This Week in the ASAM Weekly

Psychedelics are back in the news—this time with more positive vibes. RAND published a new report estimating that more than 10 million Americans microdosed psychedelics in the past year, with psilocybin by far being the most commonly used psychedelic (RAND). Not long after came an announcement for a first-of-its-kind 5-year NIDA-funded research initiative that will study the impact of psychedelic services delivered in Oregon communities (Oregon Health & Science Univeristy). Both are evidence of the public's shifting interest in the science of psychedelic medicine (Nature Medicine).

The science of social media is less clear but similarly driven by public interest. Juries in California will soon be asked to decide whether social media is addictive, even if it’s outside their skillset. We should instead be asking juries whether defining addiction is necessary to attribute harm (Nature). Many things in life can be harmful with or without addiction.

This has been the case, for example, with tobacco, prompting some governments to aggressively tax their way toward a tobacco-free culture. But if one looks at how this worked in Australia, one could argue that a smoke-free society invites the wrath of a black market—something New York may want to consider as they propose to aggressively tax nicotine pouches (CATO Institute). Maybe societies will have to accept that nicotine pouches are the lesser of two evils (International Journal of Drug Policy).

Such statements might be provocative but do get at the spirit of harm reduction. Many people who use fentanyl now tend to smoke rather than inject, and experts note this positive shift is likely contributing to a reduction in death, disease, and tax dollars spent (STAT). Prisons also need to confront “two evils” with drug addiction: urine drug tests can identify illicit drug use but more often they discourage inmates from seeking treatment (CalMatters). Both require a shift in how people feel about drug addiction. 

Such shifts are part of how we calibrate our response to addiction. Buprenorphine induction has gone through a number of phases: from in-office to low-dose, and even emergency department (ED) inductions, and now there’s growing interest with extended-release (ER) buprenorphine. A recent study found equivalent success between oral and ER inductions with low rates of precipitated withdrawals across multiple EDs with diverse populations (JAMA). This is positive news, but if you read the associated editorial, you might feel stuck in what could otherwise be an evidence-based vibe shift. 

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 

2026 Addiction Medicine Research Priorities

ASAM is requesting your input on which areas of addiction clinical practice are most in need of further research. This input will be shared with federal research agencies, including the National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), and Agency for Healthcare Research and Quality (AHRQ). We are also planning a listening session called "Bridging the Gap between Science and Clinical Practice" with federal research agency representatives at the ASAM 57th Annual Conference.

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Lead Story

Emergency Department–Initiated Buprenorphine for Opioid Use Disorder: A Randomized Clinical Trial

Journal of the American Medical Association

This multicenter randomized study examined if 7-day extended-release injectable buprenorphine compared with sublingual buprenorphine to improve treatment engagement at 7 days. It included 1,994 adult patients presenting to the emergency department with untreated opioid use disorder and a Clinical Opiate Withdrawal Scale (COWS) score of 4 or higher. In treatment at 7 days, 40.5% were in the extended-release group and 38.5% were in the sublingual buprenorphine group, demonstrating no significant difference between groups. The study concluded that a 7-day extended-release injectable preparation of buprenorphine does not improve treatment engagement.

Research and Science

Cannabis Use Among Individuals Treated with Medication for Opioid Use Disorder: Correlates, Patterns, and Motivations for Use

Substance Use and Addiction Journal

Researchers examined factors related to frequent cannabis use (≥3 days/week) among patients receiving medications for opioid use disorder (MOUD), including interviewing those with frequent use about motivations. Overall, 48% of patients in MOUD reported cannabis use and 27% reported frequent use. Patients with high-frequency use reported higher rates of anxiety, and in multivariate analysis employment and higher interoceptive awareness were associated with lower odds of frequent use. Only 15% of patients reported using cannabis purely recreationally and the other 85% reported using for symptom management or both. The most common reasons reported for use were stress, mood disorder, insomnia, and pain, but notably 52% did report wanting to reduce use. These findings highlight the need to better manage these symptoms among those receiving MOUD.  

Opioid Use Disorder Care Presentations After High-deductible Health Plan Enrollment

Journal of Addiction Medicine

Cost as a barrier can lead to delays in diagnosis and treatment for opioid use disorder (OUD), including medications for OUD (MOUD). Using commercial insurance claims, researchers compared members who remained on low-deductible health plans to ones who were switched to a high-deductible health plan (HDHP) by their employer to evaluate the potential impact on MOUD treatment. Researchers did not find any difference in time-to-first OUD-related office visit or buprenorphine prescription fills; however, they found a delay in time to OUD-related high-acuity visits (emergency department (ED)/hospital). While additional research is needed to better understand the reasons for and potential impact of delays in high-acuity visits, EDs and hospitals are important touch points for diagnosis and initiating MOUD. Delays in access to high-acuity visits could contribute to decreases in OUD treatment overall.  

Urban-rural disparities in oral nicotine pouch sales and flavors in the United States 🔓

International Journal of Drug Policy

Oral nicotine pouches (ONP) have become more popular in recent years in the US, particularly in rural areas. This study analyzed the 2021 NielsenIQ Retail Scanner Data to assess how ONP sales are associated with product attributes (flavor categories) and differences between rural and urban areas. During 2021, 40.8 million cans of ONP were sold in urban areas and 5.8 million cans were sold in rural areas; however, per capita sales were slightly higher in rural areas. In both areas, mint/menthol flavors were most popular. In areas where ONP cans were priced lower, per capita sales were higher. Urban areas were more responsive to price increases than rural areas. This study suggests that policies limiting flavors may moderate ONP sales, and that urban areas would be more responsive to excise taxes.

Learn More

The science of psychedelic medicine

Nature Medicine

This review article outlines the rapidly evolving state of psychedelics in medical use. The authors explore the proposed mechanisms of psychedelics, including acute desynchronization and subacute neuroplasticity, which allow for rewiring of the brain. The article summarizes current research in clinical applications, including for mood and anxiety disorders, addiction, pain, PTSD, and other psychiatric and neuropsychiatric conditions. While these research studies are promising, the article also highlights challenges in studying and expanding access to these treatment modalities. The authors argue that psychedelic therapy requires significant resource investment, as well as reassessment of drug policy and regulatory barriers to utilizing these therapies.

Medications for Alcohol Use Disorder Among Patients With Severe Alcohol-Related Liver Disease 🔓

JAMA Network Open

An estimated 17 million people in the US have alcohol-related liver disease (ALD) and ALD is the leading cause of liver transplant. This study looked at treatment with medications for alcohol use disorder (MAUD) of 1,309 patients with ALD referred for liver transplant. MAUD could be FDA-approved (naltrexone, acamprosate, disulfiram) off-label medications (gabapentin, baclofen, topiramate, et al). Only 36% of patients were receiving any MAUD. Over an average follow-up of 38 months, mortality decreased with the number of MAUDs used; 38% of those without MAUD died while those with 3 MAUDs had a 10% mortality. Longer duration of MAUD use was associated with improved survival, with 13% mortality for those using MAUD for more than 6 months. These results were despite the MAUD group having more severe ALD. The authors conclude there is need to improve AUD treatment for those with ALD and suggest combining hepatology and addiction services. 

Effects of physical exercise interventions on multidimensional health outcomes in patients with substance use disorders: a network meta-analysis 🔓

Frontiers in Psychiatry

This is a systematic review and meta-analysis of exercise in the treatment of substance use disorders (SUDs). The authors reviewed 33 randomized controlled trials with a total of 2,922 patients with SUDs that studied either aerobic exercise or mind-body exercise (such as yoga, tai chi, or gigong). They found that aerobic exercise primarily improved physiological health followed by substance use and sleep quality. Mind-body exercise primarily improved sleep quality with cognitive function and mental health ranking second and third. The authors reviewed research suggesting possible mechanisms such as aerobic exercise causing dopamine release in the nucleus accumbens and release of endorphins, while mind-body exercise increases parasympathetic tone, reducing cortisol and enhancing GABA neurotransmission. They conclude that aerobic and mind-body exercise produce distinct therapeutic benefits and suggest developing exercise prescriptions for SUDs. 
  

Potentiation of fentanyl-induced respiratory depression by alcohol is not fully reversed by naloxone 🔓

JCI Insight 

The high frequency of opioid overdose deaths often involves co-use of alcohol, which is reported in approximately 30% of fentanyl fatalities. Both substances depress respiratory function, and their combined effects can be lethal. This study investigated physiological parameters of respiratory-depressant effects of fentanyl when co-administered with alcohol and its sensitivity to naloxone reversal using whole-body plethysmography in male and female Long-Evans rats. The findings highlight physiological parameters of severe respiratory risks with fentanyl+alcohol co-use, which are inadequately reversed by naloxone, underscoring the need for targeted strategies to manage opioid+alcohol overdoses.

In the News

U.S. Psychedelic Use and Microdosing in 2025: Insights from a Probability-Based and Nationally Representative Survey 🔓

RAND

Latest fentanyl harm reduction move is smoking, not injecting

STAT

Alcohol’s Effects on the Body: What Does Drinking Do to Your Health?

The New York Times

Is social media addictive for teens? US courts wade into scientific debate

Nature

And So It Goes: The Cycle of Tobacco Tax Policy 🔓

CATO Institute

Why CA prison doctors want parole board to stop citing drug tests 🔓

CalMatters

OHSU-led research initiative examines supervised psilocybin 🔓

Oregon Health & Science University (OHSU) News