This Week in the ASAM Weekly
Both the RAND Corporation and SAMHSA recently released reports providing broad perspectives on addiction in America. At over 600 pages, “America’s Opioid Ecosystem” (RAND) is a comprehensive review of the dynamic systems and issues underlying not only America’s opioid crisis but the entire addiction ecosystem. The report from SAMHSA provides a more focused view on resilience by putting forth several policy recommendations that support recovery. Both examine how the health of America's addiction problem is tied to its social fabric.
Woven in this fabric is the fourth wave of America’s opioid crisis, which has gone through a temporal, demographic, and geographic spread characterized by stimulant-fentanyl co-use and deaths (Addiction). This is a challenge that we must rapidly adapt to; buprenorphine doses need to be higher than FDA recommendations in order to be effective against fentanyl (JAMA Network Open), pharmacy-based methadone treatment will need to be utilized as it is in other countries (Substance Abuse Treatment, Prevention, and Policy), and contingency management programs will need to spread from California to the rest of the country (Preventive Medicine).
There is no singular approach to addressing addiction in America. As Oregon has experienced, decriminalization or legalization without adequate treatment utilization pretty much leads to continued substance use, but it doesn’t mean decriminalization failed (USA Today). Addiction treatment was never meant to fix the social fabric of America, but we do need to fix the social fabric to treat addiction.
Thanks for reading,
Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM, Debra R. Newman, PA-C, MSPAS, MPH, Jack Woodside, MD, John A. Fromson, MD