News
The ASAM Weekly for May 19, 2026
This Week in the ASAM Weekly
Communication might just be the most valuable tool we have.
Often, it’s a way to share information: like a news story about harm reduction in Duluth (MinnPost) or the tobacco industry’s influence in the White House (The New York Times).
Other times, it’s a way of broadcasting information: like a drop in drug overdose deaths (Associated Press) or the surgeon general’s warnings about alcohol (STAT).
It becomes more valuable when the communication goes both ways: like the public comments on drug repurposing for chronic diseases (like addiction) (FDA) or the feedback on a draft of the Clinical Consensus Statement on Drug Testing in Substance Use Disorder Treatment (ASAM & ACMT).
And communication is (almost) at its best when it reaches consensus: like a group of experts agreeing on the best practices for hospital-based initiation of medications for OUD (JAMA Network Open).
But as we’re learning with conversational agents (AI) in clinical settings, there is more to communication than just comments, conversations, or consensus. Caring for another requires the ability to communicate compassion and concern, which are core characteristics of human connection and the very things that conversational agents are unable to copy (STAT) (for now).
Again, communication might be the most valuable tool we have.
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
JAMA Network Open
This survey study used a 2-round Delphi process to develop expert consensus on best practices for hospital-based MOUD initiation for patients with OUD, with a goal to provide guidance on changing inpatient addiction treatment in response to increased synthetic opioids in the unregulated drug supply. A total of 42 expert clinicians participated; clinicians were considered a national expert if they had cared for at least 100 hospitalized patients with OUD in the last two years. There was consensus that buprenorphine and methadone initiation in the hospital setting were appropriate, with less support for hospital-based naltrexone initiation. Consensus was also reached to support rapid methadone initiation; high- and low-dose buprenorphine initiation; and provision of non-MOUD full agonist opioids for treatment of opioid withdrawal during methadone initiation, as a bridge to buprenorphine initiation, and for those declining MOUD.
Research and Science
Psilocybin in the treatment of cocaine use disorder: A randomized clinical trial 🔓
JAMA Network Open
This study investigated the effect of psilocybin on cocaine use disorder (CUD). Participants (n=40) were randomly assigned to receive either a single dose of psilocybin (25 mg/70 kg), or diphenhydramine (100 mg). Both groups received cognitive behavioral therapy for CUD. Urine drug screens confirmed abstinence during the follow-up period of 180 days. At 90 days 55% of the psilocybin group remained abstinent compared to 21% of the placebo group (p<.001). Complete abstinence was more common in the psilocybin group (OR=18, p=.007), and participants in this group had a reduced risk of lapse (OR=0.28, p=.001). Adverse events occurred in 65% of the psilocybin group and 10% of the placebo group; none were serious and most were during the drug administration day. The authors conclude that psilocybin is safe and effective for the treatment of CUD and call for studies with larger sample sizes.
Alcohol, Clinical and Experimental Research
Alcohol use disorder (AUD) can result in negative interpersonal interactions due to increasing harms to others and pressure to change. This study charts the evolution of interpersonal dynamics during AUD and during a 12-month follow-up. Positive interpersonal dynamics are measured with emotional support and friendship self-report scales and negative dynamics with hostility and perceived rejection scales. The study enrolled 501 participants with AUD who were entering treatment or making a recovery attempt outside of treatment. At 12 months 17% were in abstinent remission, 18% were in non-abstinent remission, and 66% were not in remission. Negative interpersonal dynamics decreased most in abstinent recovery (p=.001), less in non-abstinent recovery (p=.003), and less still for those not in remission (p=.049). Positive interpersonal dynamics did not increase regardless of outcome.
JAMA Network Open
This economic evaluation of 325 patients assessed if a hospital-based addiction consultation service (ACS) is cost-effective for increasing the initiation of FDA-approved medication for opioid use disorder in the hospital and linking patients to follow-up care after discharge. Researchers found that a hospital-based ACS was cost-effective compared with usual care. From a health-sector perspective, the ACS was associated with an incremental cost of $162 and 0.0103 quality-adjusted life-year (QALY) gained per person, leading to an incremental cost-effectiveness ratio of $15,750/QALY gained. These findings suggest that the hospital-based ACS was a cost-effective way to improve care for hospitalized patients with opioid use disorder.
Addictive Behaviors
It is unknown if long-term remission from substance use disorders (SUD) is associated with daily functional impairment. Researchers used the World Health Organization Disability Assessment Schedule (WHODAS) to assess functional impairment among those in long-term (>1 year) SUD remission versus those with no history of SUD and found higher impairment scores among those in long-term remission and who were less likely to report no impairment. However, upon additional analysis researchers found higher WHODAS scores were associated with prior year severe psychological distress and for people who received mental health treatment; this accounted for most of the increased score among those in remission. Authors note a third of people in remission reported no functional impairment, highlighting potential for high quality of life among those with SUD, but there is ongoing need to address psychological stressors in this population.
Learn More
Frontiers in Public Health
E-cigarettes are often viewed as alternatives to combustible cigarettes with less harm, but long-term consequences are still unknown. Researchers conducted a meta-analysis, including 15 studies, to assess any association between e-cigarettes and chronic obstructive pulmonary disease (COPD). Overall, current e-cigarette use was associated with increased risk of COPD (OR=2.03), as was prior e-cigarette use (OR=1.82). In subgroup analysis, researchers also found that e-cigarette use alone (never used combustible cigarettes) was associated with increased risk of COPD (OR=2.09). Dual use of both (OR=3.13) and current e-cigarette use + former combustible cigarette use (OR=2.17) were also associated with increased risk. These findings support the need for increasing public awareness of potential risk associated with e-cigarettes.
Journal of Addiction Medicine
In reply to a letter which argues that the reported 6.7% rate of precipitated withdrawal highlighted in “Precipitated Withdrawal following Emergency Department-initiated Buprenorphine: A Retrospective Study” may not reflect the true incidence because of major retrospective-study limitations, the authors of the original article state their goal was to estimate how often precipitated withdrawal occurs after emergency department-initiated buprenorphine in real-world practice. They acknowledge that retrospective methods, missing COWS scores, and uncertain opioid exposures can bias the estimate in either direction. They explain that restricting analysis to patients with complete data raised the rate to 12.3%, showing how much missing data can change the result. The authors also note that excluding continuation therapy patients was necessary because they have a different risk profile and would likely distort the estimate. Overall, precipitated withdrawal is an uncommon but real risk that clinicians should understand so they can use buprenorphine more confidently.
The Canadian Journal of Addiction
This is a case series of three patients who transitioned from methadone to long-acting injectable buprenorphine (bup-XR) using innovative, patient-centered prescribing techniques. In case 1, a 30-year-old woman who was taking methadone (120 mg) and using 1 g of fentanyl daily was transitioned to slow-release oral morphine for three days, then received 300 mg bup-XR on day 1 followed by a second dose on day 8. In case 2, a 27-year-old man with multiple comorbidities who was on 70 mg methadone daily received 300 mg bup-XR three days after discontinuing methadone. In case 3, a 40-year-old woman who was taking 200 mg methadone and 7 g of fentanyl daily received 300 mg bup-XR 48 hours after last methadone dose, with repeat doses at days 8 and 21. All patients also received an SL buprenorphine taper in addition to initial bup-XR doses. All three patients were stabilized on bup-XR with retention for over a year in treatment and improved management of medical comorbidities.
In the News
- FDA advances drug repurposing to address unmet medical needs 🔓 US Food & Drug Administration (FDA)
- US drug overdose deaths declined in 2025, CDC report shows 🔓 The Associated Press
- Regional ER doctors grapple with a rise in severe cannabis-induced illness The Philadelphia Inquirer
- Harm reduction works. ’Wellness farms’ won’t. 🔓 MedPage Today
- Harm reduction saves lives. That might not be good enough. 🔓 MinnPost
- The Deadliest Drug: America’s alcohol epidemic is hiding in plain sight STAT
- With a friend in Trump, the tobacco industry secures a lucrative win The New York Times
- Opinion: Using AI in addiction medicine could be particularly risky STAT