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The ASAM Weekly for May 26, 2026
This Week in the ASAM Weekly
It’s interesting how an article about artificial intelligence can deepen our understanding of addiction (and vice versa). Addiction often starts not with harm but with relief, and it can be harmful not only because of what it does but also because of what it displaces (STAT).
Cannabis use provides a good example of this. For many, the harms are perceived to be mild while the benefits are professed to be real (Addiction), but what can be hard to convey is how resilience is often displaced—like when an adolescent uses cannabis to manage anxiety or an individual smokes to cope with isolation (SAMHSA).
In the context of opioids, this displacement is more consequential (deadly). Even though experts are optimistic about declines in overdose deaths, they are concerned about the conditions that still exist—physical and psychological pain, economic instability, etc—that drive people to seek relief in consequential ways (Forbes).
In a way, overcoming something difficult without depending on something that causes harm is often how recovery begins. It’s easy to overlook because it’s subtle, like recommending group therapy to someone who “doesn’t like to be in groups” while missing the point that the individual likely used substances to overcome their anxiety of being in groups (Journal of Studies on Alcohol and Drugs).
That is a point we need to better understand: when does something helpful become harmful? Usually, it is long before we acknowledge there is an addiction (The Guardian).
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
Journal of the American Heart Association
This study included 1,309 patients treated for an acute myocardial infarct (MI) at a California health system between 2012 and 2022. A total of 194 patients (15%) were methamphetamine users. The Meth-MI group had less diabetes than the No-Meth-MI group (38% vs 51%, p=.001) but many more smokers (72% vs 28%, p<.001). Nonobstructive coronary disease (e.g., vasospasm) was more common in the Meth-MI group (24% vs 11%, p<.001), which consequently had lower rates of revascularization, aspirin, and statin therapy. The Meth-MI group had double the mortality (HR, 2.1, p<.001), and methamphetamine use was the strongest predictor of mortality, greater than diabetes. The Meth-MI group was more likely to have a subsequent MI (42% vs 27%, p<.001). The risk of MI with methamphetamine use is 19% higher than the risk with cocaine use (this study excluded cocaine users). The authors believe presentations with methamphetamine use and angina, without MI, is even more common.
Research and Science
The American Journal of Psychiatry
Ketamine rapidly reduces suicidal ideation, but its effects are often short-lived. This randomized clinical trial evaluated low-dose buprenorphine as a follow-on treatment after ketamine in adults with major depressive disorder. Buprenorphine was associated with greater and more durable reductions in suicidal ideation than placebo over a four-week period, indicating a potential new treatment approach for suicide prevention.
Journal of Studies on Alcohol and Drugs
This study included 531 mutual help group (MHG) attendees with alcohol use disorder surveyed at baseline and 6 and 12 months later concerning barriers to MHG involvement. MHGs included 12-step groups as well as second-wave MHGs: Women for Sobriety, LifeRing Secular Recovery, and SMART Recovery. The most common barriers were related to social anxiety, such as “I don’t like crowds or large groups.” Second most common barriers were dislike of meeting attendees and content, such as “I didn’t like hearing the same stories over and over.” Least common barriers had to do with motivation or perceived need, e.g., “I could change and do it myself.” More barriers resulted in less MHG involvement at 6 and 12 months. All second-wave MHG attendees reported fewer barriers, possibly because they self-selected these groups after attending 12-step MHGs. Social anxiety was the most common barrier, and the authors suggest MHGs offer smaller meetings and make efforts to welcome newcomers.
Drug and Alcohol Dependence
Opioid use disorder (OUD) is common among those incarcerated with an increased risk of overdose after release. Researchers conducted a retrospective cohort study to assess any association between medications for OUD (MOUD) receipt during incarceration and treatment trajectories for one-year post-release from New York City jails. Researchers found 26.2% of incarcerated people with OUD received MOUD maintenance, while 41.5% received withdrawal management, and 32.3% received no MOUD in the days prior to release. Researchers identified eight treatment trajectories, including continuous MOUD, treatment discontinuation after six months, MOUD with reincarceration events, and others with little or no MOUD. In-jail MOUD was strongly associated with continuous MOUD (aOR=12.5) post-release, and the authors note these findings highlight the potential for in-jail MOUD to improve MOUD uptake and continuity in the community.
Substance Use and Addiction Journal
While food addiction (FA) does not have established diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there is research to support FA as a behavioral addiction and that it may be like other substance use disorders (SUD). Researchers conducted cross-sectional survey interviews at SUD treatment facilities to assess how FA is addressed. Researchers found that most programs did not provide formal FA treatment; 29% did have within-facility FA treatment. The authors note programs often reported eating disorders were outside of treatment scope and thus did not address FA. The authors call for additional research in this area, while highlighting the need for formal diagnostic criteria, clarification of overlaps and distinction between FA and eating disorders, and mechanisms for treatment reimbursement.
Learn More
Opioid-related medication access for adolescents who test positive for fentanyl
Pediatrics
This retrospective cross-sectional study examined access to buprenorphine and naloxone for adolescents who tested positive for fentanyl during an emergency department visit in an academic children’s hospital in Washington, DC. Between November 2023 and February 2025, there were 84 ED encounters for adolescents (age 12-19) with positive UDS results for fentanyl; 62 were positive for illicit fentanyl, and 23 patients (39%) were diagnosed with OUD. Of the ED visits, 34% resulted in inpatient admission. Inpatient admission was associated with significantly higher rates of buprenorphine initiation for patients diagnosed with OUD (10/13, 77%) as compared to those who were only seen in the ED (3/13, 23%). Naloxone was prescribed in 34% of encounters and was associated with an opioid-related diagnosis. While small, the study highlights important trends including a need to increase naloxone awareness and prescribing for adolescents at risk for overdose, as well as a need for increased MOUD initiation in ED settings for adolescents with OUD.
Addiction
The objective of this mixed-methods analysis is to characterize public comments submitted to Regulations.gov regarding the United States Drug Enforcement Administration’s (DEA) cannabis rescheduling proposal and identify underlying justifications for support or opposition. Using Large Language Model (LLM)-based classification validated against human annotations, the study found that among 42,913 comments, 28.85% supported rescheduling, 6.74% opposed, and 63.50% deemed the proposal insufficient, favoring further rescheduling or complete de-scheduling of cannabis. Among the 200 manually annotated comments, therapeutic benefits and economic impacts were the most common justifications among supporters. Public health risks, addictiveness concerns, and concerns about underage use were predominant in opposing comments. Insufficient rescheduling comments cited therapeutic benefits, economic impacts, and criminal justice reform as primary justifications.
Journal of Substance Use and Addiction Treatment
This is a qualitative study of 12 participants who received buprenorphine at an SSP as part of a parent randomized controlled trial of buprenorphine treatment at SSPs. Interviews focused on experiences with clinicians, experiences initiating buprenorphine, prior OUD treatment experiences, and perceptions of buprenorphine continuation. Four main themes were identified: (1) onsite treatment facilitated buprenorphine initiation, but additional support was needed, (2) precipitated withdrawal complicated initiation, (3) the SSPs were seen as welcoming and affirming, and (4) strong relationships with providers were critical for buprenorphine initiation. The authors proposed a “low-threshold, high-touch” model as the ideal way to support patients through buprenorphine initiation, emphasizing the core principles of low-threshold care while also integrating peer support through the initiation process to check in on the patient.
In the News
- AI dependence has a lot in common with addiction 🔓 STAT
- Minnesota becomes first state to ban prediction markets The New York Times
- Alcohol use disorder: Change can start with questions from a doctor STAT
- US overlooks drug treatment centers in hepatitis C fight 🔓 Roll Call
- Gambling addicts are struggling as Kalshi and Polymarket explode in the US: ‘You could be betting your rent away’ 🔓 The Guardian
- Drug overdose deaths fell in 2024. Why experts remain cautious 🔓 Forbes
- Advisory: Addressing cannabis use disorder in primary care settings—A lifespan approach 🔓 SAMHSA