Polysubstance Use Trends

Most US overdoses now involve multiple substances, fundamentally changing the clinical picture. The session covers fentanyl-stimulant co-use (the rising 'speedball' pattern), alcohol-cocaine combinations and cocaethylene toxicity, benzodiazepine-opioid risk and the post-2024 federal scheduling debate, polysubstance overdose patterns and reversal challenges, novel detection methods for emerging combinations, and the treatment implications when patients have concurrent multi-drug use disorders. Discussion addresses xylazine-fentanyl wound care, methamphetamine-fentanyl polysubstance epidemiology, the role of naloxone for non-opioid overdose, and the urgent need for randomised trial evidence on optimal MAT strategies in polysubstance use disorder populations.