Polysubstance use disorder - Revision history

Aidan: /* Background */

2020-07-09T14:29:44Z

Background

Aidan at 14:28, 9 July 2020

2020-07-09T14:28:53Z

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-== Background ==
+==Background==
-* Co-occurring [[Substance use disorder|substance use disorders]] are common, involving both legal and illegal substances
+*Co-occurring [[Substance use disorder|substance use disorders]] are common, involving both legal and illegal substances.
-* [[Tobacco use disorder]] and [[alcohol use disorder]] are the most common co-occurring substance use disorders, followed by [[opioid use disorder]], [[cocaine use disorder]], and [[cannabid use disorder]]
+*[[Tobacco use disorder]] and [[alcohol use disorder]] are the most common co-occurring substance use disorders, followed by [[opioid use disorder]], [[cocaine use disorder]], and [[cannabid use disorder]].
-=== Risk Factors[[CiteRef::bhalla2017cl]] ===
+===Risk Factors[[CiteRef::bhalla2017cl]]===
-* Younger age
+*Younger age
-* Lower education
+*Lower education
-* Lower socioeconomic status
+*Lower socioeconomic status
-* Childhood abuse
+*Childhood abuse
-* Male sex
+*Male sex

Aidan: Created page with "== Background == * Co-occurring substance use disorders are common, involving both legal and illegal substances * Tobacco use disorder and al..."

2020-07-09T14:07:02Z

Created page with "== Background == * Co-occurring substance use disorders are common, involving both legal and illegal substances * Tobacco use disorder and al..."

New page

== Background ==

* Co-occurring [[Substance use disorder|substance use disorders]] are common, involving both legal and illegal substances
* [[Tobacco use disorder]] and [[alcohol use disorder]] are the most common co-occurring substance use disorders, followed by [[opioid use disorder]], [[cocaine use disorder]], and [[cannabid use disorder]]

=== Risk Factors[[CiteRef::bhalla2017cl]] ===

* Younger age
* Lower education
* Lower socioeconomic status
* Childhood abuse
* Male sex

← Older revision		Revision as of 14:29, 9 July 2020
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	*Co-occurring [[Substance use disorder\|substance use disorders]] are common, involving both legal and illegal substances.		*Co-occurring [[Substance use disorder\|substance use disorders]] are common, involving both legal and illegal substances.
	*[[~~Tobacco~~ use disorder]] and [[~~alcohol~~ use disorder]] are the most common co-occurring substance use disorders, followed by [[opioid use disorder]], [[cocaine use disorder]], and [[~~cannabid~~ use disorder]].		*[[Alcohol use disorder]] and [[Tobacco use disorder]] are the most common co-occurring substance use disorders, followed by [[opioid use disorder]], [[cocaine use disorder]], and [[cannabis use disorder]].

	===Risk Factors[[CiteRef::bhalla2017cl]]===		===Risk Factors[[CiteRef::bhalla2017cl]]===
Line 12:		Line 12:
	*Male sex		*Male sex

	=== Epidemiology ===		===Epidemiology===

	* About 25% of people with one substance use disorder have co-occurring substance use disorders[[CiteRef::bhalla2017cl]].		*About 25% of people with one substance use disorder have co-occurring substance use disorders[[CiteRef::bhalla2017cl]].

	== Management ==		==Management==

	=== Screening ===		===Screening===

	* [[ASSIST]], [[TAPS]], and [[AUDIT-C]] can all be used		*[[ASSIST]], [[TAPS]], and [[AUDIT-C]] can all be used

	=== Treatment ===		===Treatment===

	* The co-occurring disorders should ideally be treated concurrently, based on the severity of each one.		*The co-occurring disorders should ideally be treated concurrently, based on the severity of each one.

	==== Benzodiazepine and opioid use disorders ====		====Benzodiazepine and opioid use disorders====

	* Benzodiazepine use has a high risk of [[hepatitis c virus]] infection, [[HIV]] infection, and death.		*Benzodiazepine use has a high risk of [[hepatitis c virus]] infection, [[HIV]] infection, and death.
	* Specifically with opioids, it increases the risk of respiratory depression, overdose, and death.		*Specifically with opioids, it increases the risk of respiratory depression, overdose, and death.
	* However, the risk of death from an untreated opioid use disorder is likely higher than if it is treated despite the concurrent use of benzodiazepines.		*However, the risk of death from an untreated opioid use disorder is likely higher than if it is treated despite the concurrent use of benzodiazepines.
	* Despite this, opioids and benzodiazepines should not be coprescribed unless clearly documented as a taper.		*Despite this, opioids and benzodiazepines should not be coprescribed unless clearly documented as a taper.

	==== Cocaine and alcohol use disorders ====		====Cocaine and alcohol use disorders====

	* Old data suggest that as much as 60-80% of patients with [[cocaine use disorder]] have a concurrent [[alcohol use disorder]].		*Old data suggest that as much as 60-80% of patients with [[cocaine use disorder]] have a concurrent [[alcohol use disorder]].
	* Coingestion causes the formation of a cocaine metabolite cocaethylene, not otherwise present, which increases the effects (positive and negative) of the cocaine and prolongs its half-life.		*Coingestion causes the formation of a cocaine metabolite cocaethylene, not otherwise present, which increases the effects (positive and negative) of the cocaine and prolongs its half-life.

	==== Opioid and alcohol use disorders ====		====Opioid and alcohol use disorders====

	* Continue with standard treatments including motivational interviewing.		*Continue with standard treatments including motivational interviewing.
	* For medical management of the opioid use, [[Suboxone]] is likely safer in these patients than [[methadone]].		*For medical management of the opioid use, [[Suboxone]] is likely safer in these patients than [[methadone]].
	* For medical management of the alcohol use, [[naltrexone]] is contraindicated since it will precipitate withdrawal, but [[acamprosate]] and [[gabapentin]] can still be used.		*For medical management of the alcohol use, [[naltrexone]] is contraindicated since it will precipitate withdrawal, but [[acamprosate]] and [[gabapentin]] can still be used.
	** However, [[gabapentin]] should be used with care, since concomitant [[opioid]] and [[gabapentin]] use may increase fatal overdose compared to those without [[gabapentin]] use.		**However, [[gabapentin]] should be used with care, since concomitant [[opioid]] and [[gabapentin]] use may increase fatal overdose compared to those without [[gabapentin]] use.

	==== Tobacco use disorder ====		====Tobacco use disorder====

	* Many patients who are being treated for other substance use disorders are interested in smoking cessation as well.		*Many patients who are being treated for other substance use disorders are interested in smoking cessation as well.
	* Patients should be screened and offered treatment for concurrent [[tobacco use disorder]].		*Patients should be screened and offered treatment for concurrent [[tobacco use disorder]].

	==== Alcohol and tobacco use disorders ====		====Alcohol and tobacco use disorders====

	* This combination is the most common diagnosis among those with co-occurring substance use disorders.		*This combination is the most common diagnosis among those with co-occurring substance use disorders.
	* Smoking is associated with increased alcohol consumption and severity of alcohol use disorder, as well as the usual ill effects of smoking and alcohol use.		*Smoking is associated with increased alcohol consumption and severity of alcohol use disorder, as well as the usual ill effects of smoking and alcohol use.
	* Combination [[varenicline]] and [[naltrexone]] appears effective.		*Combination [[varenicline]] and [[naltrexone]] appears effective.
	* Psychosocial interventions including brief interventions and contingency management may be helpful.		*Psychosocial interventions including brief interventions and contingency management may be helpful.

	== Prognosis ==		==Prognosis==

	* More severe physical and mental health problems, including liver disease and HIV, compared to those with a single [[substance use disorder]].		*More severe physical and mental health problems, including liver disease and HIV, compared to those with a single [[substance use disorder]].
	* Concurrent use of sedatives, such as [[opioids]] with [[benzodiazepines]] or alcohol, is associated with higher rates of respiratory depression, overdose, and death.		*Concurrent use of sedatives, such as [[opioids]] with [[benzodiazepines]] or alcohol, is associated with higher rates of respiratory depression, overdose, and death.