Abstract
Background: Much of the blame of the increasing death toll by drug overdoses has justifiably been attributed to the United States’ current opioid epidemic. However, nearly 80% of overdoses related to opioids involve another drug substance or alcohol. The objective of this study was to elucidate overrepresentation of drugs in polypharmacy arrests by identifying drugs that were more likely to be found in conjunction with other substances, using the drug arrest data provided by the Maine Diversion Alert Program (DAP). Methods: Single drug arrest and multiple drug arrest totals reported to the DAP from June 2013 to early 2018 were examined. Drugs involved in the arrests were classified by Drug Enforcement Administration Schedule (I–V or non-controlled prescription) and categorized into five drug families: hallucinogens, opioids, sedatives, stimulants, and miscellaneous. Multiple drug arrest totals were compared to single drug arrest totals to create a multiple-to-single ratio (MSR) specific to each drug family and each drug. Chi-square was used to determine statistical significance through GraphPad’s 2x2 contingency tables. Results: Over three-fifths (63.8%) of all arrests involved a single drug. Opioids accounted for over half (53.5%) of single arrests, followed by stimulants (27.7%) and hallucinogens (7.7%). Similarly, nearly two-fifths (39.6%) of multiple arrests were opioids, followed by stimulants (30.8%) and miscellaneous (13.0%). Miscellaneous family drugs were recorded with the highest multiple-to-single ratio (1.51), followed by sedatives (1.09), stimulants (0.63), opioids (0.42), and hallucinogens (0.35). Carisoprodol (8.80), amitriptyline (6.34), and quetiapine (4.69) had the highest MSR values and therefore were the three most overrepresented drugs in polysubstance arrests. Conclusion: The abuse of opioids, both alone and in conjunction with another drug, deserves continued surveillance in public health. In addition, common prescription drugs with lesser-known misuse potential, especially carisoprodol, amitriptyline, and quetiapine, require more attention by medical providers for their ability to enhance the effects of other drugs or to compensate for undesired drug effects.