News
The ASAM Weekly for September 23rd, 2025
This Week in the ASAM Weekly
Over 34 states have laws allowing the involuntary treatment of individuals with severe substance use disorders (SUDs), but in many of the states, these laws have not been enforced. In response, the president recently signed an executive order directing vigorous support of such statutes. Regardless of the intent, just “passing a law doesn’t create a system” (The New York Times).
In 2018, Massachusetts passed a law to pilot receipt of medications for opioid use disorder (MOUD) in jails and bolstered it with a collaborative network to oversee implementation and outcomes. In addition to improved receipt of MOUD, the results show how the pilot program reduced nonfatal and fatal overdose, deaths from any cause, and even re-incarceration (The New England Journal of Medicine). On the other hand, the Connecticut prison system seems to be struggling to keep drugs out, while trying to treat addictions from within, demonstrating how the prisons and the community are actually one connected system (CT Mirror).
Such examples show that there is no one system that can treat OUD, and unfortunately, there is no one law that creates all the systems needed to treat OUD. For example, directors at opioid treatment programs (OTP) acknowledge how difficult it is to hire and retain the staff needed to provide quality OUD treatment (Substance Use & Misuse). Further, individuals on opioid agonist medications who also have a psychiatric disorder often find it difficult to receive the comprehensive treatment they need (The American Journal on Addictions). Both are examples of how 20th-century systems struggle to solve 21st-century problems.
To truly build systems that adapt to 21st-century treatment needs, we have to update 20th-century laws (policies, regulations, etc). In the US, stimulants are the fastest-growing substance use category in overdose deaths, yet we don’t have any overdose reversal agents or FDA-approved medications for stimulant use disorder (MMWR). Contingency management (CM) is the most effective treatment available, but many barriers have prevented the wide-scale adoption of CM throughout the country. Now, a new study in The American Journal of Psychiatry might change all of that. It found that CM for stimulant use disorder can reduce all-cause mortality by up to 40%.
That's a big deal. In fact, it’s soooo big it deserves its own executive order. One that simply says:
“Contingency management saves lives.”
Thanks for reading,
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
ASAM’s Latest Benzodiazepine Tapering Tools
ASAM has expanded its benzodiazepine tapering resource suite to better support both clinicians and patients. New resources include:
- The clinical practice guideline, now published in JGIM
- Self-paced microlearning videos highlighting key takeaways
- A digital pocket guide for patients, families, and caregivers
- A visual infographic poster for patients
Lead Story
Contingency Management for Stimulant Use Disorder and Association With Mortality: A Cohort Study
The American Journal of Psychiatry
This national retrospective cohort study found that veterans with stimulant use disorder who received contingency management (CM) were 41% less likely to die in the year following treatment initiation relative to matched comparison subjects. These findings provide the strongest real-world evidence to date that CM is associated with reduced all-cause mortality, underscoring its potential as a life-saving intervention in routine care. Results support expanding access to CM across health care systems and public health settings.
Research and Science
Medications for Opioid Use Disorder in County Jails — Outcomes after Release
The New England Journal of Medicine
This is an observational study involving county jails participating in pilot programs to offer MOUD. Using linked state-level data, researchers analyzed outcomes for individuals with presumed OUD in these carceral settings who did or did not receive MOUD. Of 6,400 individuals in the study, 42.4% received MOUD in jail; among those treated with MOUD, 67.9% received buprenorphine, 25.7% received methadone, and 6.5% received extended-release naltrexone. Disparities existed in MOUD receipt in jail; participants in the MOUD group were more likely than those in the non-MOUD group to be White non-Hispanic (75.4% vs 58.1%). Treatment with MOUD while in jail was associated with higher initiation, engagement, and retention in community MOUD after release. Receipt of MOUD in jail was associated with lower postrelease risk of fatal overdose (aHR 0.48; 95% CI, 0.36 to 0.64), nonfatal overdose (aHR 0.76; 95% CI, 0.68 to 0.85), death from any cause (aHR 0.44; 95% CI, 0.35 to 0.56), and reincarceration (aHR 0.88; 95% CI, 0.81 to 0.94).
Use of stigmatizing language related to substance use disorders in media: A systematic review
Drug and Alcohol Dependence
This is a systematic review of peer-reviewed publications examining stigmatizing language within media channels. Thirteen studies were included, covering digital news, video-based, and social media. The use of stigmatizing language was frequent across these different media types, with common terms being “addict,” “abuse/abuser,” and “junkie.” Stigmatizing language was more prevalent in news media than in other types. Findings were less consistent regarding trends in stigmatizing language over time; while there were identified decreases in stigmatizing language this was not consistent across contexts.
The American Journal on Addictions
Substance use and mental health disorders commonly co-occur, and to better understand this overlap and treatment, researchers used longitudinal data of patients receiving MOUD to evaluate changes over time. Many patients had at least one mental health diagnosis other than SUD, with depression and anxiety being the most common. There was a small increase in the percentage of patients without a psychiatric diagnosis over the study period (36.7% vs 42.2%). Psychiatric treatment rates for the mental health comorbidity were very low at baseline (8%) and decreased by end of study period (3.6%). This study highlights the need for psychiatric and psychotherapeutic treatments for this population and potential of integrated care models.
Substance Use and Misuse
Researchers interviewed methadone treatment program directors to assess barriers and enablers of access to methadone treatment. Significant barriers identified include staffing and a need to invest in this workforce, eg, changing reimbursement structures for programs. Another barrier was decrease in patient demand—which the directors attribute to changes in drug supply and the perception that methadone may not work for fentanyl and xylazine—and a preference for alternative medications with fewer treatment requirements. They noted changes in relaxation with increased take homes have improved patient satisfaction. The directors recommended rapid titration of dosing at initiation, and that increased resources to address basic needs and social support would improve treatment and access.
Learn More
Drug and Alcohol Dependence
This study assessed the effects of binge drinking (BD) on brain function using EEG data. University students (n=52) were labeled binge drinkers (5 or more drinks in < 2 hours at least monthly) or controls (minimal alcohol use). The EEGs were recorded during a cognitive task requiring recognition of abstract figures presented briefly on a screen. BDs were studied during a hangover following an episode of BD and on a non-drinking day. During the hangover state BDs, compared to controls, showed reductions in EEG amplitudes corresponding to impairments in attention and memory processing. On non-drinking days BDs showed increases in EEG amplitudes corresponding to recruitment of additional neural resources suggesting a compensation for an underlying neural deficit. These results demonstrate acute neurocognitive deficits during a hangover and raise concern about cumulative long-term effects of BD.
The American Journal of Psychiatry
This review article examines data from both basic and clinical research to address a need for systematic reviews concerning the relevance of potential toxicity for the therapeutic use of ketamine. While there is evidence consistent with neurotoxic effects when ketamine is used in relatively high doses, these doses are higher than used in most clinical applications, and there was no clear evidence of neurotoxicity for doses in the clinical range.
Problematic Use of Buspirone and Tandospirone: A Scoping Review
Journal of Addiction Medicine
This review produced 9 experimental studies designed to assess the misuse liability of buspirone, comparing it to sedatives or placebo. Most of the participants in these experimental studies had a history of problematic alcohol or sedative use. The experimental studies showed buspirone to have little reinforcing effects and was described as producing tension, anxiety, and nervousness. Benzodiazepines were strongly preferred over buspirone. There were 4 case reports of problematic use. All 4 patients had a history of SUD, 2 had schizoaffective disorder, and 1 had schizophrenia. In one patient psychotic symptoms were exacerbated by buspirone. Two began use during incarceration, where buspirone misuse was reported to be widespread. Accounts in online forums confirm the prevalence of buspirone misuse in incarcerated populations.
In the News
Drug Overdose Deaths Involving Stimulants ― United States, January 2018–June 2024 🔓
Morbidity and Mortality Weekly Report
Los Angeles Times
Online Gambling Boom in Philippines Shows Risks to Poor Nations
Bloomberg
CT prison overdoses reflect need to keep drugs out, treat addiction 🔓
CT Mirror
Marijuana use linked to increased risk of type 2 diabetes 🔓
United Press International (UPI)
Enhanced Games athletes can dope to compete for US$1 million prizes. But at what cost to sport?🔓
The Conversation
Trump Wants States to Force More Drug Users Into Rehab: What to Know
The New York Times