<figure class="wp-block-image size-full"><figcaption class="wp-element-caption">Two at-home drug testing kits. Analysis of drug testing over the last decade shows people in the US are increasingly abusing more than one substance at a time. (Matt Faubion/AKPM)</figcaption></figure>



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Sage, an 18-year-old in Anchorage, talked about his substance abuse recently at a community event hosted by Volunteers of America Alaska. We’re not using Sage’s last name to protect his privacy. He said he started smoking weed in sixth grade. 

“I ended up smoking weed that was laced with either fentanyl or heroin, because I suddenly felt very heavy and nauseous, and I started to feel very itchy, and had a really weird taste in my mouth,” Sage said. 

He recalled other times he took combinations of drugs or times he didn’t know exactly what he was taking. 

“I was on Adderall, meth, weed, Xanax, and alcohol and nicotine,” Sage said. “That was one of the worst nights of my life.”

According to Katie Schneider, a physician assistant who runs Southcentral Foundation’s detox center, Sage’s experience is pretty typical of substance abuse today. She’s seen the ways Alaskans use drugs change over her twenty years in the field, and when she first started, she said people mainly used single substances.

“Over the last couple of years, we’ve really seen a huge change in how many people are using large amounts, frequently, of substances together,” Schneider said. 

Experts say Alaskans are combining substances more often, called “polysubstance abuse,” and becoming dependent on more than one drug. According to data from drug testing labs, last year 93% of samples positive for fentanyl were positive for at least one other drug. 

Over the past decade, the number of fentanyl users combining the drug with stimulants like methamphetamine and cocaine rose from about 40% to over 90%. Opioids and stimulants are a particularly risky combination and the rise in that combination is what some in the field call the fourth wave of the opioid epidemic.

Schneider said, like Sage, many people in Alaska don’t know exactly what’s in the substances they’re abusing. Fewer people can access prescription pain pills on the black market, and more are taking pills made in small illegal labs without knowing the ingredients. 

At the detox center, Schneider focuses on helping people through the first days and weeks of sobriety and she said this work is much harder when people are dependent on more than one substance. 

“It makes withdrawal management more complicated,” Schneider said. “It makes medication assisted treatment a lot more difficult, and I think it just complicates things for people in general.”

She said people in addiction treatment have more trouble identifying their triggers when they’ve been using multiple substances. Certain combinations of drugs, such as opiates and benzodiazepines like Xanax, Schneider said, increase risk of overdose. 

“And when you see alcohol combined with any of these other things that can lower your central nervous system, all of those things combined can decrease your ability to breathe, which can cause you to die,” Schneider said. 

About sixty percent of overdoses last year in Alaska were from two or more drugs and nationally, polysubstance abuse is one of the key drivers in the rise in opioid-related deaths.

The Department of Corrections in Alaska is the biggest behavioral healthcare provider in the state. Adam Rutherford, director of the department’s division of health and rehabilitation services, said he’s seen a rise in people using multiple substances. Alaska’s geography makes drug trafficking harder, so he said many Alaskans consume whatever drugs are available because the choices are so limited. 

“You’ll know when there’s influxes of substances that are coming in, because if there’s a big introduction of heroin into our system, all of a sudden, everyone’s using heroin, along with things,” Rutherford said. “Or if there’s a meth introduction, there’s that switch.” 

And nationwide, fentanyl is being added to more drugs, like methamphetamine and even heroin because it’s cheap, relatively easy to make, potent, and is easier to traffick. 

But despite the increased complexity of addiction to multiple substances, physician assistant Schneider said recovery is within reach. She said if people are facing polysubstance addictions, it’s safest to get professional help in an inpatient detox facility. 

“It doesn’t mean that we cannot treat it, or that it’s going to be miserable,” Schneider said. “It’s just, sometimes I’ve heard people say things like ‘kick it on the couch’ for certain withdrawals, and when you’re using, especially, multiple substances, get the help of a medical professional. Make sure there’s somebody who knows about withdrawal that’s giving you advice and monitoring you, because it can be more complicated. And it could actually hurt you, and we don’t want that to happen.”

18-year-old Sage, who shared his story of substance abuse with peers, got professional help. 

“Currently, I am completely sober, and I actually just got a job today,” Sage said. 

The audience of peers and adults erupted into applause. 

He said he hopes young people stay away from drugs completely. But if they don’t, he suggests testing drugs with reagent kits that are easy to order online. That way, people can know exactly what they’re taking.  

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