The Polysubstance Overdose-Death Crisis

John F Peppin,1 Robert B Raffa,2– 5 Michael E Schatman6,7 1Department of Internal Medicine, Marian University College of Osteopathic Medicine, Indianapolis, IN, USA; 2Temple University School of Pharmacy, Philadelphia, PA, USA; 3University of Arizona College of Pharmacy, Tucson, AZ, USA; 4Neumentum, Inc., Morristown, NJ, USA; 5Enalare Therapeutics, Naples, FL, USA; 6Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA; 7Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, USA Correspondence: Michael E Schatman Tel +1 425 647-4880 Email Michael.Schatman@tufts.edu In the late 1990s and early 2000s, it was recognized that an increasing number of people were dying from opioid overdose, and regulatory agencies, professional societies, and legislative bodies actively adopted and promulgated efforts to reduce the “epidemic”. Yet, despite multiple guidelines, legislative enactions (often draconian), and attempts at legal and financial-penalty remedies, death rates continue to climb. The literature is now replete with the terms “opioid-induced respiratory depression” and “opioid overdose death” to describe the cause of death in many of these cases. Unfortunately, this terminology is too simplistic and now woefully outdated. It understates the complexities of these deaths, and the fact that the majority of overdose deaths currently involve multiple substances – that is, it is now a polysubstance-overdose death crisis.