, Masterton G |title=Fatal poisonings attributed to benzodiazepines in Britain during the 1980s |journal=Br J Psychiatry |volume=163 |issue= 3|pages=386–93 |year=1993 |pmid=8104653 |doi=10.1192/bjp.163.3.386|s2cid=46001278 }}</ref><ref name="pmid12474705">{{cite journal |vauthors=Buckley NA, Dawson AH, Whyte IM, O'Connell DL |title=[Relative toxicity of benzodiazepines in overdose.] |journal=BMJ |volume=310 |issue= 6974|pages=219–21 |year=1995 |pmid=7866122 |doi= 10.1136/bmj.310.6974.219|url= |pmc=2548618}}</ref><ref>{{cite journal |author=Drummer OH |author2=Ranson DL |date=December 1996 |title=Sudden death and benzodiazepines |journal=Am J Forensic Med Pathol |volume=17 |issue=4 |pages=336–42 |pmid=8947361 |doi=10.1097/00000433-199612000-00012}}</ref>
** [[GHB]] combined with alcohol can lead to a long-lasting coma-like state (‘G-sleep’) or even accidental death, particularly in light of GHB's narrow threshold for overdose.
* Depressants combined with [[stimulant]]s. For example:
** [[Alcohol (drug)|Alcohol]] and [[cocaine]] (for example [[coca wine]]) increase cardiovascular toxicity;<ref>{{Cite journal |last1=Pergolizzi |first1=Joseph |last2=Breve |first2=Frank |last3=Magnusson |first3=Peter |last4=LeQuang |first4=Jo Ann K. |last5=Varrassi |first5=Giustino |date=2022-02-22 |title=Cocaethylene: When Cocaine and Alcohol Are Taken Together |journal=Cureus |language=en |volume=14 |issue=2 |pages=e22498 |doi=10.7759/cureus.22498 |doi-access=free |pmid=35345678 |pmc=8956485 |issn=2168-8184}}</ref> alcohol or depressant drugs, when taken with opioids, lead to an increased risk of overdose
** Opioids or cocaine taken with [[Ecstasy (drug)|ecstasy]] or [[amphetamines]] also result in additional acute toxicity.<ref name="EEM"/>

==Scheduling==
Within the general concept of multiple drug use, several specific meanings of the term must be considered. At one extreme is planned use, where the effects of more than one drug are taken for a desired effect. Another type is when other drugs are used to counteract the negative side effects of a different drug (e.g. depressants are used to counteract anxiety and restlessness from taking stimulants). On the other hand, the use of several substances in an intensive and chaotic way, simultaneously or consecutively, in many cases each drug substituting for another according to availability.<ref name="EEM">{{Cite web|url=http://ar2006.emcdda.europa.eu/en/page012-en.html?CFID=7908701&CFTOKEN=472a97577904fd31-16A12971-F8FA-A4BE-70FBED3F5065929B&jsessionid=2e30fd1d0c7948157239|title=EMCDDA Annual Report 2006 ch. 8}}</ref>

==Research==
The phenomenon is the subject of established academic literature.<ref name="pmid15135556">{{cite journal |vauthors=Scholey AB, Parrott AC, Buchanan T, Heffernan TM, Ling J, Rodgers J |title=Increased intensity of Ecstasy and polydrug usage in the more experienced recreational Ecstasy/MDMA users: a WWW study |journal=Addict Behav |volume=29 |issue=4 |pages=743–52 |date=June 2004 |pmid=15135556 |doi=10.1016/j.addbeh.2004.02.022 |url=http://psy.swansea.ac.uk/staff/parrott/Scholey-and-p-and-etal-Intensity-and-polydrug-AddBeh-2004.pdf }}</ref>

A study among treatment admissions found that it is more common for younger people to report polysubstance use.<ref>"Polydrug Use Among Treatment Admissions: 1998." OAS Home: Alcohol, Tobacco & Drug Abuse and Mental Health Data from SAMHSA, Office of Applied Studies. Web. 29 Sept. 2011. [http://oas.samhsa.gov/2k1/polydrugTX/polydrugTX.htm]</ref>

==See also==
{{div col|colwidth=20em}}
* [[Alcohol licensing laws of the United Kingdom]]
* [[Ban on caffeinated alcoholic drinks in the United States]]
* [[Counterfeit drug]]
* [[Designer drug]]
* [[Drug checking]]
* [[Drug overdose]]
* [[Gateway drug theory]]
* [[Harm reduction]]
* [[Illegal drug trade]]
* [[Mickey Finn (drugs)]]
* [[Over the counter drug]]
* [[Pharmacology]]
* [[Polysubstance dependence]]
* [[Psychopharmacology]]
* [[Psychotomimetism]]
* [[Purple drank]]
* [[Reagent testing]]
* [[Recreational drug use]]
* [[Responsible drug use]]
{{div col end}}

==References==
{{Reflist}}

==Bibliography==
* {{cite book |author1-last=Martin |author1-first=Christopher S. |author2-last=Chung |author2-first=Tammy |author3-last=Langenbucher |author3-first=James W. |year=2017 |chapter=Part 1: Defining and Characterizing the Nature and Extent of Substance Use Disorders – Historical and Cultural Perspectives on Substance Use and Substance Use Disorders |chapter-url=https://books.google.com/books?id=O-goDQAAQBAJ&pg=PA27 |editor-last=Sher |editor-first=Kenneth J. |title=The Oxford Handbook of Substance Use and Substance Use Disorders: Volume 1 |location=[[Oxford]] and [[New York City|New York]] |publisher=[[Oxford University Press]] |series=Oxford Library of Psychology |pages=27–59 |doi=10.1093/oxfordhb/9780199381678.013.001 |isbn=9780199381678 |lccn=2016020729}}
* {{cite book |author1-last=Anthony |author1-first=James |author2-last=Barondess |author2-first=David A. |author3-last=Radovanovic |author3-first=Mirjana |author4-last=Lopez-Quintero |author4-first=Catalina |year=2017 |chapter=Part 1: Psychiatric Comorbidity – Polydrug Use: Research Topics and Issues |chapter-url=https://books.google.com/books?id=_MySDAAAQBAJ&pg=PA27 |editor-last=Sher |editor-first=Kenneth J. |title=The Oxford Handbook of Substance Use and Substance Use Disorders: Volume 2 |location=[[Oxford]] and [[New York City|New York]] |publisher=[[Oxford University Press]] |series=Oxford Library of Psychology |pages=27–59 |doi=10.1093/oxfordhb/9780199381708.013.006 |isbn=9780199381708 |lccn=2016020729}}
* {{cite book |author1-last=Hernández-Serrano |author1-first=Olga |author2-last=Gras |author2-first=Maria E. |author3-last=Font-Mayolas |author3-first=Sílvia |author4-last=Sullman |author4-first=Mark J. M. |year=2016 |chapter=Part VI: Dual and Polydrug Abuse – Chapter 83: Types of Polydrug Usage |editor-last=Preedy |editor-first=Victor R. |title=Neuropathology of Drug Addictions and Substance Misuse, Volume 3: General Processes and Mechanisms, Prescription Medications, Caffeine and Areca, Polydrug Misuse, Emerging Addictions and Non-Drug Addictions |location=[[Cambridge, Massachusetts]] |publisher=[[Academic Press]], imprint of [[Elsevier]] |pages=839–849 |doi=10.1016/B978-0-12-800634-4.00083-4 |isbn=978-0-12-800634-4}}

== External links ==
* {{cite web |author=<!--Staff writer(s); no by-line.--> |date=26 May 2020 |title=The Science of Drug Use: A Resource for the Justice Sector |url=https://www.drugabuse.gov/drug-topics/criminal-justice/science-drug-use-resource-justice-sector |website=www.drugabuse.gov |location=[[North Bethesda, Maryland]] |publisher=[[National Institute on Drug Abuse]] |access-date=23 December 2021}}
* {{cite book |author=<!--Staff writer(s); no by-line.--> |date=31 January 2018 |title=School-Based Drug Abuse Prevention: Promising and Successful Programs |url=https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/sclbsd-drgbs/sclbsd-drgbs-eng.pdf |url-status=live |website=www.publicsafety.gc.ca |location=[[Ottawa, Ontario]] |publisher=[[Public Safety Canada]] |isbn=978-1-100-12181-9 |archive-url=https://web.archive.org/web/20210519141305/https://www.publicsafety.gc.ca/cnt/rsrcs/pblctns/sclbsd-drgbs/sclbsd-drgbs-eng.pdf |archive-date=19 May 2021 |access-date=23 December 2021}}
* {{cite web |vauthors=Sacco LN, Finklea K |date=3 May 2016 |url=https://fas.org/sgp/crs/misc/R42066.pdf |url-status=live |title=Synthetic Drugs: Overview and Issues for Congress |location=[[Washington, D.C.]] |publisher=[[Congressional Research Service]] |archive-url=https://web.archive.org/web/20211208164344/https://sgp.fas.org/crs/misc/R42066.pdf |archive-date=8 December 2021 |access-date=23 December 2021}}

{{Drug use}}
{{Psychoactive substance use}}
{{Combined substance use and adulteration}}

{{DEFAULTSORT:Poly Drug Use}}
[[Category:Drug culture]]
[[Category:Polysubstance combinations|*]]