Polysubstance use, the use of multiple substances either concurrently or simultaneously, is very common and continues to shape substance use patterns and overdose trends. This week's NDEWS Rapid Street Report presents data for cities we visited in 2026. The top three substances reported, excluding alcohol, were recreational marijuana (50.8%), psilocybin (13.2%), and medical marijuana (13.1%). Combinations of drug patterns involving five substances are presented from the anonymous survey, we found differing patterns for each. We will continue to analyze the data moving for polysubstance use patterns.

Additionally, this briefing features publications that have examined topics including polysubstance use across the lifespan, substance use initiation and later substance-related outcomes, treatment approaches for stimulant-opioid co-use, and challenges associated with defining and measuring polysubstance use among adolescents.

As always, we welcome your input.

The Rapid Street Reporting (RSR) team visited eight cities across the United States from the beginning of 2026 up to now (August 14th, 2026), anonymously surveying 1,471 people. For less common substances, participants were asked, “The last time you used “[drug name]”, did you mix it with other drugs or use it in combination with other drugs?” The map below shows the cities included in the 2026 data collection. The accompanying graph summarizes the substances most commonly reported as having been used during the 12 months prior to the interview to demonstrate the prevalence of use overall.

Click here to read the full report.

Click here to learn more about NDEWS Rapid Street Reporting.

Image source: Journal of Addiction Medicine, Figure 1. (A) Unweighted prevalence of lifetime alcohol, cannabis, nicotine, and “other” substance use (i.e., all additional use categories collapsed) by chronological age and (B) split by sex. *Note: Age 17 has a smaller cell size (n = 375).

A recently published study in Drug and Alcohol Dependence by Sullivan et al. analyzed substance use patterns among 11,880 U.S. youth participating in the Adolescent Brain Cognitive Development (ABCD) Study and found that substance use increased steadily from late childhood through mid-adolescence, with 38% reporting lifetime use by age 16. Alcohol, cannabis, and nicotine were the most commonly used substances, with girls reporting higher rates than boys beginning in early adolescence. Nearly 15% of participants reported polysubstance use, most commonly nicotine and cannabis, highlighting evolving risk patterns as youth age.

Read the full study here.

Image source: Molecular Psychiatry, a Age- and sex-adjusted proportions of the number of different substances used in adults with substance use, by substance (ordered by proportion of using ≥4 substances). b Age- and sex-adjusted proportions of the number of substance use disorders (SUDs) among adults with a specific SUD, by SUD (ordered by proportion of having ≥3 SUDs). c Age- and sex-adjusted proportions of the number of moderate-severe SUDs in adults with a specific moderate-severe SUD, by moderate-severe SUD (ordered by proportion of having ≥3 moderate-severe SUDs). Figure footnote: Source: 2022-2023 National Surveys on Drug Use and Health data. Rx=prescription; Opioid misuse=Heroin, illegally made fentanyl (IMF) use, or Rx opioid misuse; S/T sedative or tranquilizer; § Past-month measure.

A recent publication in Molecular Psychiatry by Beth Han et al. found that polysubstance use disorders are common among US adults with substance use disorders, particularly among those with cocaine, methamphetamine, hallucinogen, and opioid use disorders. Data showed that initiation of substance use before age 18 was associated with substantially higher rates of polysubstance use disorders, while delaying initiation until age 21 or later was linked to markedly fewer substance use disorders and fewer moderate-to-severe substance use disorders. The authors conclude that prevention efforts aimed at delaying or preventing alcohol, cannabis, and nicotine use before age 21 may help reduce the long-term burden of polysubstance addiction and related harms.

Read the full study here.

Image source: Cambridge University Press, Psychological Medicine

A recent publication in Psychological Medicine by Fleury et al. argues that polysubstance use is increasingly the norm among adolescents who use substances, while research and clinical frameworks remain concentrated in single-substance models. The authors highlight challenges related to definitional inconsistencies, the timing and intent of co-use, and the continued dominance of single-substance research frameworks. The editorial argues for clearer definitions, inclusive research designs, and interdisciplinary approaches to improve the study and understanding of adolescent polysubstance use.

Read the full study here.

Image source: Journal of Addiction Medicine

A recent publication in Journal of Addiction Medicine by Jegede et al. found that contingency management improved abstinence outcomes among individuals with stimulant-opioid co-use. In a systematic review and meta-analysis of 26 randomized controlled trials involving 2,356 participants, contingency management significantly increased the longest duration of continuous abstinence from concurrent stimulant and opioid use and increased the likelihood of submitting stimulant-opioid–negative urine samples compared with control conditions. Overall treatment retention did not differ between groups, although subgroup analyses suggested improved retention among participants not receiving medication for opioid use disorder. The authors noted that none of the included trials reported fentanyl exposure and concluded that future research should examine contingency management effectiveness in the context of fentanyl-contaminated stimulant markets and evolving polysubstance use patterns.

Read the full study here.

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The NDEWS Weekly Briefing curates emerging data and findings from across the Early Warning Network, which includes three core components: our Scientific Advisory Group (SAG), comprised of national experts and federal partners; our Sentinel Site Directors (SSDs), who lead local surveillance in key geographic regions; and our Community-Based Health Experts, who provide on-the-ground insights from populations most impacted by drug trends. Together, these contributors generate timely, multidisciplinary and impactful information, ranging from peer-reviewed research findings to local surveillance data. These contributions inform public health and research communities.

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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:

     • NDEWS Special Reports using substance-related EMS data
     • NDEWS Rapid Street Reporting (RSR) survey data reports
     • NDEWS Web Monitoring Team Reddit Alerts
     • NDEWS Sentinel Site Reports
     • Previous issues of the NDEWS Weekly Briefings

The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.