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Examination of multiple drug arrests reported to the Maine Diversion Alert Program



Much of the responsibility for the increasing drug overdoses in the US has been attributed to opioids but most opioid overdoses also involve another drug. The objective of this study was to identify the drugs involved in polysubstance arrests. The substances that were more likely to be found in conjunction with other substances, using the drug arrests reported to Maine’s Diversion Alert Program (DAP) were examined.


Single and multiple drug arrests were quantified (N = 9,216). Multiple drug arrest percentages were compared to single drug arrest percentages to create a Multiple-to-Single Ratio (MSR) specific to each drug family and each drug to identify over (MSR > 1) and under-representation (MSR < 1).


Over three-fifths (63.8%) of all arrests involved a single drug. Opioids accounted for over-half (53.5%) of single arrests, followed by stimulants (27.7%) and hallucinogens (7.7%). Similarly, nearly two-fifths (39.6%) of multiple arrests were for opioids, followed by stimulants (30.8%) and miscellaneous (13.0%). Miscellaneous psychoactive prescription substances (e.g. clonidine, gabapentin, cyclobenzaprine, hydroxyzine) had the highest (1.51) MSR of any drug family. Conversely, stimulants (0.63), opioids (0.42), and hallucinogens (0.35) were significantly underrepresented in polysubstance arrests. Carisoprodol (8.80), amitriptyline (6.34), and quetiapine (4.69) had the highest MSR. Bath-salts (0.34), methamphetamine (0.44), and oxycodone (0.54) had the lowest MSR.


The misuse of opioids, both alone and in conjunction with another drug, deserves continued surveillance. In addition, common prescription drugs with less appreciated misuse potential, especially carisoprodol, amitriptyline, and quetiapine, require greater attention for their ability to enhance the effects of other drugs.

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This study was supported by the Fahs-Beck Fund for Research and Experimentation. The contributions of Kevin J. Simpson, MD, Matthew T. Moran, MD, and Dipam T. Shah, MD are gratefully acknowledged. Jove Graham, PhD provided valuable input regarding the data-analysis. BJP is supported by the Health Resources Services Administration (D34HP31025). Software was provided by NIEHS (T32 ES007060-31A1). The Diversion Alert’s Data Sharing and Use Agreement precludes sharing of arrest data.


Funders including the Fahs-Beck Fund for Research and Experimentation had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. Fahs-Beck Fund for Research and Experimentation, 2017–01, Brian J Piper, Health Resources and Services Administration, D34HP31025, Brian J Piper, National Institute of Environmental Health Sciences, T32 ES007060-31A1

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Authors and Affiliations



Maaz Siddiqui: Formal analysis, Investigation, Data curation, Writing—Original Draft, Writing—Review & Editing, Visualization. John P. Piserchio: Formal analysis, Investigation, Data curation, Writing—Original Draft, Writing—Review & Editing, Visualization. Misha Patel: Formal analysis, Investigation, Data curation, Writing—Original Draft, Writing—Review & Editing, Visualization. Jino Park: Formal analysis, Investigation, Data curation, Writing—Original Draft, Writing—Review & Editing, Visualization. Michelle L. Foster: Resources, Data curation, Writing—Original Draft, Writing—Review & Editing. Clare E. Desrosiers: Resources, Data curation, Writing—Original Draft, Writing—Review & Editing. John Herbert: Funding acquisition, Investigation, Data curation, Writing—Original Draft, Writing—Review & Editing. Stephanie D. Nichols: Writing—Original Draft, Writing—Review & Editing. Kenneth L. McCall: Methodology, Writing—Original Draft, Writing—Review & Editing, Brian J. Piper: Supervision, Conception, Visualization, Writing—Original Draft, Writing—Review & Editing.

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Correspondence to Brian J. Piper.

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Ethics approval

This investigation was performed in line with the principles of the Declaration of Helsinki. The Wright Center IRB of Scranton, Pennsylvania approved this study.

Conflict of interest

BJP is part of an osteoarthritis research team supported by Pfizer and Eli Lilly. SDN’s research is supported by Shire. This research was supported by the Fahs-Beck Fund for Research and Experimentation. Diversion Alert (MF, CED, JF) was supported by a grant from Eastern Maine Medical Center. The other authors have no disclosures.

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Siddiqui, M.Z., Piserchio, J.P., Patel, M. et al. Examination of multiple drug arrests reported to the Maine Diversion Alert Program. Forensic Sci Med Pathol 18, 133–140 (2022).

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  • Addiction
  • Drug misuse
  • Opioids
  • Stimulants