News
The ASAM Weekly for April 7, 2026
This Week in the ASAM Weekly
Historically in the US, science did not drive our response to alcohol and drug use. For decades morality is what drove most Americans, followed by the government’s criminalizing approach. Only in recent years has public health led the charge, but still about one quarter of US adults don’t think addiction is a health condition (Journal of Addiction Medicine).
This could partly explain why only about one quarter of Americans with opioid use disorder are on life-saving medications—20+ years after buprenorphine was first approved. But as we’re learning in the fentanyl era, there are many other factors to consider about low uptake of medications for OUD, such as the ubiquity of fentanyl, lipophilicity, and especially the fear of precipitating withdrawal (Journal of General Internal Medicine).
Such factors have also forced us to be creative in some of the most challenging of situations. In Canada, our colleagues have trialed different forms of opioid medications when the limits of methadone have been reached (JAMA Network Open). Experts throughout the US are trying to keep up with the internet, which has become the cookbook for synthetic drugs (The New York Times). Even street medicine teams (and the like) are blazing trails with direct-to-inject protocols, leveraging the pragmatism of pharmacokinetics in some of the most challenging settings (Medscape Medical News).
It’s that combination of both art and science that has always guided us toward more effective treatments. Right now, we are in the midst of what could be a therapeutic revolution with GLP-1s: all kinds of studies are finding benefits in addiction treatments (NIH). Maybe one day these meds will help with the challenges of buprenorphine inductions or the limits of methadone treatment.
If and when that day comes, you’ll be sure to learn about it in the regularly updated MOUD Playbook from the Agency for Healthcare Research and Quality.
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!
Join the ASAM Criteria Task Group on Interoperable Data Standards
ASAM is seeking experts to serve on this Task Group, which will help define and recommend approaches for integrating interoperable data standards into ASAM tools and resources for substance use disorder (SUD) assessment and treatment planning.
Interested? Apply here to learn more.
Lead Story
Do US Adults View Drug and Alcohol Addiction as a Health Condition? 🔓
Journal of Addiction Medicine
Participants (n=5,250), part of Gallup’s random sample of US households, completed a web-based survey that explored their beliefs about addiction. Asked if addiction is a health condition, 77% of US adults agreed, 16% disagreed, and 6% didn’t know. Men were more likely to disagree (20%) than women (15%). Those who have struggled with addiction but not in recovery were more likely to disagree (22%) than those in recovery (13%) or with no personal addiction experience (16%). Those with less education and income were more likely to disagree. Those who disagreed that addiction is a health condition were less likely to believe it is treatable by doctors (OR=0.3), believe that medications are effective treatments (OR=0.4), or help friends or family with addiction (OR=0.5).
Call for Volunteers! ASAM is looking for volunteers to write mock clinical cases for patients in jail or prison, and those reentering the community. Contributors will be mentioned in The ASAM Criteria®, Fourth Ed., Volume 3: Correctional Settings and Community Reentry. Applications accepted until April 17, 2026. To learn more and apply click here.
Research and Science
Journal of General Internal Medicine
Researchers interviewed clinicians and people who use fentanyl (PWUF) to identify barriers to buprenorphine initiation in the context of fentanyl. Barriers identified included a fear of withdrawal, lack of standardized buprenorphine initiation, and cheap and easy access to fentanyl. Clinicians expressed concern that experiencing precipitated withdrawal would deter patients from using buprenorphine in the future, so they focused on preparing patients for its potential severity. PWUF wanted information on the likelihood of precipitating withdrawal. Lack of standardized initiation complicated clinicians’ decision-making, while PWUF often relied on non-clinician sources to guide how they initiated buprenorphine. Researchers found that compassionate and clear communication did facilitate initiation.
Journal of Addiction Medicine
This systematic review and meta-analysis of stimulant-induced psychosis (SIP) identified 77 studies that met inclusion criteria. Nine studies concerned therapeutic use of stimulants and 68 addressed nontherapeutic use (primarily methamphetamine). In therapeutic use the incidence of SIP was 0.6%, typically with prolonged treatment, and usually resolved after discontinuation. For nontherapeutic use the prevalence of SIP was 33%. Nontherapeutic use involved high doses and often administration intravenously or by smoking. Nontherapeutic SIP was more severe with persecutory delusions and hallucinations; most resolved within a month, 9% had symptoms lasting greater than one month, and there were reports of relapses and flashbacks. Despite the low incidence of SIP with therapeutic use, the authors were concerned given the widespread and increasing prescription of stimulants.
Slow-Release Oral Morphine vs Methadone for Opioid Use Disorder in the Fentanyl Era 🔓
JAMA Network Open
This comparative effectiveness study examined 4,059 person-trials of slow-release oral morphine (SROM) versus methadone for the treatment of OUD in British Columbia, Canada, from July 2017 to June 2024. Researchers utilized data from the Vancouver Coastal Health Authority, which is publicly funded and covers areas that have been significantly impacted by overdoses. During the study period, both SROM and methadone were prescribed by clinicians and dispensed via witnessed dosing at community pharmacies. The primary outcome was treatment discontinuation (defined as 7 or more days without medication) at 12 months, with secondary outcomes of treatment adherence (proportion of days covered over a 365-day window) and all-cause mortality. The intention-to-treat analysis had high rates of treatment discontinuation in both groups (99.3% for SROM and 97.9% for methadone). The median duration of treatment for methadone was 8 days versus 3 days for SROM. During the study period, 121 deaths occurred, with an overall mortality rate of 8.2% for the SROM group and 7% for the methadone group. About half of the deaths were opioid-related, and only 2 deaths occurred while participants were taking MOUD.
Frontiers in Psychiatry
Prior animal and human studies have shown some promise for GLP-1RAs for use in substance use disorder (SUD) treatment but have been limited in size, follow-up, and generalizability. Researchers used a nationally representative longitudinal health data set to conduct a case-control study and evaluate association between GLP-1RAs and incidence of alcohol use disorder (AUD), opioid use disorder (OUD), nicotine use disorder (NUD), cocaine use disorder (CUD), or any SUD. Researchers found GLP-1RAs were associated with lower odds of AUD (OR=0.26), OUD (OR=0.31), NUD (OR=0.32), CUD (OR=0.25), and any SUD (OR=0.25). While additional research is needed, including randomized controlled trials, the authors note these findings support the potential use of GLP-1RAs across multiple disorders.
Learn More
Nature Mental Health
This study tested a hypothesis that momentary craving and reinforcement learning influence each other during substance-related decision-making. Two substance-using groups with moderate to high addiction risk levels (alcohol drinkers and cannabis users; total n=132) performed a decision-making task in which they received a group-specific addictive cue or monetary outcomes and reported moment-to-moment subjective craving. Computational modeling revealed that momentary craving biased substance-specific learning rate in both groups, but in opposite directions. Expected values and outcomes jointly influenced elicited craving across groups and decision contexts. Regressions incorporating model-derived parameters best predicted alcohol, but not cannabis, addiction risk scores, supporting the selective utility of using these model-based parameters in making clinical predictions. Together, these findings provide a computational framework that accounts for the interaction between craving and maladaptive choices across addictive domains.
Predicting individual incubation of opioid craving by whole-brain functional connectivity
Proceedings of the National Academy of Sciences (PNAS)
Relapse driven by craving is a central challenge in treating opioid addiction. Using resting-state fMRI and connectome-based predictive modeling, this study identified a whole-brain connectivity pattern that predicted incubation of oxycodone craving after voluntary abstinence in rats. Connectivity changes during abstinence predicted the magnitude of incubation, measured by increased oxycodone seeking from early to late abstinence. The predictive connectome involved interactions among cortical, basal ganglia, insular, hippocampal, and sensorimotor systems. Pharmacological inactivation of the dorsomedial striatum modulated connectivity strength within this network, demonstrating a causal role of the connectome in incubation of craving. These findings identify a brain-wide marker of incubation of opioid craving and provide a translational framework for developing targeted interventions and monitoring therapeutic outcomes in opioid addiction treatment.
The Lancet Regional Health – Americas
RAPID HCV is a multicenter, open label randomized controlled trial which was conducted at five opioid treatment programs (OTPs) in the US and Canada between August 2021 and November 2023. Participants were randomized to either onsite OTP-delivered HCV testing and treatment with peer support (the RAPID HCV intervention) or referral to offsite specialist care. The primary outcome was HCV treatment initiation within 12 weeks, with secondary outcomes of time to HCV treatment, HCV treatment completion, and sustained virological response (SVR) measured 10–36 weeks after end of treatment. Participants (n=182) were randomized, with 122 eligible for treatment and included in study analysis. In the RAPID HCV arm, 89% initiated treatment compared to 21% in the referral arm. Participants in the RAPID HCV arm also had significantly sooner treatment initiation (average 20 days vs 168 days). Of those who initiated treatment, there were similar completion rates and SVR among both settings.
In the News
- Treating addiction 🔓 National Institutes of Health
- Lawsuit accuses sportsbooks of using addictive technology 🔓 ESPN
- A Secret History of Psychosis The New York Times
- Opinion | The $2 drug test sending nearly 30,000 innocent Americans to jail The Washington Post
- How the Internet Became the ‘Cookbook’ of the Drug Trade The New York Times
- USC Street Medicine: Unhoused, but Not Uncared for 🔓 Medscape Medical News
- The MOUD Playbook 🔓 Agency for Healthcare Research and Quality