Individuals with opioid use disorders may be using other substances while seeking treatment for their opioid use disorder. Polysubstance use with alcohol, tobacco, marijuana, stimulants, and other drugs is common. Each practice or organization developing a MAT program should have patient-centered strategies to address polysubstance use and recurrence of use.
Treatment strategies should reflect the nature of addictive disorders and hold engagement in treatment and recovery support as the ultimate goals. While medications may help their opioid use disorder, patients may need additional treatment modalities to successfully treat addiction to other substances and to support recovery.
Often, the opioid misuse poses the greatest immediate threat to the patient’s life because of the risk of death from overdose. Therefore, providers should embrace a harm reduction approach that recognizes that maintaining engagement in treatment is best for the patient. Patients should not be abruptly tapered off medications against their wishes or as a punishment for continued substance use.
However, providers should not ignore continued use of opioids or other substances or feel compelled to continue prescribing if they are uncomfortable doing so. Ongoing use typically indicates a patient’s need for a higher level of treatment intensity or recovery support. Providers should address the patient’s substance use during medication management visits, use motivational interviewing techniques and other brief counseling strategies to address the issue, and, if needed, support the patient’s transition to a higher level of care.
Learn more about Prevention and Response to Recurrence of Use of illicit and prescription opioids.