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The ASAM Weekly for May 5, 2026
This Week in the ASAM Weekly
Addiction care is often talked about as a continuum of care, and within this continuum, there is a cascade. This is demonstrated in the cascade of care for opioid use disorder (OUD), which follows metrics such as OUD prevalence, medication for OUD (MOUD) access, MOUD retention, negative outcomes, etc.
Policy plays an important role in this cascade. For example, the 2018 SUPPORT Act likely led to an expansion of MOUD access throughout the country, having a trickle-down effect on the cascade of care (JAMA Network Open). But policy itself does not provide care, and it is therefore dependent on other entities to actually provide care. This can be felt, for example, when the expectations of state Medicaid programs on addiction care are misaligned with how managed care plans actually implement those expectations (The Milbank Quarterly).
Policies, unfortunately, can also create gaps in care. For example, too many states still penalize prenatal drug use, deterring too many from receiving care and too many clinicians from providing it—leaving a gap big enough for drug overdoses to remain the leading cause of pregnancy-associated death (Drug and Alcohol Dependence). But when clinical and scientific experts work to fill those gaps, impressive things can result, like the progress made in treating neonatal opioid withdrawal (JAMA).
Sometimes, though, gaps in care can be so big, it’s better to just call them gaping holes. Methadone access in the US is one such gaping hole, and the Modernizing Opioid Treatment Access Act (MOTAA) could help fill it by saving lives (Journal of Addiction Medicine). But even when progress is made, cracks in care can reappear, and so we must be vigilant about protecting addiction care. For example, drug testing strips only cost $1 (The New York Times).
In the end, maintaining continuity in addiction care depends on many things, like bridging gaps, filling holes, and fixing cracks in different care cascades. But the goal is not to make addiction care continuous, it’s to make it seamless.
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
Lead Story
The Milbank Quarterly
Medicaid managed plan coverage for medications for alcohol use disorders (AUD) and opioid use disorder (OUD) varies across states but is generally lower in Republican-leaning states. Researchers conducted a national survey to evaluate if these differences in coverage were due to variation in state policy or variations in Medicaid managed plan alignment with state policy. Researchers found that while Republican-leaning states were generally a little less likely to require coverage of most or all medications for AUD and OUD and place limits on prior authorization, managed plans in Republican-leaning states were much less likely to follow state requirements. Given these findings, efforts to increase access to medications for AUD and OUD will need to address misalignment between managed care plans and state policy, and not just focus on making changes to state policy.
Research and Science
Cascade of Care for Opioid Use Disorder Among Medicaid Beneficiaries 🔓
JAMA Network Open
This is a cross-sectional study of 126,430,422 Medicaid beneficiary-year observations from 2019 to 2023 that aimed to identify trends in OUD diagnosis and treatment. The study included Medicaid beneficiaries between ages 18–64, from 47 states and DC. The percentage of Medicaid beneficiaries diagnosed with OUD decreased from 4.2% in 2019 to 3.6% in 2023, with an overall decline in 34 states. Of those diagnosed with OUD, the percentage who received MOUD increased from 60% to 69.1%, with an increase in 45 states. However, the percentage who continued MOUD for at least 180 days decreased from 62.6% to 57.6%. The percentage of beneficiaries with OUD who had an OUD-related hospitalization was relatively unchanged, at 10.9% in 2019 and 10.6% in 2023.
Drug and Alcohol Dependence
This study examined pregnancies among women aged 15–54 years from 2016 to 2020 and the prevalence of OUD diagnosis and MOUD, including methadone, buprenorphine, and naltrexone. Researchers also examined pre-pregnancy clinical factors associated with MOUD in a nationwide commercial insurance database. They found that less than half of pregnant women with OUD received MOUD, the gold standard for treatment. The results demonstrate substantial missed opportunities for MOUD treatment during pregnancy, highlighting the need for targeted interventions to improve evidence-based perinatal OUD care.
Symptom-Based Dosing for Neonatal Opioid Withdrawal: The OPTimize NOW Randomized Clinical Trial
Journal of the American Medical Association
This cluster, crossover randomized clinical trial assessed if pharmacologic treatment with a symptom-based dosing approach decreases time to medical readiness for discharge compared with a scheduled opioid taper for infants with opioid withdrawal cared for with the Eat, Sleep, Console approach. Researchers found that time to medical readiness for discharge was 2.3 days shorter for infants treated with symptom-based dosing compared with a scheduled opioid taper. No difference was noted in safety outcomes through 3 months of age. Symptom-based dosing decreased time to medical readiness for discharge for infants with opioid withdrawal cared for with the Eat, Sleep, Console approach.
Addiction
Repeated measures can be useful to monitor treatment and inform clinical decisions, but many validated assessment tools are long and time-consuming. Researchers conducted a systematic review to assess single-item patient-reported outcome measures (PROMs) as a potential tool in substance use disorder (SUD) treatment. A total of 35 studies were included in the review, evaluating 68 single-item PROMs and measuring nine clinical constructs, including cravings, self-efficacy, treatment readiness, and quality of life. Researchers found most of the measures did not have defined clinical thresholds, but measures assessing cravings, treatment-readiness, and self-efficacy had the most robust data. While additional research is needed, including longitudinal evaluation, single-item PROMs could be useful in SUD treatment settings, given their limited burden and strong psychometric performance.
Learn More
“Smart” harm reduction vending machines to improve public health: Evaluating the utilization 🔓
Journal of Substance Use & Addiction Treatment
This report presents evaluation outcomes from two “smart” harm reduction vending machines (VMs) placed in community settings in central Pennsylvania from May 2024 to May 2025. The VMs dispensed free harm reduction items, and also provided information about and linkages to health care and other services. A total of 2,321 clients registered and accessed services via the VMs, with 14,867 total sessions. An additional 4,472 non-registered individuals interacted with the machines to view items or resources. The most popular items were hygiene kits (n=3,454), wound care kits (n=1,674), and safer sex kits (n=1,553); 2,755 drug testing strips and 1,906 naloxone kits were dispensed. As harm reduction VMs are implemented in more locations in the US, this study provides valuable insights into how they are utilized.
Actigraphy-based sleep outcomes in substance use disorders: A systematic review and meta-analysis
Sleep Medicine Reviews
While polysomnography (PSG) is the gold standard for measuring sleep architecture, it is expensive and conducted in the artificial setting of a sleep lab. Actigraphy (using devices usually worn on the wrist) provides less quantity and quality of information but can observe multiple nights for longitudinal studies in the patient’s natural environment. This systematic review identified nine studies (1,366 subjects) that used actigraphy with control groups to assess sleep in subjects with SUDs. Researchers found total sleep time was reduced in AUD (-50 minutes) and OUD (-40 minutes). Nicotine use disorder was associated with increased waking after sleep onset. Researchers note that the objective actigraphy (and also PSG) reveals sleep disruption that was not evident on subjective sleep self-reports. These studies using actigraphy produced results similar to previous PSG studies, confirming the accuracy of actigraphy.
Methadone Diversion and Overdose: What Does the Evidence Say? A Narrative Review
Journal of Addiction Medicine
Efforts to relax restrictions on the use of methadone in OUD often generate concerns about diversion and the risk of overdose. This paper reports on 20 studies concerning methadone diversion. Various studies show 6% to 88% of patients report ever diverting methadone. Reasons for diversion include income and to help others treat withdrawal or reduce opioid use (38%–90%). Use of diverted methadone for euphoria was less common (0%–29%). Studies in countries where physicians prescribe methadone did not show an increased incidence of diversion. Overdose deaths due to methadone also involve methadone prescribed for pain, so the role of diverted methadone is hard to tease out. The authors conclude that overall evidence does not suggest restrictions on methadone access reduce diversion or overdose.
In the News
- U.S. Government Will Stop Paying for Test Strips to Detect Deadly Drugs The New York Times
- What the assault on the US Centers for Disease Control’s Office on Smoking and Health means for the USA and Global Public Health 🔓 Tobacco Control
- These Salmon Got High on Cocaine. That Wasn’t the Craziest Part. The New York Times
- RFK Jr. wants to treat addiction on wellness farms, without medication 🔓 National Public Radio
- Psychedelic Medicine Goes Mainstream: Breakthrough or Bubble? 🔓 Forbes
- Purdue Pharma to be dissolved as judge approves criminal sentence in opioid case 🔓 The Guardian