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The ASAM Weekly for March 10, 2026
This Week in the ASAM Weekly
The total consumption model (TCM) is a theory proposing that the prevalence of problematic behavior follows closely with that of population-level behavior, driven by social network effects and exogenous influences. This model of collectivity has been demonstrated in alcohol consumption, gambling, and now adolescent cannabis use (Addiction), which helps explain why more adolescents are showing up to hospitals with cannabis intoxication—because more people are using cannabis (WTOP).
Fundamental to TCM is that social influences shape individual behavior. We’ve seen this on a global scale with social media and it too seems that the more people use it, the more individuals have problems because of it (Spectrum News). No wonder adolescent social media use has also become a problem of growing concern.
But social influences can also encourage more positive behavior. Messaging about the harms of injection drug use may be responsible for increasing preference towards smoking (whether or not it’s protective), but for racially marginalized populations, preference towards smoking might also be about stigma (Preventive Medicine). Overdose prevention centers (OPC) help reduce the harmful behaviors of drug use but are also challenged by exogenous influences: city zoning, local economies, and community perceptions (JAMA Network Open).
Community perceptions about prevalence are an important part of population-level behavior. As the city of Los Angeles welcomes more recovery housing, neighbors are raising concerns about clustering within neighborhoods, bringing noise, traffic, and other nuisances (Santa Monica Daily Press). But if the problem is viewed through TCM, the leaders are trying to reduce density (prevalence) through zoning in order to minimize the negative effects of clustering (problematic behavior).
Sometimes, those attempts at reducing problematic behavior can go too far. There is growing interest in the use of involuntary treatment to address the co-epidemics of homelessness and addiction. The problem with involuntary treatment is that it often doesn’t work, and it can be harmful and costly. If TCM were applied in this case, then leaders would be better off reducing the population-level prevalence of both addiction and homelessness—rather than focusing on the most problematic behavior prevalence—if they truly wanted to reduce the problematic behaviors associated with homelessness and addiction (The Conversation).
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), Agency for Healthcare Research and Quality (AHRQ), and the Food and Drug Administration (FDA). 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.
PROVIDE INPUTIf you have any questions, please email Radhika Sagar, OTR/L, MOT, Clinical Algorithm Analyst, at [email protected]. Thank you!
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Does the total consumption model apply to cannabis use? 🔓
Addiction
This repeated cross-sectional study based on annual surveys tested whether the total consumption model and its extension, the theory of collectivity, apply to adolescent cannabis use in Sweden. Frequency of cannabis use was measured by a question on how many occasions the respondent has used hashish or marijuana. The seven response alternatives ranged from 0 to 50 times or more. Increases in mean frequency use were associated with a higher prevalence of high-frequency users. Adolescent cannabis use in Sweden appears to conform to key predictions of the total consumption model and its extension, the theory of collectivity.
Research and Science
Overdose Prevention Centers and Neighborhood Commercial Activity in New York City 🔓
JAMA Network Open
Only three publicly recognized overdose prevention centers (OPCs) currently operate in the US: two in New York City which opened in November 2021 and one in Providence, Rhode Island, which opened in January 2025. One of the concerns often raised about OPCs is potential for negative impacts on local businesses in the surrounding neighborhoods. This study used neighborhood-level foot traffic and consumer spending to evaluate the economic impact of the opening of two OPCs in New York City, one in East Harlem and one in Washington Heights. Researchers examined anonymized mobility and consumer spending data from SafeGraph (a geolocation analytics firm) to compare observed post-OPC implementation outcomes with comparable areas in NYC from June 2021 to June 2022. The opening of the OPCs had no statistically significant impact on either consumer spending or neighborhood foot traffic, suggesting that the OPCs had no meaningful impact on neighborhood commerce or local businesses.
Opioid Agonist Therapy for Fentanyl–Related Opioid Use Disorder: A Systematic Review 🔓
Journal of Addiction Medicine
The high potency of fentanyl has required novel induction strategies around the use of medications for opioid use disorder (MOUD) for patient comfort and to avoid precipitated opioid withdrawal (POW). This literature review included 180 studies of MOUD induction. One study of standard dose induction (2–4 mg bup-sl) found 22% of patients had severe POW. Low or microdose bup-sl (eg, 0.5 mg with gradual dose increase over several days) had 34%–60% success, 2% POW, and 86% 30-day retention. With high or macrodose bup-sl (eg, 8 mg, repeated hourly), one study (average dose of 35 mg/day) reported no POW and 58% retention at 3 months. Studies described accelerated methadone inductions rapidly reaching doses over 100 mg/day. Inpatient inductions allow close monitoring during rapid dose increases. The authors emphasized the poor overall quality of these studies; only 17/180 were RCTs and many lacked comparison groups.
Route of drug use among North Carolina drug overdose decedents, 2018–2023
Preventive Medicine
Information about overdose deaths between 2018 and 2023 was obtained from the North Carolina Unintentional Drug Overdose Reporting System (n=19,520). Overdose deaths increased from 2,046 in 2018 to 4,252 in 2023. Most deaths (88%) involved opioids (76% fentanyl), followed by stimulants (61%), benzodiazepines (21%), and anticonvulsants (17%). Deaths involving multiple drugs appear in more than one category. The route of drug use was recorded in 46% of deaths with injection (25%) the most common followed by snorting (14%), smoking (12%), and ingestion (4%). The route of drug use changed during the study period: injection decreased (37% to 18%), snorting increased (6% to 18%), smoking increased (4% to 18%), and ingestion increased (2% to 5%). At the end of the study period the percentage of deaths due to injection, snorting, and smoking were similar, despite the common belief that snorting and smoking are safer.
Drug and Alcohol Dependence
Prior authorization (PA) requirements often cause delays and/or barriers to medication access. To address this, many states have removed PA requirements for transmucosal buprenorphine. This study seeks to quantify the impact of the removal of PA requirements on transmucosal buprenorphine dispensing in Kentucky. To do so, the study analyzed Kentucky Medicaid claims from January 2016 to June 2023 for enrollees with OUD to assess changes in buprenorphine receipt for OUD treatment after removal of PA requirements in February 2019. There was a significant immediate increase of 4 per 100 enrollees who received buprenorphine after the removal of PA requirements, which then continued at a slower growth rate.
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MDM Policy and Practice
Alcohol contributes to significant morbidity and mortality, often over a lifetime, but there is limited data on long-term alcohol use trajectories based on use patterns in adolescents. Researchers utilized Bayesian simulation to calculate age- and sex-specific transition probabilities between 4 drinking risk levels, abstinence, and alcohol dependence from 12 to 65 years of age. Overall, high- and very high-risk use had greater risks of transitioning to dependence, while low-risk states more often transitioned to abstinence. Authors noted that while additional research is needed to incorporate other demographic factors, these transition probabilities can be used in decision analysis to better inform policymakers about the long-term effects and cost-effectiveness of early adolescent interventions.
Journal of Psychopharmacology
This retrospective descriptive analysis of national surveillance data from the French Addictovigilance Network examined ketamine trends in France from 2019 to 2023. It found a marked increase in ketamine-related complications, particularly among young users. Severe urinary and biliary complications, alongside rising reports of ketamine use disorder, highlight an urgent need for awareness among clinicians, systematic screening, and targeted harm reduction and clinical screening strategies.
Substance Use and Misuse
Chemsex, the use of substances specifically to enhance sexual stimulation and for increased euphoric effects during sex, is a significant risk factor for HIV among men who have sex with men (MSM). Researchers sought to better understand this relationship and the impact of pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART). Researchers found the majority of chemsex encounters involved methamphetamines and were associated with compulsive sexual behavior and engagement in condomless sex. However, the association with condomless sex was only among those not currently using PrEP/ART. The researchers noted that chemsex was not associated with decreased concerns about sexually transmitted infections. The authors note interventions need to address both the substance use and connecting this population to PrEP/ART.
In the News
- Addiction recovery has exploded across L.A, now City Hall wants spacing rules Santa Monica Daily Press
- It's not too late to regulate kratom Santa Fe New Mexican
- What the science says about social media addiction in minors 🔓 Spectrum News
- Cannabis is becoming more legal — unless you’re pregnant STAT
- What decades of research reveal about involuntary substance use treatment – and why evidence points elsewhere 🔓 The Conversation
- Children’s National Hospital sees more cannabis addiction among teens and tweens 🔓 WTOP
- Caregiving For Someone With a Substance Abuse Problem 🔓 AARP