News
The ASAM Weekly for June 2, 2026
Using Human-in-the-Loop AI to Understand Stigma During the Deployment of Addiction Evidence-Based Practices in the HEALing Communities Study
Medications for opioid use disorder (MOUD), and overdose education and naloxone distribution (OEND), are among the most supported evidence-based practices (EBPs) in addiction medicine. Yet the real-world deployment of those EBPs at scale in diverse communities remains limited. Research shows that stigma toward these EBPs, toward people who use drugs or people receiving MOUD, plays a significant role in limiting the deployment and use of these EBPs in communities impacted by the opioid crisis.
The HEALing Communities Study (HCS) created a rare opportunity to increase the prioritization and deployment of these EBPs to reduce opioid overdose deaths. HCS was a multisite, community-level, cluster-randomized, wait-list controlled trial that tested the Communities That HEAL (CTH) intervention across 67 communities in 4 states (Kentucky, Massachusetts, New York, and Ohio). CTH is a coalition-driven, data-guided approach designed to increase adoption of EBPs across settings, paired with communication campaigns intended to reduce stigma and ultimately reduce opioid overdose deaths. The community coalitions implemented hundreds of EBPs to reduce fatal overdose. Our research focused on New York, where each coalition included service providers; county and state government officials; addiction, health, and mental health stakeholders; law enforcement; people with lived experience; family members of people who died from overdose; coroners; medical examiners; and others.
In New York, 16 HCS counties prioritized and deployed 213 EBPs and locally tailored communication campaigns. We collected meeting minutes in 13 of the 16 counties, with meetings commonly lasting 2–4 hours, and most minutes were audio recorded. Minutes captured how coalitions learn about EBPs, interpret local data, and identify local partners to implement EBPs. In our paper, we examined the following questions: (1) In which EBP did stigma discussion cluster (MOUD vs OEND vs safer prescribing)? (2) Was stigma, framed as a myth about MOUD, a clinical workflow barrier (e.g., pharmacies, health care settings), a public messaging challenge, or an equity concern? To answer these questions, minutes from the coalition meetings were analyzed to determine how coalitions learn, deliberate, and use data-driven decision making on the prioritization and deployment of EBPs in New York.
Lead Story
Journal of General Internal Medicine
GLP-1 receptor agonists (GLP-1 RAs) are treatments for type 2 diabetes (T2D) and have also shown benefits in treating alcohol and tobacco use disorders. Information was obtained from a research database for 9,011 patients with T2D and OUD treated with methadone, of which 1,663 were prescribed GLP-1 RAs. During a one-year follow-up there was a reduced incidence of myocardial infarction in those treated with GLP-1 RAs (HR 0.58, p=.001). GLP-1 RA treatment was associated with more sustained OUD remissions (HR 1.75, p=.001) and fewer overdose events (HR 0.55, p=.001). Patients receiving GLP-1 RAs had fewer episodes of major depression (HR 0.71, p<.001), anxiety disorders (HR 0.77, p<.001), and suicidal thoughts and behaviors (HR 0.27, p<.001). T2D occurs in more than one in five methadone-treated patients with OUD (vs 11% of the general population) and GLP-1 RAs offer multiple benefits to these patients.
Research and Science
Drug and Alcohol Dependence
This retrospective study compared outcomes for patients with stimulant use disorder enrolled in a smartphone-based contingency management program according to the amount of total incentives possible—either $75 ("low-value") or $599 ("moderate-value"). The low-value program was based in New Jersey, funded through SAMHSA (which limited reimbursement to $75 per patient at the time of implementation but has since been increased), and rewarded completing drug testing, attending counseling visits, and completing cognitive behavioral therapy (CBT) modules rather than abstinence over 16 weeks. The moderate-value program was funded by West Virginia’s Medicaid managed care organizations, lasted up to 26 weeks, and largely rewarded negative drug screening results, with additional rewards for counseling and CBT modules. Patients in the moderate-value program submitted significantly higher rates of negative substance tests (36%, with an average of 3.2 negative tests) compared to those in the low-value group (24.7%, with an average of 24.8 negative tests).
Once-weekly semaglutide in adults with daily cigarette use: A randomized clinical trial 🔓
JAMA Network Open
This parallel-arm phase 2a randomized clinical trial of 24 participants examined the effects of semaglutide versus placebo on cigarette smoking, cigarette cravings, and weight outcomes in people who smoke. Participants were non-treatment-seeking adults between the ages of 21 and 65 who smoked at least 5 cigarettes per day. Participants in the semaglutide arm received 9 weeks of subcutaneous semaglutide at a dose of 0.25 mg for 4 weeks, 0.5 mg for 4 weeks, and 1.0 mg for 1 week. There was no statistically significant difference in laboratory measures of smoking resistance or number of cigarettes smoked per day; however, semaglutide reduced cigarette craving and body weight.
Antenatal opioid exposure and cerebral cortical maturation in newborns 🔓
JAMA Network Open
Previous studies have shown decreased cognitive and language abilities in children with prenatal exposure to opioids. This study measured the effects of prenatal opioid exposure on the cerebral cortex using MRIs on newborns (<8 weeks of age). Newborns (n=259, 164 with prenatal opioid exposure) were recruited from an ongoing study of neonatal opioid withdrawal. Compared to unexposed controls, newborns with prenatal opioid exposure had the greatest reduction in cortical surface area in the frontal lobe (-1048 mm², p<.001), followed by parietal (-501 mm², p=.01), temporal (-422 mm², p=.01), and occipital (-232 mm², p=.05) regions. Sulcal depth was reduced in the frontal lobe (-0.11 mm, p=.05) and parietal region (-0.19 mm, p=.003). These effects were greater with prenatal methadone exposure than prenatal exposure to buprenorphine. Prenatal polysubstance exposure produced greater effects than opioid only exposure.
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Reducing buprenorphine misinformation as a strategy to improve adoption in primary care 🔓
Substance Use and Misuse
Access to buprenorphine (bup) for opioid use disorder (OUD) remains limited despite policy efforts to reduce barriers. This qualitative study examined misinformation about bup among primary care providers and the impact of a brief prescribing support program. Common misconceptions included that bup substitutes one harmful drug for another, should be prescribed short-term at the lowest dose possible, and is complicated to manage. These misconceptions were more frequently reported among providers in rural areas and those who had never prescribed bup. After the intervention, misinformation decreased, particularly among those who had never prescribed. Further research is needed to assess impact on prescribing behavior, but these findings highlight the potential for such intervention to improve bup access in primary care settings.
Drug and Alcohol Dependence
Tianeptine is an atypical tricyclic antidepressant with mu-opioid receptor agonist activity not approved in the United States but often marketed as a dietary supplement and misused. This systematic review assessed reported findings about its toxicity, withdrawal, management, and outcomes. Toxicities resemble those of opioids—including central nervous system depression, sedation and respiratory failure, and death—but also included rhabdomyolysis and acute kidney injury. Reported withdrawal symptoms included nausea, diarrhea, anxiety, paranoia, and hallucinations. Management included naloxone (though response was unclear) and supportive care for acute intoxication and withdrawal management. Buprenorphine and methadone use were reported for long-term management. The authors note providers should consider tianeptine in suspected opioid-like toxicity or withdrawal, particularly when toxicology is negative for opioids.
In the News
- Alcohol, poor diets fueling a new category of liver disease: MetALD STAT
- Meta settles a school district’s social media addiction lawsuit The New York Times
- Addiction counselor shortage hits Michigan hard: ‘We’re all struggling’ 🔓 Bridge Michigan
- Bees and birds are drinking alcohol from flowers 🔓 SciTechDaily
- Opinion | Testing sewage water can help detect opioids earlier The Washington Post
- MDMA trial for PTSD treatment launched by Veterans Affairs 🔓 The Hill
- College-age adults are rushing to prediction market sites. Addiction experts are alarmed 🔓 CNN