Polysubstance use

Some ingredients such as caffeine, creatine and β-alanine are found in nearly all pre-workout blends, but each branded product is a "proprietary blend" with an average of 18 different ingredients, the exact composition and proportions of which can vary widely between different products.^[3][4] Additionally legal psychoactive substances occasionally used in these proprietary blends that are typically legal include 5-HTP, tyrosine, and yohimbine. Although these products are not banned, the Food and Drug Administration warns consumers to be cautious when consuming pre-workout.^[5]

Benzodiazepines can cause death when mixed with other CNS depressants such as opioids, alcohol, or barbiturates.^[6][7][8] Alcohol and cocaine (for example coca wine) increase cardiovascular toxicity.^[9] Opioids or cocaine taken with ecstasy or amphetamines also result in additional acute toxicity.^[10]

Within the general concept of multiple drug use, several specific meanings of the term must be considered. At one extreme is planned use, where the effects of more than one drug are taken for a desired effect. Another type is when other drugs are used to counteract the negative side effects of a different drug (e.g. depressants are used to counteract anxiety and restlessness from taking stimulants). On the other hand, the use of several substances in an intensive and chaotic way, simultaneously or consecutively, in many cases each drug substituting for another according to availability.^[10]

The phenomenon is the subject of established academic literature.^[11] A study among treatment admissions found that it is more common for younger people to report polysubstance use.^[12]