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The ASAM Weekly for June 23, 2026
This Week in the ASAM Weekly
Stigma, Pity, and the Limits of Empathy
A few months ago, I was invited to speak to a group of medical providers in Oklahoma about best practices for the medical management of substance use disorders. My colleague, O'Nesha Cochran, a peer mentor, was also invited to present. Her talk was exceptional. She first shared her personal story of childhood neglect, sexual exploitation, drug use, and incarceration, and then explained how that history now helps her connect with others still struggling with trauma and substance use. That connection, she said, is vital to getting beyond the stigma and discrimination so often faced by drug users. She and other peers can tell a patient, "I know what you've been through. I understand what you've done. I get it. I see you." And I know you matter.
After she finished speaking, an audience member asked what medical providers can do to reduce stigma during clinical encounters. O'Nesha's reply surprised me, and I've been thinking about it ever since. "You need to stop feeling sorry for us," she answered. "Don't pity us. Look at us and know we've been through it and we're still here." If you can, she said, feel empathy. But leave the handwringing at home.
Read the full editorial here.An analysis of data from more than 7,000 adolescents over 5 years found significant associations between rising social media use trajectories and substance use. Four distinct social media use trajectories were identified, with greater social media use over time throughout early adolescence being proportionally associated with an elevated likelihood of substance use.
This is a retrospective cohort study of 14,763 individuals with OUD on opioid agonist therapy (OAT) in New South Wales, Australia, from 2006 to 2017. The authors evaluated OAT cessation and retention and all-cause mortality among individuals with or without serious mental illness (SMI), including psychotic and bipolar disorders. Within the cohort, 13.5% had SMI. The risk of treatment cessation was 16% higher during the first treatment episode for those with SMI compared to those without. SMI was associated with a 35% increased all-cause mortality risk as well. Being on OAT was associated with an average 24% reduction in all-cause mortality over time; however, the protective effect was stronger in earlier stages of treatment.
This study extracted data from the physician health program records of 45 physicians and 37 pharmacists with SUDs who received medication for addiction treatment (MAT) with naltrexone (43%), buprenorphine (37%), extended-release naltrexone (24%), and methadone (6%). Of professionals not using MAT, 44% had consistently negative toxicology results compared to 79% of those using extended-release naltrexone, 60% using methadone, 45% using buprenorphine, and 43% using oral naltrexone. Neurocognitive testing was obtained on 49% of participants. Successful or very successful outcomes were obtained in 72% of professionals, and over 80% returned to practice. The authors conclude that the use of MAT was not associated with unfavorable outcomes or increased impairment and should be considered for health care professionals when clinically indicated.
Previous studies with neurocognitive testing in OUD have shown impairments in memory domains. This study included 94 participants with OUD and 40 controls. Of the participants with OUD more than half were receiving MOUD with methadone (n=31) or buprenorphine (n=24). All had hippocampal and intracranial volumes measured by MRI and completed two tests of memory. Individuals with OUD had smaller volumes of the left and right hippocampus compared to controls, most prominently in the posterior hippocampus. Results of memory tests correlated with hippocampal volumes. Individuals treated with methadone had smaller posterior hippocampal volumes compared to controls and buprenorphine-treated individuals. The posterior hippocampus is involved in memory retrieval while the anterior hippocampus is involved in memory encoding. Individuals with OUD can have impairments particularly in memory retrieval.
Federal prohibition of cannabis coexists with widespread legal availability of intoxicating tetrahydrocannabinol (THC) products, driven in part by the 2018 Farm Bill which permits hemp-derived compounds and enables circumvention through alternative cannabinoids and product formulation. Consumers can access high-dose THC products outside regulated cannabis markets, often without standardized testing, labeling, or age restrictions, creating risks for misexposure and complicating clinical care. Current and proposed federal policies, including delayed implementation of stricter THC caps and potential rescheduling of cannabis, have not resolved fragmented regulatory authority or closed existing loopholes. Evidence from tobacco and alcohol regulation suggests that effective oversight would require federal assignment of authority (eg, the US Food and Drug Administration) and a shift toward regulating total intoxicating cannabinoid content, supported by standardized testing, labeling, and research to inform evidence-based thresholds and clinical guidance.
This qualitative study sought to identify barriers, facilitators, and adaptations of contingency management (CM) and the community reinforcement approach (CRA) within permanent supportive housing (PSH). The authors conducted 25 semi-structured interviews between May and July 2022 with individuals living in PSH who use methamphetamine in Seattle, Washington. The Consolidated Framework for Implementation Research was used to guide analysis. Participants were largely interested in both CM and CRA; however, there were concerns regarding resources and sustainability, particularly within PSH settings which were often understaffed. Participants identified a significant need for mental health support, a desire for more community activities, and felt that the program would need to be individualized to incentivize a range of behaviors.
- Alcohol Consumption During Pregnancy Among Women Aged 18–49 Years — United States, 2021–2024 🔓 Morbidity and Mortality Weekly Report
- Lawsuits claiming social media is 'addictive' gain momentum 🔓 MedPage Today
- FDA memo raises new questions about fruity vape authorization 🔓 The Associated Press
- How kratom, an addictive gas station drug, found allies in Trump's cabinet The New York Times
- In a state where addiction exacts a steep toll, Medicaid work rules could endanger lives 🔓 Public Health Watch & KUNM
- Opinion | What we get wrong about Nixon's war on drugs The Washington Post
- US Health Department announces over $700 million to combat mental health, addiction, homelessness 🔓 Reuters