{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:43:17Z","timestamp":1787668997161,"version":"build-2736575974"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T00:00:00Z","timestamp":1673913600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Introduction<\/jats:title>\n \n Polysubstance use<\/jats:ext-link>\n is the use of more than one non-prescribed licit or illicit substance at one time. This is a common phenomenon, but little is known about the severity and the various substances used by adults in Malaysia.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the pattern of polysubstance use and its associated factors among general adults in Malaysia.<\/jats:p>\n <\/jats:sec>\n \n Methodology<\/jats:title>\n This was a secondary data analysis from the National Health and Morbidity Survey (NHMS) 2019), a cross-sectional population survey with a two-stage stratified random sampling design. A total of 10,472 Malaysians aged 18 years and above participated in this survey. Polysubstance use was defined as concurrent use of more than one substance, either alcohol, tobacco, or drugs (opioids, marijuana, amphetamine\/ methamphetamine or kratom). A latent class analysis (LCA) was used to identify the membership of polysubstance groups. The association of class membership with demographic profiles was examined using Multinomial Logistic Regression analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Fit indices (AIC = 16458.9, BIC = 16443.6) from LCA supported 3 classes solution: Class 1; \u201cmoderate-drug\u201d group primarily combination used of tobacco and alcohol (2.4%), Class 2; \u201chigh-drug\u201d group using multiple substance including kratom (0.3%) and Class 3; \u201clow-drug\u201d group reporting minimal alcohol and tobacco use or non-user (97.3%). The multinomial model showed young adults (18\u201340 years) had a higher likelihood of being polysubstance users both for moderate-drug class (OR = 4.1) and high-drug class (OR = 3.9) compared to older age (\u226560 years). Chinese (OR = 18.9), Indian (OR = 23.3), Indigenous Sabah & Sarawak (OR = 34.6) and others ethnicity (OR = 8.9) showed higher odds of being moderate-drug users than Malays. The greater odds of moderate-drug use for males (OR = 35.5), working groups (OR = 1.5) and low education level group (OR = 3.2).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Our study highlights patterns and demographics related to the use of polysubstances among adults in Malaysia. These results would help formulate specific prevention programmes for these high-risk groups.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0264593","type":"journal-article","created":{"date-parts":[[2023,1,17]],"date-time":"2023-01-17T16:53:31Z","timestamp":1673974411000},"page":"e0264593","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Patterns of polysubstance use among adults in Malaysia\u2014A latent class analysis"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8065-8341","authenticated-orcid":true,"given":"Wan Shakira","family":"Rodzlan Hasani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania Gayle","family":"Robert Lourdes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shubash Shander","family":"Ganapathy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur Liana","family":"Ab Majid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0612-3282","authenticated-orcid":true,"given":"Hamizatul Akmal","family":"Abd Hamid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Fadhli","family":"Mohd Yusoff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,1,17]]},"reference":[{"key":"pone.0264593.ref001","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-14-1044","article-title":"Prevalence and factors determining psychoactive substance (PAS) use among Hawassa University (HU) undergraduate students, Hawassa Ethiopia","volume":"14","author":"A Kassa","year":"2014","journal-title":"BMC Public Health"},{"key":"pone.0264593.ref002","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1037\/1064-1297.5.4.353","article-title":"Concurrent versus simultaneous polydrug use: prevalence, correlates, discriminant validity, and prospective effects on health outcomes","volume":"5","author":"M Earleywine","year":"1997","journal-title":"Exp Clin Psychopharmacol"},{"key":"pone.0264593.ref003","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0376-8716(00)00157-5","article-title":"A behavioral economic analysis of polydrug abuse in alcoholics: asymmetrical substitution of alcohol and cocaine","volume":"62","author":"NM Petry","year":"2001","journal-title":"Drug Alcohol Depend"},{"key":"pone.0264593.ref004","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1080\/10826084.2018.1517797","article-title":"Early adolescent patterns of alcohol and tobacco use in eight Association of South-East Asian Nations (ASEAN) member states","volume":"54","author":"SA Hong","year":"2019","journal-title":"Substance use \\& misuse"},{"key":"pone.0264593.ref005","unstructured":"Institute for Public Health. National Health and Morbidity Survey (NHMS) 2019: Vol. I: NCDs\u2014Non-Communicable Diseases: Risk Factors and Other Health Problems. Ministry of Health Malaysia Setia Alam, Malaysia; 2020."},{"key":"pone.0264593.ref006","volume-title":"ASEAN drug monitoring report 2016","author":"M Kanato","year":"2017"},{"key":"pone.0264593.ref007","unstructured":"National Anti-Drugs Agency (NADA). Drugs Statistics: Statistic Trend Of Number Of Drug Addicts Detected According To Age Category, 2016\u20132020. 2022 [cited 20 Jul 2022]. https:\/\/www.adk.gov.my\/en\/statistic-trend-of-number-of-drug-addicts-detected-according-to-age-category-2016-2020\/."},{"key":"pone.0264593.ref008","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.drugpo.2009.12.003","article-title":"The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy","volume":"21","author":"B Vicknasingam","year":"2010","journal-title":"International Journal of Drug Policy"},{"key":"pone.0264593.ref009","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1080\/15563650701241795","article-title":"Opioid receptors and legal highs: Salvia divinorum and Kratom","volume":"46","author":"KM Babu","year":"2008","journal-title":"Clin Toxicol"},{"key":"pone.0264593.ref010","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.drugalcdep.2014.03.017","article-title":"Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users","volume":"139","author":"D Singh","year":"2014","journal-title":"Drug Alcohol Depend"},{"key":"pone.0264593.ref011","doi-asserted-by":"crossref","first-page":"e2625","DOI":"10.1002\/hup.2625","article-title":"Multiple DSM-5 substance use disorders: A national study of US adults","volume":"32","author":"SE McCabe","year":"2017","journal-title":"Human Psychopharmacology: Clinical and Experimental"},{"key":"pone.0264593.ref012","first-page":"18","article-title":"Trends in poly drug use-associated deaths based on confirmed analytical toxicology results in Tehran, Iran, in 2011\u20132016","volume":"13","author":"M Akhgari","year":"2021","journal-title":"Addiction \\& Health"},{"key":"pone.0264593.ref013","doi-asserted-by":"crossref","first-page":"165","DOI":"10.2471\/BLT.17.196287","article-title":"Lead poisoning outbreak among opium users in the Islamic Republic of Iran, 2016\u20132017","volume":"96","author":"T Ghane","year":"2018","journal-title":"Bull World Health Organ"},{"key":"pone.0264593.ref014","doi-asserted-by":"crossref","first-page":"e180919","DOI":"10.1001\/jamanetworkopen.2018.0919","article-title":"Exposure-response association between concurrent opioid and benzodiazepine use and risk of opioid-related overdose in Medicare Part D beneficiaries","volume":"1","author":"I Hernandez","year":"2018","journal-title":"JAMA Netw Open"},{"key":"pone.0264593.ref015","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1001\/archpsyc.62.6.617","article-title":"Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication","volume":"62","author":"RC Kessler","year":"2005","journal-title":"Arch Gen Psychiatry"},{"key":"pone.0264593.ref016","first-page":"47","article-title":"Binge drinkers, illicit drug users, and polydrug users: An epidemiological study of American collegians","author":"W Feigelman","year":"1998","journal-title":"Journal of Alcohol and Drug Education"},{"key":"pone.0264593.ref017","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/YCO.0000000000000069","article-title":"Polysubstance use: diagnostic challenges, patterns of use and health","volume":"27","author":"JP Connor","year":"2014","journal-title":"Curr Opin Psychiatry"},{"key":"pone.0264593.ref018","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1111\/j.1360-0443.2005.01322.x","article-title":"Cannabis use and other illicit drug use: testing the cannabis gateway hypothesis","volume":"101","author":"DM Fergusson","year":"2006","journal-title":"Addiction"},{"key":"pone.0264593.ref019","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.annepidem.2013.07.012","article-title":"Comparisons of polydrug use at national and inner city levels in England: associations with demographic and socioeconomic factors","volume":"23","author":"JL Carter","year":"2013","journal-title":"Ann Epidemiol"},{"key":"pone.0264593.ref020","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1016\/j.drugalcdep.2011.09.002","article-title":"Tobacco, alcohol, cannabis and other illegal drug use among young adults: the socioeconomic context","volume":"121","author":"B Redonnet","year":"2012","journal-title":"Drug Alcohol Depend"},{"key":"pone.0264593.ref021","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1017\/S0033291706007690","article-title":"Race\/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"36","author":"SM Smith","year":"2006","journal-title":"Psychol Med"},{"key":"pone.0264593.ref022","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.drugalcdep.2017.01.021","article-title":"Gender and race\/ethnic differences in the persistence of alcohol, drug, and poly-substance use disorders","volume":"174","author":"EA Evans","year":"2017","journal-title":"Drug Alcohol Depend"},{"key":"pone.0264593.ref023","doi-asserted-by":"crossref","first-page":"112462","DOI":"10.1016\/j.jep.2019.112462","article-title":"Patterns and reasons for kratom (Mitragyna speciosa) use among current and former opioid poly-drug users","volume":"249","author":"D Singh","year":"2020","journal-title":"J Ethnopharmacol"},{"key":"pone.0264593.ref024","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3109\/00952990.2015.1101467","article-title":"Patterns of substance use and correlates of lifetime and active injection drug use among women in Malaysia","volume":"42","author":"JA Wickersham","year":"2016","journal-title":"Am J Drug Alcohol Abuse"},{"key":"pone.0264593.ref025","article-title":"Psychiatric and substance abuse comorbidity among HIV seropositive and HIV seronegative prisoners in Malaysia","author":"MM Zahari","year":"2010","journal-title":"Taylor \\& Francis"},{"key":"pone.0264593.ref026","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.drugalcdep.2015.02.040","article-title":"Latent class analysis of substance use among men who have sex with men in Malaysia: Findings from the Asian Internet MSM Sex Survey","volume":"151","author":"SH Lim","year":"2015","journal-title":"Drug Alcohol Depend"},{"key":"pone.0264593.ref027","doi-asserted-by":"crossref","first-page":"e0245593","DOI":"10.1371\/journal.pone.0245593","article-title":"Polysubstance use among adolescents in Malaysia: Findings from the National Health and Morbidity Survey 2017","volume":"16","author":"WS Rodzlan Hasani","year":"2021","journal-title":"Plos one"},{"key":"pone.0264593.ref028","doi-asserted-by":"crossref","first-page":"4684","DOI":"10.3390\/ijerph19084684","article-title":"Prevalence of Drug and Substance Use among Malaysian Youth: A Nationwide Survey","volume":"19","author":"R Ismail","year":"2022","journal-title":"International Journal of Environmental Research and Public Health"},{"key":"pone.0264593.ref029","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s11121-011-0201-1","article-title":"Latent class analysis: an alternative perspective on subgroup analysis in prevention and treatment","volume":"14","author":"ST Lanza","year":"2013","journal-title":"Prevention science"},{"key":"pone.0264593.ref030","unstructured":"Global Tobacco Surveillance System. Global Adult Tobacco Survey (GATS): Indicator Guidelines: Definition and Syntax 2009. 2009 [cited 20 Jan 2022]. 28.%09World Health Organization (WHO). WHO Global Health Observatory, Indi."},{"key":"pone.0264593.ref031","unstructured":"World Health Organization (WHO). WHO Global Health Observatory, Indicator Metadata Registry List: Alcohol, consumers, past 12 months. In: World Health Organization [Internet]. 2021. https:\/\/www.who.int\/data\/gho\/indicator-metadata-registry\/imr-details\/2325."},{"key":"pone.0264593.ref032","unstructured":"The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). General population surveys (GPS): Methods and definitions Lisbon. 2012. https:\/\/www.emcdda.europa.eu\/stats07\/GPS\/methods."},{"key":"pone.0264593.ref033","unstructured":"Department of Statistics Malaysia (DOSM). Household Income and Basic Amenities Survey Report 2016: Technical Notes: Cut-off income for household group by income (page 197). 2016. https:\/\/uploads-ssl.webflow.com\/5d14ef3beaa3ed3bcb066799\/5da0b256718f35dc29b0b3a9_Laporan%2BHIS%2C%2BMalaysia%2B2016.pdf."},{"key":"pone.0264593.ref034","first-page":"266","volume-title":"Applications of Latent Trait and Latent Class Models","author":"AL McCutcheon","year":"1997"},{"key":"pone.0264593.ref035","doi-asserted-by":"crossref","first-page":"1","DOI":"10.18637\/jss.v042.i10","article-title":"poLCA: An R package for polytomous variable latent class analysis","volume":"42","author":"DA Linzer","year":"2011","journal-title":"J Stat Softw"},{"key":"pone.0264593.ref036","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.jep.2012.03.009","article-title":"Mitragyna speciosa use in the northern states of Malaysia: a cross-sectional study","volume":"141","author":"K Ahmad","year":"2012","journal-title":"J Ethnopharmacol"},{"key":"pone.0264593.ref037","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1007\/s13181-011-0155-5","article-title":"Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa)","volume":"7","author":"FG Kapp","year":"2011","journal-title":"Journal of Medical Toxicology"},{"key":"pone.0264593.ref038","doi-asserted-by":"crossref","first-page":"S278","DOI":"10.1111\/1556-4029.12009","article-title":"A drug fatality involving Kratom","volume":"58","author":"MF Neerman","year":"2013","journal-title":"J Forensic Sci"},{"key":"pone.0264593.ref039","doi-asserted-by":"crossref","first-page":"75","DOI":"10.32890\/uumjls.11.1.2020.6928","article-title":"Enforcement status of the poison act 1952 against offences related to kratom (Mitragyna speciosa korth) misuse in Malaysia","volume":"11","author":"S Khalil","year":"2020","journal-title":"UUM Journal of Legal Studies (UUMJLS)"},{"key":"pone.0264593.ref040","volume-title":"Statistic Trend Of Number Of Drug Addicts Detected According To Type Of Drugs, 2016\u20132020","author":"National Anti Drugs Agency (NADA)","year":"2021"},{"key":"pone.0264593.ref041","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.drugalcdep.2010.08.010","article-title":"Patterns of polydrug use in Great Britain: Findings from a national household population survey","volume":"113","author":"GW Smith","year":"2011","journal-title":"Drug Alcohol Depend"},{"key":"pone.0264593.ref042","first-page":"162","article-title":"An epidemiologic analysis of co-occurring alcohol and tobacco use and disorders: findings from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"29","author":"DE Falk","year":"2006","journal-title":"Alcohol Research \\& Health"},{"key":"pone.0264593.ref043","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511499777","volume-title":"Stages and pathways of drug involvement: Examining the gateway hypothesis","author":"DB Kandel","year":"2002"},{"key":"pone.0264593.ref044","first-page":"S67","article-title":"Tobacco, alcohol, and illicit drug use: racial and ethnic differences among US high school seniors, 1976\u20132000","volume":"117","author":"JM Wallace","year":"2002","journal-title":"Public health reports"},{"key":"pone.0264593.ref045","first-page":"185","volume-title":"Non-Communicable Diseases, Risk Factors & Other Health Problems","author":"Institute for Public Health","year":"2015"},{"key":"pone.0264593.ref046","doi-asserted-by":"crossref","unstructured":"Heath DB. International Handbook on Alcohol and Culture. Praeger Publisher: Westport CT; 1995.","DOI":"10.5040\/9798400671340"},{"key":"pone.0264593.ref047","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1002\/ajim.22333","article-title":"Work-related stress factors associated with problem drinking: A study of the Spanish working population","volume":"57","author":"E Colell","year":"2014","journal-title":"Am J Ind Med"},{"key":"pone.0264593.ref048","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1093\/aje\/kwj064","article-title":"Drug dependence enviromics: job strain in the work environment and risk of becoming drug-dependent","volume":"163","author":"PL Reed","year":"2006","journal-title":"Am J Epidemiol"},{"key":"pone.0264593.ref049","doi-asserted-by":"crossref","first-page":"212","DOI":"10.15288\/jsad.2013.74.212","article-title":"Job strain, hazardous drinking, and alcohol-related disorders among Brazilian bank workers","volume":"74","author":"CT Lima","year":"2013","journal-title":"J Stud Alcohol Drugs"},{"key":"pone.0264593.ref050","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/S0376-8716(98)00028-3","article-title":"Self-report among injecting drug users: a review","volume":"51","author":"S. Darke","year":"1998","journal-title":"Drug Alcohol Depend"},{"key":"pone.0264593.ref051","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1111\/j.1360-0443.1987.tb03909.x","article-title":"The reliability and consistency of self-reports on substance use in a longitudinal study","volume":"82","author":"Z Barnea","year":"1987","journal-title":"Br J Addict"},{"key":"pone.0264593.ref052","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1111\/add.13058","article-title":"Predictors of comorbid polysubstance use and mental health disorders in young adults\u2014a latent class analysis","volume":"111","author":"CL Salom","year":"2016","journal-title":"Addiction"},{"key":"pone.0264593.ref053","first-page":"58","article-title":"Multiple drug use in adolescents and young adults","volume":"31","author":"L-H Quek","year":"2012","journal-title":"Drug and Alcohol Review"},{"key":"pone.0264593.ref054","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1037\/adb0000068","article-title":"The relationship between psychological distress and adolescent polydrug use","volume":"29","author":"AB Kelly","year":"2015","journal-title":"Psychology of Addictive Behaviors"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264593","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,12]],"date-time":"2024-10-12T07:13:09Z","timestamp":1728717189000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264593"}},"subtitle":[],"editor":[{"given":"George","family":"Vousden","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,1,17]]},"references-count":54,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0264593","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,17]]}}}