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The ASAM Weekly for October 7th, 2025

Oct 8, 2025

This Week in the ASAM Weekly

It’s incredible to think how much has been published about the opioid crisis—in the news, in peer-reviewed publications, and everywhere else on the internet. Millions of words have been written and read by hundreds of thousands of people who can consume only a fraction of what’s out there. Yet somehow from all of this we’ve formed a language for an epidemic.

“Medication-based recovery” is an evolution of terms that serves as a foundation for three new stages in the cascade of care model: protection, remission, and recovery. As Drs. McLellan and Volkow explain, this represents a new way to think about opioid use disorder (OUD) treatment and recovery, made possible by a highly effective medication (New England Journal of Medicine).

Low-threshold buprenorphine was conceptualized in response to stigma and treatment barriers. Based on the four principles of harm reduction, same-day starts, flexibility, and meeting patients where they are, its use is being adapted throughout communities, from syringe service programs to street medicine teams (Substance Use: Research and Treatment).

Safer Opioid Supply (SOS) programs were developed to reduce exposure to a dangerous drug supply, but for the individuals that they serve, SOS programs also provide stability, dignity, and hope (Harm Reduction Journal). In a similar way, mobile vans were rolled out to bring harm reduction into the community, but for many they are a lifeline to lifesaving care (Reason Foundation).

These are just a few examples among the many words, terms, and concepts that have formed the language of the opioid crisis. With such a vast lexicon, we need more resources to make sense of it all.

Introducing the recently updated Medications for Opioid Use Disorder Playbook from the Agency for Healthcare Research and Quality—it's like having a personal tour guide who’s fluent in the opioid crisis.

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

NEW! The ASAM Handbook of Addiction Medicine, 3rd Edition, is here!

Written for generalists, nurses, physician assistants, and other clinicians, the third edition offers concise, evidence-based guidance for the evaluation and management of substance use disorders. This fully updated edition provides clear, practical coverage of major drug classes, treatment modalities, and medical considerations, with an emphasis on patient-centered care. Each chapter concludes with review questions to reinforce key concepts and support clinical learning.

Lead Story

Medications for Opioid Use Disorder Playbook🔓

Agency for Healthcare Research and Quality (AHRQ)

The AHRQ Integration Academy developed the Medications for Opioid Use Disorder Playbook as a practical guide for providing medications for opioid use disorder (MOUD) and immediate care for patients with OUD in primary care and other ambulatory care settings. It is interactive, web-based, and has the latest guidance, tools, resources, and examples that address key aspects of MOUD implementation. The MOUD Quick Start Guide covers the essentials of low-threshold care, while the balance of the Playbook offers more in-depth resources and guidance for those practices interested in working toward more comprehensive, whole-person care. The low-threshold approach ensures immediate access to MOUD, eliminating barriers for both patients and providers.

Research and Science

Environmental, Psychiatric, and Genetic Predictors of Alcohol Use Disorder Criterion Count: Analyses of African and European Ancestries

The American Journal of Psychiatry

Quantifying the contribution of environmental and genetic factors to alcohol use disorder (AUD) criterion count across different ancestries may provide insight into the biopsychosocial etiology of AUD. Although polygenic risk prediction represents an important future application, its utility may be enhanced when considered in the context of environmental predictors. The authors used large African- and European-ancestry samples to examine how genetic, psychiatric, and environmental factors predict AUD criterion count. In both African and European ancestry groups, environmental factors explained the majority of the variance in AUD criterion count, but polygenic risk was also a statistically significant predictor. These findings may help inform clinical, research, and policy efforts to mitigate AUD risk.

Low-Threshold Buprenorphine in Non-Traditional Settings: A Scoping Review 🔓

Substance Use: Research and Treatment

This is a scoping review of low-threshold buprenorphine programs in non-clinical settings, including key components of delivery models, implementation barriers and facilitators, and outcomes. Of the articles identified, 41 met inclusion criteria and were grouped into the following common low-threshold program models: syringe service programs, mobile units, community centers, and street medicine models of care. Community partnerships were a key facilitator across programs, and funding was identified as a common barrier. Programs varied widely in reported outcomes—particularly how retention in treatment is defined. Further research is needed to determine which outcomes are of most importance, and especially which outcomes are most important to people who use drugs and who utilize program services.

Creation of a telehealth addiction consultation service at a rural hospital: a case study 🔓

Addiction Science and Clinical Practice

In this case report, the authors describe their experience with telehealth consultation services in rural Massachusetts. Due to a low volume of addiction treatment services in the area, the authors developed a program where outpatient addiction medicine experts provided consultation to the staff at the rural hospital. For eight months, the experts provided 36 consults, assisting with diagnosis, inpatient management, and initiation of MOUD. In addition, experts provided training to hospital staff on harm reduction strategies and reducing stigma. Future plans include providing telehealth patient consultation that is billable and could sustain the program. 

Food addiction and personality traits: A three-levels meta-analysis of correlational studies

Eating Behaviors

Researchers conducted a systematic review and meta-analyses to investigate any association between personality traits and food addiction using different models. In the first model they found positive association with harm avoidance and negative association with cooperativeness and self-directedness. Interestingly, researchers did not find an association with reward dependence. In additional models results showed an association with urgency, impulsivity, lack of perseverance, and lack of premeditation. While some of these associations are similar to personality traits associated with other substance use disorders there were some differences, notably the association with harm avoidance. 

Learn More

Goals for Opioid Use Disorder Medications — Protection, Remission, and Recovery

The New England Journal of Medicine 

Various providers of treatment for OUD have different goals. Some provide MOUD for protection from overdose and other harms while others pursue a goal of abstinence without the use of medications. The authors propose a cascade of care model that includes this range of goals. In the first stage—protection—MOUD provides immediate protection from overdose and other harms. The next stage—remission from OUD—involves reduction in OUD symptoms and can include MOUD, behavioral therapy, and AA/NA attendance. The final stage— recovery from all SUDs—involves sustained reduction in all SUD symptoms. This final stage includes significant, sustained reduction in the misuse of all substances, improvement in physical health, and improvement in social functioning. Rather than discharging patients for failure to progress towards recovery, providers would encourage patients to progress towards remission and recovery.

‘I won’t make it without this program’: the impact of safer opioid supply program closures in Ontario 🔓

Harm Reduction Journal

This is a qualitative study of semi-structured interviews with 25 people who use drugs and were enrolled in six safer opioid supply (SOS) programs in Ontario, Canada. SOS programs, combined within community health centers and wraparound care, offer medical-grade opioids and other substances under a prescribing model to provide an alternative to the unregulated drug supply. Interviews focused on participants’ experiences with SOS programs and the impact of program closures in light of Ontario’s August 2024 restrictions on harm reduction initiatives. Overall, participants felt the SOS programs decreased their overdose risk, connected them to wraparound services, and reduced their reliance on the unregulated drug supply. Participants felt significant uncertainty and anxiety around SOS program closure, particularly as related to concerns that they would need to then return to the increasingly dangerous unregulated drug supply and lose access to important health and social services.

Ketamine-Associated Uropathy During Therapeutic and Nontherapeutic Use: Prevalence, Clinical Features, Mechanisms, and Strategies for Risk Reduction 🔓

The Journal of Clinical Psychiatry

Ketamine misuse has been associated with uropathy with symptoms of urgency, frequency, dysuria, hematuria, and incontinence. In one study this occurred with high-dose (>1g/day) and long-duration (median, 35 months) use. Only about half of users reported reduction in symptoms after stopping ketamine. Exposure of bladder epithelial cells to ketamine and its metabolites causes inflammation and cell death, resulting in bladder ulceration and fibrosis. Urologic symptoms have been reported in patients receiving ketamine to treat psychiatric conditions. Ketamine’s therapeutic effects are temporary and maintenance treatment of up to six years has been described. The authors advise patients to hydrate well and void frequently on days ketamine is administered. Patients should be monitored for symptoms of uropathy and urine tested for blood, protein, and cells.

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