Use of sedative drugs among adults reporting illicit opioid use or prescription opioid use in the United States, 2017-2024.

INTRODUCTION: Co-use of opioids and sedatives significantly increases the risk of overdose. This study examined associations between person-level characteristics and persons who co-use different types of opioids (prescription and/or illicit opioids) and sedatives. METHODS: The study population included a large sample of adults aged ≥ 18 years assessed for substance use disorder treatment in the United States. Data were collected between January 2017 and June 2024 using the Addiction Severity Index-Multimedia Version instrument. Co-use was defined as reporting past 30-day use of both opioids and sedatives. Multivariable Poisson regressions were used to examine associations between person-level characteristics and co-use. RESULTS: The percentage of adults reporting sedative co-use was 17.5% among those using prescription opioids only (n = 36,978), 17.5% among those using illicit opioids only (n = 13,492), and 29.9% among those using both prescription and illicit opioid (n = 19,542). Being non-Hispanic White and having psychiatric conditions were associated with increased prevalence of co-use, regardless of opioid type. Adults assessed in the Northeast (adjusted prevalence ratios (aPRs)= 5.88 [95%CI= 4.49-7.97]), or Midwest (aPR=2.52 [95%CI=1.83-3.47]) versus the West were associated with an increased prevalence of co-use of illicit opioids only and sedatives but were not associated with co-use of prescription opioids only and sedatives. CONCLUSIONS: Findings provide new insights into co-use of opioids and sedatives and help inform prevention strategies. In addition to checking prescription drug monitoring programs and care coordination, potential opportunities for preventing co-use of illicit opioids and sedatives include disrupting the availability of illicit opioids and checking persons' substance use and overdose history.