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Review
. 2022 Feb;42(2):47-59.
doi: 10.24095/hpcdp.42.2.01.

Patterns and motivations of polysubstance use: a rapid review of the qualitative evidence

[Article in English, French]
Michèle Boileau-Falardeau  1   2 , Gisèle Contreras  2 , Geneviève Gariépy  1   3 , Claudie Laprise  1   4
Affiliations
Review

Patterns and motivations of polysubstance use: a rapid review of the qualitative evidence

[Article in English, French]
Michèle Boileau-Falardeau et al. Health Promot Chronic Dis Prev Can. 2022 Feb.

Abstract
in English, French

Introduction: Polysubstance use-the use of substances at the same time or close in time-is a common practice among people who use drugs. The recent rise in mortality and overdose associated with polysubstance use makes understanding current motivations underlying this pattern critical. The objective of this review was to synthesize current knowledge of the reasons for combining substances in a single defined episode of drug use.

Methods: We conducted a rapid review of the literature to identify empirical studies describing patterns and/or motivations for polysubstance use. Included studies were published between 2010 and 2021 and identified using MEDLINE, Embase, PsycINFO and Google Scholar.

Results: We included 13 qualitative or mixed-method studies in our analysis. Substances were combined sequentially to alleviate withdrawal symptoms or prolong a state of euphoria ("high"). Simultaneous use was motivated by an intention to counteract or balance the effect(s) of a substance with those of another, enhance a high or reduce overall use, and to mimic the effect of another unavailable or more expensive substance. Self-medication for a pre-existing condition was also the intention behind sequential or simultaneous use.

Conclusion: Polysubstance use is often motivated by a desire to improve the experience based on expected effects of combinations. A better understanding of the reasons underlying substance combination are needed to mitigate the impact of the current overdose crisis.

Introduction: La polyconsommation (l’usage de plusieurs substances en même temps ou sur une courte période) est une pratique courante chez les personnes qui consomment des drogues. La récente hausse de la mortalité et des surdoses associées à la polyconsommation rend essentielle la compréhension des motivations qui sous-tendent cette tendance. Cette revue visait à résumer les connaissances actuelles sur les raisons pour lesquelles plusieurs substances peuvent être combinées au cours d’un épisode spécifique de consommation de drogues.

Méthodologie: Nous avons effectué une revue rapide de la littérature pour cerner les études empiriques qui décrivent les motivations et les tendances associées à la polyconsommation de substances. Les études incluses ont été publiées entre 2010 et 2021 et repérées au moyen de MEDLINE, Embase, PsycINFO et Google Scholar.

Résultats: Nous avons inclus 13 études qualitatives ou à méthodes mixtes dans notre analyse. Les substances ont été combinées séquentiellement pour atténuer les symptômes de sevrage ou prolonger un état d’euphorie (« high »). L’usage simultané était motivé par l’intention de contrer ou d’équilibrer les effets d’une substance par ceux d’une autre, d’augmenter un état d’euphorie, de réduire la consommation globale ou de reproduire l’effet d’une autre substance non accessible ou plus coûteuse. L’automédication en vue de soulager un problème de santé était une autre des raisons à un usage séquentiel ou simultané.

Conclusion: La polyconsommation de substances est souvent motivée par le désir d’améliorer une expérience en fonction des effets attendus des combinaisons. Il nous faut mieux comprendre les raisons qui sous-tendent la combinaison de substances si nous voulons atténuer les répercussions de la crise actuelle des surdoses.

Keywords: co-ingestion; co-use; drug combination; misuse; polydrug use; polysubstance use; rapid review.

Plain language summary

The use of multiple substances in a single episode is common, but increases the risk of an acute toxicity event. Polysubstance use is driven by people’s experience and expectation of substance effects. Substances can be combined sequentially to alleviate withdrawal symptoms or prolong a state of euphoria (“high”). Substances can be used simultaneously to counteract or balance their effect(s), enhance a high, reduce overall use, or mimic the effect of another substance. While substances are generally combined to improve the experience, reducing overall use or selfmedicating a pre-existing condition are also motivations.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Data identification, selection and extraction process
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