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Polysubstance Use
Using more than one thing at a time

"If our response to this crisis is just about opioids, we are missing a massive moment to actually be set up to deal with subsequent epidemics - much less actually understand what's going on now."

- Dr. Mishka Terplan


Our bodies are amazing. They are engaged in constant, complex chemical conversations and interactions. Everything we do, feel, absorb, or ingest affects these chemical reactions - and shapes how we feel.

By nature, most people are polysubstance users.


We probably take more than one medication.

We might drink coffee and use benzodiazepines.

We may use alcohol and we smoke cigarettes.

We use cannabis and take dietary supplements.

We drink grapefruit juice at breakfast when we take our medications. 

We use opioids and take prenatal vitamins. 

Because of this it's important for us to know how the substances we use interact.


When we combine substances we may:

  • reduce their benefits

  • amplify their effects

  • put our lives in danger

Avoid Dangerous Combinations
If you use these substances together you are at danger of overdosing or drug poisoning.
We care about your health and wellbeing.         Please don't combine these substances.
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NOTE:  If you are using more than one of these medications at the same time you can work closely with your prescriber to maximize the positive therapeutic benefits of these drug combinations while being careful to minimize the risks of taking them together.
Types of Drug Interactions and Effects

Synergistic interactions occur when the combined effect of two substances is greater than the sum of each substance's individual effects.

Antagonist interactions are interactions between two or more drugs that have opposite effects on the body. Drug antagonism may block or reduce the effectiveness of one or more of the drugs.

Agonists are substance that bind to a receptor and activate the receptor to produce a biological response. Whereas an antagonist blocks the action of the agonist, an agonist causes an action. An inverse agonist causes an action opposite to that of the agonist.

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NOTE: Stimulants include nicotine, amphetamines (including Adderall),  methamphatamines, and methylphenidate (Ritalin and Concerta).

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NOTE: If you are using more than one of these medications at the same time you can work closely with your prescriber to maximize the positive therapeutic benefits of these drug combinations while being careful to minimize the risks of taking them together.

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What Happens When You Mix Drugs?

Which of the following is risky behavior: a person taking cholesterol medicine with grapefruit juice? Or a person taking Acetaminophen before going out for drinks? Or a person on blood thinners who takes an aspirin? Turns out, all of them are risky. Each has inadvertently created a drug interaction that could lead to serious complications. Céline Valéry describes the dangers of mixing substances.

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Cochrane Library "Cochrane summarizes the findings so people making important decisions – you, your doctor, the people who write medical guidelines – can use unbiased information to make difficult choices without having to first read every study out there..."

MotherToBaby "MotherToBaby, a service of the non-profit Organization of Teratology Information Specialists, is dedicated to providing evidence-based information to mothers, health care professionals, and the general public about medications and other exposures during pregnancy and while breastfeeding. Talk directly to the experts behind the most up-to-date research!" Call 866-626-6847 or text 855-999-3525

Drugs and Lactation Database (LactMed) The LactMed® database contains information on drugs and other chemicals to which breastfeeding mothers may be exposed. It includes information on the levels of such substances in breast milk and infant blood, and the possible adverse effects in the nursing infant. Suggested therapeutic alternatives to those drugs are provided, where appropriate. All data are derived from the scientific literature and fully referenced. A peer review panel reviews the data to assure scientific validity and currency.

UpToDate UpToDate® is a subscription-based resource designed to provide physicians access to current clinical information. It addresses specific clinical issues in the form of topic reviews.  According to UpToDate,  it “is designed to get physicians the concise, practical answers they need when they need them most—at the point of care.” Topic reviews are written by physician experts who review the literature then synthesize the information into specific recommendations for diagnosis, management, and therapy.

UpToDate® also provides patient education materials and information. Topics cover the most common medical conditions and procedures and provide information that can answer basic medical questions, helping patients make informed decisions.

  • The Basics: These topics are 1-3 pages in length and are written in simple language. They answer the four or five most important questions a person might have about a medical problem. The Basics topics are best for readers who want a general overview.

  • Beyond the Basics: These topics are 5-10 pages long and are more detailed. Beyond the Basics topics are best for readers who want a lot of information and are comfortable with some technical medical terms.

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