Polysubstance use in a Brazilian national sample: Correlates of co-use of alcohol and prescription drugs

Abstract

Background: Responses to problem substance use have largely focused on illicit drugs, but reports on rising prescription drug misuse worldwide raise questions about their combined use with alcohol and potential consequences. The current study assessed prevalence of alcohol in conjunction with nonmedical opioid and benzodiazepine use across a nationally representative sample of adults in Brazil. Methods: Cross-sectional data on prevalence were estimated from the 2015 Brazilian Household Survey on Substance Use. We estimated past month nonmedical use of benzodiazepines and alcohol and past month nonmedical use of opioids and alcohol among adults who reported any past-year alcohol use. Zero-inflated Poisson models assessed independent correlates of alcohol and nonmedical opioid use, and alcohol and nonmedical benzodiazepine use. Results: Among adults who reported past year alcohol use, 0.4% (N = 257,051) reported past month alcohol and non-medical benzodiazepine use, and 0.5% (N = 337,333) reported past month alcohol and non-medical opioid use. Factors independently associated with co-use of alcohol and benzodiazepines included having depression (adjusted prevalence ratio (aPR):4.61 (95%CI 1.76–12.08)), anxiety (aPR:4.21 (95%CI 1.59–11.16)) and tobacco use (aPR: 5.48 (95%CI 2.26–13.27)). Factors associated with past-month alcohol and opioid use included having experienced physical or a threat of violence (aPR: 4.59 (95%CI 1.89–11.14)), and tobacco use (aPR:2.81(95%CI:1.29–6.12)). Conclusions: Co-use of prescription drugs with alcohol remains relatively rare among Brazilians, but findings point to a unique profile of persons at risk. Results of this study are important in light of changing dynamics and international markets of prescription drugs and the need for more research on use of these substances on a global scale.

Keywords:

• Polysubstance
• Latin America
• prescription drugs
• alcohol

Acknowledgments

This study was funded by different Brazilian government agencies: The original data collection and survey design was funded by a contract with SENAD (in the context of the Federal decree 7.179, May 10, 2010). New analyses and interpretation of the data and manuscripts were supported by the FAPERJ “Health Network Program” grant (E26/010.002428/2019), profiting from its component: “analysis/reanalysis of Brazilian major databases on substance use,” coordinated by Dr. Bastos. Dr. Mota is a senior statistician of the FAPERJ network. Dr. Bastos and Dr. De Boni are CNPq career scientists. Dr. Cerdá was additionally supported by grant funding from NIH (R01DA045872-01A1 and R01DA046620 01A1, PI: Magdalena Cerdá). The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

NK drafted the manuscript; JM conducted the primary analyses; PLNS, MV, and NB carried out sampling design and planning of the survey; CC oversaw the execution of the survey, data collection and analysis; MC contributed to conceptualization of the manuscript and analysis; FIB was the principal investigator for the survey, oversaw data collection and analysis and contributed to the manuscript. All authors significantly revised and reviewed the manuscript and approved of the final version.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any agency of the Brazilian government.

Additional information

Funding

The present research was financially supported by Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Brazilian office of drug control (SENAD). Dr. Cerdá was additionally supported by grant funding from NIH (R01DA045872-01A1 and R01DA04662001A1, PI: Magdalena Cerdá).