Polysubstance Use Profiles Among the General Adult Population, United States, 2022.

In a 2022 nationally representative US survey of 15,800 adults, 20.9% reported using two or more drugs in the past year. Four distinct patterns emerged: medically guided use (11.5% of adults, 6.1% with substance use disorder), principal cannabis use (4.0%, 31.9% with disorder), self-guided nonmedical use (3.4%, 14.5% with disorder), and indiscriminate coexposures (2.1%, 58.9% with disorder). The findings reveal two previously unrecognized classes and indicate that many adults with polysubstance use have untreated substance use disorders. Prevention and treatment should be personalized to each person's specific drug-use profile.

Study at a glance

Abstract

Objectives. To characterize present-day polysubstance use patterns in the general adult population. Methods. From a 2022 nationally representative survey in the United States, we defined polysubstance use as last 12-month use of 2 or more drugs (n = 15 800). Latent class analyses included medical (as indicated) and nonmedical (not as directed) use of prescription opioids, stimulants, benzodiazepines, and antidepressants; recreational use of cannabis, psilocybin or mushrooms, other psychedelics, cocaine, methamphetamine, and illicit opioids; and concomitant use with alcohol, cannabis, prescriptions, or recreational drugs. Results. The national prevalence of polysubstance use was 20.9% (95% confidence interval = 20.5%, 21.3%), broken down into the following 4 latent classes: (1) medically guided polysubstance use (11.5% prevalence, 6.1% substance use disorder [SUD]): prescribed drug use, some cannabis, and no concomitant use; (2) principal cannabis use variety (4.0% prevalence, 31.9% SUD): high probability of cannabis use with various drugs concomitantly used; (3) self-guided polysubstance use (3.4% prevalence, 14.5% SUD): nonmedical use of prescriptions and concomitant use; and (4) indiscriminate coexposures (2.1% prevalence, 58.9% SUD): concomitant drug use with indiscriminate drug preference. Conclusions. Different polysubstance profiles show adults with untreated SUDs, and there are 2 previously unrecognized classes. Prevention and treatment strategies addressing polysubstance use should take a personalized perspective and tailor to individuals' use profile. (Am J Public Health. 2025;115(5):747-757. https://doi.org/10.2105/AJPH.2024.307979).