Polysubstance use among patients with opioid use disorder

The opioid crisis remains a major U.S. public health priority. Overdose deaths involve 2.4 substances on average, underscoring the pervasiveness and mortality risks of polysubstance use in opioid use disorder (OUD).

National laboratory urine drug test (UDT) data linked with medical and pharmacy claims were used to examine polysubstance use among patients with OUD. Data were collected from June 2017 through May 2025 and analyzed from November 2025 through February 2026. Data included 143,108 adults aged 18-64 years with at least one opioid UDT between December 2017 and May 2024, an OUD diagnosis within 180 days prior to the UDT, and continuous medical and pharmacy enrollment for 180 days before and 365 days after the UDT.

Findings show high rates of polysubstance use among patients with OUD even without non-opioid SUD diagnoses. Marijuana, methamphetamine, and alcohol were the most prevalent substances in UDTs. Patients with positive non-opioid UDTs were more likely to be younger, male, White, non-Hispanic, and enrolled in managed Medicaid. These patients also had high rates of co-occurring mental and physical health conditions and MOUD and psychotropic medication use.

These findings highlight the utility of UDTs linked with medical and pharmacy claims data as a public health surveillance tool. Large-scale UDT data linked with clinical claims may complement traditional surveillance approaches by providing timely, clinically contextualized information on polysubstance use patterns among patients with OUD.