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The ASAM Weekly for August 5th, 2025

Aug 6, 2025

This Week in the ASAM Weekly

Guest Editorial: Reconceptualizing Recovery: Findings from the National Survey on Drug Use and Health

by Emily Pasman, PhD, LMSW
With helpful feedback from Tess K. Drazdowski, PhD, Rebecca J. Evans-Polce, PhD, Ty S. Schepis, PhD, Curtiss W. Engstrom, MS, Vita V. McCabe, MD, and Sean Esteban McCabe, PhD.

Of the estimated 48.5 million Americans with a past-year substance use disorder (SUD), many will eventually seek recovery. Broadly, recovery is a process through which people with SUDs achieve long-term health and wellness. While various definitions of recovery have been proposed, most center around elements of SUD symptom reduction and improved functioning across life domains, rather than substance use cessation. In this way, recovery may involve complete abstinence, reduction or moderation of use to a non-problematic level, or substitution of one drug with another that is perceived to be less harmful.

Indeed, a large body of research shows abstinence is not necessary for positive outcomes. For example, data from Project MATCH indicate some people with alcohol use disorder can reduce their use and sustain nonhazardous levels of drinking for up to 10 years post-treatment. A systematic review of cannabis use among people receiving medications for opioid use disorder concluded cannabis use did not negatively impact treatment outcomes. Further, people tend to be more successful in treatment when they are able to set their own goals, and when their goals are in alignment with those of their providers.

Read the full editorial here.

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM; John A. Fromson, MD; Sarah Messmer, MD, FASAM; Jack Woodside, MD

Lead Story

Implementation Gaps in US Syringe Service Programs, 2022 🔓

JAMA

The authors of this study performed a cross-sectional analysis of the Syringe Services Programs in the US (SSPUS) dataset to determine implementation gaps. 613 syringe service programs (SSPs) included in the dataset were geocoded to county boundaries, which were then analyzed for urbanicity and SSP need (based on HCV mortality, HIV incidence, and drug overdose mortality). The study found that most high-need counties did not have an SSP: 81.2% of high HCV need counties, 69.5% of high HIV need counties, and 75.7% of high overdose need counties did not have an SSP. SSPs were more commonly located in urban counties than in suburban or rural counties. The study is limited in that not all SSPs are represented within the SSPUS database; however, it highlights important implementation gaps.

Research and Science

Modeling the impact of changing drug markets and structural determinants on HCV and/or HIV transmission among people who inject drugs in the United States: A rural and urban comparison 🔓

International Journal of Drug Policy

This study created an HCV and HIV transmission model calibrated to urban and rural area data (San Diego, CA, and Central/Northern Wisconsin). Fentanyl use was assumed to increase mortality and injection-related risk of HCV and HIV (based on San Diego data). HCV and HIV incidence were predicted using recent trends in fentanyl use, transition from injecting to smoking drugs, opiate agonist treatment, and incarceration in the mode compared to no trend changes. The model suggests that fentanyl use contributed to 18% of new HCV infections in Central/Northern Wisconsin and 34% of new HCV infections in San Diego, as well as 10% of new HIV infections in San Diego. The increased transmission risk from fentanyl use was partially mitigated by a shift from injecting to smoking drugs (in San Diego), increases in opiate agonist treatment (in both areas), and reductions in incarceration (in Wisconsin). Overall, fentanyl increased HCV in both urban and rural areas, highlighting the need for harm reduction initiatives.

Quetiapine: A Novel Additive to the Illicit Heroin Supply in Los Angeles

Journal of Addiction Medicine

Data from a drug checking service in Los Angeles showed that of 178 opioid samples, 52 contained heroin and 157 contained fentanyl. In addition, 25% of the 52 heroin samples also contained quetiapine (an atypical antipsychotic). None of the heroin-negative samples contained quetiapine. Of the quetiapine-positive heroin samples, 31% also contained fentanyl, whereas of the quetiapine-negative samples, 69% contained fentanyl. Clients believed the samples containing quetiapine were black tar heroin; they were unaware that the samples contained quetiapine. Two clients reported increased euphoria from the quetiapine samples, and one reported a pins and needles sensation. A drug checking service in North Carolina found quetiapine in samples from CA, MI, WI, and NC, indicating this may be a national trend.

Prenatal Cannabis Use and Neonatal Outcomes A Systematic Review and Meta-Analysis

JAMA Pediatrics

This updated systematic review and meta-analysis of 51 studies explored whether cannabis use in pregnancy is associated with neonatal outcomes. Prenatal cannabis use was associated with an increased odds of preterm birth, small for gestational age, low birth weight, and perinatal mortality. Using cannabis in pregnancy was associated with increased risk of adverse neonatal outcomes. Health care professionals should include these takeaways in their patient counseling, and increased public health measures are needed to raise awareness on the safety of use.

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“From Homelessness to Safety”: Short-Term Outcomes of Low-Threshold Shelter on Individuals Experiencing Substance Use Disorder and Unsheltered Homelessness

Substance Use and Addiction Journal

Over two-thirds of homeless individuals in the United States have an SUD. Early in the COVID pandemic, an encampment of homeless individuals developed in Boston. In response, the Boston Public Health Commission, City, and State established low-threshold shelters (LTS). These LTS utilize a harm reduction approach and, unlike traditional shelters, do not require abstinence or SUD treatment. Fifty residents of LTS were surveyed and reported significant improvements in quality of life, including personal hygiene, access to food, sleep quality, and security of belongings. Over two-thirds reported increased access to mental health and healthcare providers. Concerning substance use, 45% were engaged in SUD treatment, 71% reported decreased frequency of use, 86% were using MOUD, and 82% were confident an overdose would be reversed. LTS removed access barriers to people with homelessness and SUD, and improved both the quality of life and the SUD.

Priorities for addressing mental health conditions and substance use disorders in prisons in sub-Saharan Africa: expert consensus from a Delphi panel

The Lancet Psychiatry

People incarcerated in Africa are largely overlooked in global mental health research and guidelines. To address this gap, this study used the Delphi method, four rounds of surveys with 97 participants from 27 countries, to identify 38 key challenges in sub-Saharan African prisons. These surveys span ten themes, including care pathways, workforce shortages, gender-specific needs, acute conditions, policy reform, infrastructure, and re-entry support. These priorities offer a roadmap for improving mental health and substance use treatment and underscore the need for investment in healthcare and alternatives to incarceration.

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