{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T01:47:19Z","timestamp":1778809639265,"version":"3.51.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T00:00:00Z","timestamp":1639958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007268","name":"Washington University in St. Louis","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007268","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Stimulant use among individuals with opioid use disorder has recently increased, driven by changes in drug distribution channels. However, our understanding of polysubstance use is often limited by a need to provide targeted treatment to a primary drug of addiction. Yet there is a crucial need to better understand pathways to addiction, and how the use of multiple substances may differ between populations, as well as time periods.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Using a national opioid surveillance system, we analyzed survey data from new entrants to 124 opioid use disorder treatment centers from 2017 to 2020. Age of first use was collected for prescription opioids, illicit opioids, prescription stimulants, crack\/cocaine, and methamphetamines. Year of initial use of an opioid or stimulant was calculated and grouped by 5 year blocs, inclusive of initial use starting from 1991 and ending in 2020 (<jats:italic>n<\/jats:italic> = 6,048).<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Lifetime exposure to stimulants was 82.5% among individuals with opioid use disorder. Mean age of initiation increased for all drugs in 2016\u20132020, in particular prescription opioids (22.3 to 31.8). Stimulants were initiating drugs for a substantial proportion of individuals with opioid use throughout the analyzed time period. Those initiating opioid\/stimulant use from 1991 to 1995 had a mean average of 6.8 years between first and second drug exposure, which steadily decreased to 1.5 years between exposures in 2016\u20132020. Sankey plots depict significantly more drug transitions in those initiating use from 1991 to 2000 (65.1% had at least two drug transitions) compared to 2010\u20132020 (16.0%). Opioid-stimulant use increased over time among racial\/ethnic minorities, sexual minorities, and those with an educational attainment of high school or less.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> These data highlight not only the substantial prevalence of stimulant use among individuals who develop opioid use disorder, but also the variability through which pathways of use occur. Prevention and intervention efforts need to take into account increasing ages of initial drug exposures, demographic shifts in stimulant-using populations, and more rapid drug transitions between opioid and stimulants. But at a broader level, prevention, harm reduction ideology, and addiction medicine needs to take into account the ubiquity of polysubstance use among individuals with substance use disorders.<\/jats:p>","DOI":"10.3389\/fpsyt.2021.786056","type":"journal-article","created":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T08:03:41Z","timestamp":1639987421000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Shifting Pathways of Stimulant Use Among Individuals With Opioid Use Disorder: A Retrospective Analysis of the Last Thirty Years"],"prefix":"10.3389","volume":"12","author":[{"given":"Matthew S.","family":"Ellis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary A.","family":"Kasper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Scroggins","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,20]]},"reference":[{"key":"B1","year":"2021","journal-title":"Drug Overdose Deaths in the U.S. Up 30% in 2020"},{"key":"B2","doi-asserted-by":"publisher","first-page":"61","DOI":"10.7326\/M20-1212","article-title":"Collision of the COVID-19 and addiction epidemics","volume":"173","author":"Volkow","year":"2020","journal-title":"Ann Intern Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"108180","DOI":"10.1016\/j.jsat.2020.108180","article-title":"COVID-19-related treatment service disruptions among people with single- and polysubstance use concerns","volume":"121","author":"Mellis","year":"2021","journal-title":"J Subst Abuse Treat."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e6","DOI":"10.1097\/ADM.0000000000000684","article-title":"Opioid use disorder and COVID-19: crashing of the crises","volume":"14","author":"Khatri","year":"2020","journal-title":"J Addict Med."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2440","DOI":"10.1001\/jama.2020.21512","article-title":"Treatment of opioid use disorder among commercially insured patients in the context of the COVID-19 pandemic","volume":"324","author":"Huskamp","year":"2020","journal-title":"JAMA."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1624","DOI":"10.1001\/jama.2016.1464","article-title":"CDC guideline for prescribing opioids for chronic pain\u2013United States, 2016","volume":"315","author":"Dowell","year":"2016","journal-title":"JAMA."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1097\/MLR.0000000000001411","article-title":"State opioid limits and volume of opioid prescriptions received by medicaid patients","volume":"58","author":"Zhang","year":"2020","journal-title":"Med Care."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1550","DOI":"10.1377\/hlthaff.2019.00103","article-title":"Prescription drug monitoring program mandates: impact on opioid prescribing and related hospital use","volume":"38","author":"Wen","year":"2019","journal-title":"Health Aff."},{"key":"B9","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1186\/s12913-017-2354-5","article-title":"Evaluating the impact of prescription drug monitoring program implementation: a scoping review","volume":"17","author":"Finley","year":"2017","journal-title":"BMC Health Serv Res."},{"key":"B10","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1080\/03007995.2017.1419171","article-title":"Abuse-deterrent opioids: an update on current approaches and considerations","volume":"34","author":"Pergolizzi","year":"2018","journal-title":"Curr Med Res Opin."},{"key":"B11","doi-asserted-by":"publisher","first-page":"485","DOI":"10.5055\/jom.2017.0412","article-title":"Evaluating the abuse potential of opioids and abuse-deterrent -opioid formulations: a review of clinical study methodology","volume":"13","author":"Setnik","year":"2017","journal-title":"J Opioid Manag."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1667","DOI":"10.1213\/ANE.0000000000002388","article-title":"America's opioid epidemic: supply and demand considerations","volume":"125","author":"Clark","year":"2017","journal-title":"Anesth Analg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.drugpo.2019.01.010","article-title":"The triple wave epidemic: supply and demand drivers of the US opioid overdose crisis","volume":"71","author":"Ciccarone","year":"2019","journal-title":"Int J Drug Policy."},{"key":"B14","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1016\/j.drugalcdep.2016.03.014","article-title":"Understanding the demand side of the prescription opioid epidemic: does the initial source of opioids matter?","volume":"173","author":"Cicero","year":"2017","journal-title":"Drug Alcohol Depend."},{"key":"B15","doi-asserted-by":"publisher","first-page":"e2036687","DOI":"10.1001\/jamanetworkopen.2020.36687","article-title":"Systematic evaluation of state policy interventions targeting the US opioid epidemic, 2007-2018","volume":"4","author":"Lee","year":"2021","journal-title":"JAMA Netw Open."},{"key":"B16","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1007\/s11920-018-0872-4","article-title":"Psychiatry and pain management: at the intersection of chronic pain and mental health","volume":"20","author":"Goesling","year":"2018","journal-title":"Curr Psychiatry Rep."},{"key":"B17","doi-asserted-by":"publisher","first-page":"S93","DOI":"10.36076\/ppj.2017.s109","article-title":"Prescription opioid abuse in chronic pain: an updated review of opioid abuse predictors and strategies to curb opioid abuse: part 1","volume":"20","author":"Kaye","year":"2017","journal-title":"Pain Phys."},{"key":"B18","doi-asserted-by":"publisher","first-page":"S111","DOI":"10.1037\/tra0000660","article-title":"COVID-19, mental health, and opioid use disorder: old and new public health crises intertwine","volume":"12","author":"Henry","year":"2020","journal-title":"Psychol Trauma."},{"key":"B19","doi-asserted-by":"publisher","first-page":"244","DOI":"10.2105\/AJPH.2019.305412","article-title":"Polysubstance SSE: a broader understanding of substance use during the opioid crisis","volume":"110","author":"Cicero","year":"2020","journal-title":"Am J Public Health."},{"key":"B20","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1038\/s41380-020-00949-3","article-title":"Polysubstance use in the US opioid crisis","volume":"26","author":"Compton","year":"2021","journal-title":"Mol Psychiatry."},{"key":"B21","doi-asserted-by":"publisher","first-page":"106729","DOI":"10.1016\/j.ypmed.2021.106729","article-title":"Polysubstance use trends and variability among individuals with opioid use disorder in rural versus urban settings","volume":"2021","author":"Ellis","year":"","journal-title":"Prev Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1001\/jamapsychiatry.2021.2588","article-title":"Methamphetamine use, methamphetamine use disorder, and associated overdose deaths among US adults","volume":"78","author":"Han","year":"2021","journal-title":"JAMA Psychiatry."},{"key":"B23","doi-asserted-by":"publisher","first-page":"317","DOI":"10.15585\/mmwr.mm6912a1","article-title":"Patterns and characteristics of methamphetamine use among adults - United States, 2015-2018","volume":"69","author":"Jones","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B24","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1111\/add.14812","article-title":"Increases in methamphetamine use among heroin treatment admissions in the United States, 2008-17","volume":"115","author":"Jones","year":"2020","journal-title":"Addiction."},{"key":"B25","first-page":"1","article-title":"Drug overdose deaths in the United States, 1999-2018","author":"Hedegaard","year":"2020","journal-title":"NCHS Data Brief"},{"key":"B26","doi-asserted-by":"publisher","first-page":"388","DOI":"10.15585\/mmwr.mm6817a3","article-title":"Drug overdose deaths involving cocaine and psychostimulants with abuse potential - United States, 2003-2017","volume":"68","author":"Kariisa","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"B27","doi-asserted-by":"publisher","first-page":"108750","DOI":"10.1016\/j.drugalcdep.2021.108750","article-title":"The continued rise of methamphetamine use among people who use heroin in the United States","volume":"225","author":"Strickland","year":"2021","journal-title":"Drug Alcohol Depend."},{"key":"B28","year":"2019","journal-title":"2019 National Drug Threat Assessment"},{"key":"B29","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/j.drugalcdep.2018.08.029","article-title":"Twin epidemics: the surging rise of methamphetamine use in chronic opioid users","volume":"193","author":"Ellis","year":"2018","journal-title":"Drug Alcohol Depend."},{"key":"B30","year":"2020","journal-title":"COVID-19 and the Drug Supply Chain: From Production and Trafficking to Use"},{"key":"B31","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1001\/jamapsychiatry.2014.366","article-title":"The changing face of heroin use in the United States: a retrospective analysis of the past 50 years","volume":"71","author":"Cicero","year":"2014","journal-title":"JAMA Psychiatry."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.786056\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T08:03:42Z","timestamp":1639987422000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2021.786056\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,20]]},"references-count":31,"alternative-id":["10.3389\/fpsyt.2021.786056"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2021.786056","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,20]]},"article-number":"786056"}}