Prevalence of comorbid substance use disorders among people with opioid use disorder: A systematic review & meta-analysis

Thomas Santo Jr; Natasa Gisev; Gabrielle Campbell; Samantha Colledge-Friday; Jack Wilson; Lucy Thi Tran; Michelle Lynch; Daniel Martino-Burke; Sophia Taylor; Louisa Degenhardt

doi:10.1016/j.drugpo.2024.104434

Prevalence of comorbid substance use disorders among people with opioid use disorder: A systematic review & meta-analysis

Int J Drug Policy. 2024 Apr 26:128:104434. doi: 10.1016/j.drugpo.2024.104434. Online ahead of print.

Affiliations

¹ National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia. Electronic address: t.santojr@unsw.edu.au.
² National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia.
³ National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia; School of Psychology, University of Queensland, St. Lucia, Queensland, Australia.
⁴ National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, New South Wales, Australia; National Drug Research Institute, Curtin University, Melbourne, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Australia.
⁵ Matilda Centre, The University of the Sydney, Sydney, Australia.

PMID: 38677160
DOI: 10.1016/j.drugpo.2024.104434

Abstract

Background: Comorbid substance use disorders (SUDs) among people with opioid use disorder (OUD) contribute to poor clinical outcomes, including overdose and mortality. We present the first systematic review and meta-analysis to estimate the prevalence of specific non-opioid SUDs among people with OUD.

Methods: We searched Embase, PsycINFO, and MEDLINE from 1990 to 2022 for studies that used Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria to assess the prevalence of non-opioid SUDs among individuals with OUD. We used random-effects meta-analyses with 95% Confidence Intervals (CIs) to pool current and lifetime prevalence estimates separately. Meta-regressions and stratified meta-analyses were used to examine differences in prevalence estimates by sample characteristics and methodological factors.

Results: Of the 36,971 publications identified, we included data from 194 studies and 77,212 participants with OUD. The prevalence of any comorbid SUD among people with OUD was 59.5% (95%CI 49.1-69.5%) for current non-opioid SUDs, with 72.0% (95%CI 52.5-87.9%) experiencing a comorbid SUD in their lifetime. Of the studies that examined current comorbid SUDs, cocaine use disorder (30.5%, 95%CI 23.0-38.7%) was most common, followed by alcohol (27.1%, 95%CI 24.4- 30.0%), cannabis (22.7%, 95%CI 19.0-26.6%), sedative (16.1%, 95%CI 13.1-19.3%), and methamphetamine (11.4%, 95%CI 6.8-17.1%) use disorders. Substantial heterogeneity (I²>90%) across estimates was observed. Substantial heterogeneity (I2>90%) was observed across estimates, with significant variations in prevalence identified across geographic locations, recruitment settings, and other study-level factors.

Conclusion: Findings from this study emphasize the importance of comorbid SUD treatment access for people with OUD. Our estimates can inform the provision of treatment and harm reduction strategies for people with OUD and specific subpopulations.

Keywords: Comorbidity; Meta-analysis; Opioid use disorder; Polysubstance use; Systematic review.

Publication types

Review