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The ASAM Weekly for June 30, 2026
This Week in the ASAM Weekly
Ever wonder how to write an ASAM Weekly commentary?
First, you need awesome co-editors (Brandon, Jack, John, and Sarah) and staff (Cathy) to identify topical publications that connect with a diverse audience — like a publication on improving naloxone and buprenorphine provision in the pediatric emergency department (Pediatric Emergency Care).
Then, try to map out common threads throughout the week's publications. Let's try it with J-curves: if more experts are finding that low-level drinking isn't protective (Journal of Studies on Alcohol and Drugs), then shouldn't we have more conviction about the dose-dependence between other addictions and their harms? It's true with cannabis (Harm Reduction Journal) and probably worse with gambling (The Denver Post).
The commentary should also touch upon broader themes, like how the common thread is actually the authors: international addiction experts (Addiction), physicians honored by ASAM (JAMA Network Open), and scientists who probably don't know about the ASAM Weekly (Drug and Alcohol Dependence). Every week, the publications are from a variety of individuals who care about addiction.
And every week, the publications are for a variety of individuals who care about addiction, like the friendly colleague who forwards a review on gambling disorder (American Family Physician), or a former government insider who recognizes the importance of flooding HHS with our voice (US Department of Health and Human Services). The ASAM Weekly (and) commentary is about and for those who care about addiction — like yourself.
So if you've ever wondered how to write an ASAM Weekly commentary, start from a place of gratitude, add some witty insight, and end with a sense of closure.
Thank you all for making the ASAM Weekly what it is: the newsletter for and about those who care about addiction.
And one last time…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
This study used a cause-specific modeling approach to estimate the lifetime risk of alcohol-attributable mortality and morbidity in the United States based on a person's average lifetime weekly alcohol consumption to assess the impact of per-occasion alcohol consumption on health. Researchers found that alcohol consumption, including at what may be perceived as "moderate" levels, is associated with increased mortality and morbidity risks. These results support tightening alcohol use guidance in the United States, for both males and females, to no more than 1 drink per day.
Now through August 31st, the American Society of Addiction Medicine (ASAM) has made available for public comment a draft of the proposed standards for the Correctional Settings and Reentry Volume of the 4th Edition of The ASAM Criteria®. For more information and instructions to review, please click here.
Pediatric emergency rooms offer a potential significant opportunity for intervention among patients with opioid use disorder (OUD). Researchers evaluated the impact of an electronic medical record-based best practice alert (BPA) along with provider education on buprenorphine prescribing and naloxone distribution rates. Among patients with BPA-qualifying chief complaints, researchers found that buprenorphine prescribing rates increased from 1.04% to 2.46% post intervention and naloxone distribution rates increased from 3.89% to 11.39%. Researchers did find a small increase in naloxone distribution post intervention even among patients who did not have BPA-qualifying chief complaints.
Naltrexone is an approved treatment for opioid use disorder (OUD) but prior studies have shown low rates of initiation and high rates of discontinuation. Researchers conducted a meta-analysis to evaluate naltrexone initiation and discontinuation rates, along with individual- and study-level factors associated with both. In pooled analysis, oral naltrexone initiation rate was 60.3% and long-acting injectable initiation rate was 18.2%. Rate of discontinuation of oral naltrexone was 50% at 1 month and 71% by 6 months, while the discontinuation of injectable naltrexone was 26.1% at 1 month and 60% by 6 months. Researchers did find that naltrexone initiation rates were higher when offered alone versus when offered along with methadone and/or buprenorphine. They did not find any difference in discontinuation rates when psychosocial interventions were provided along with naltrexone.
This retrospective cohort study looked at hospitalizations of adults with OUD who were treated with short-acting opioids between February and December 2024 and factors associated with patient-directed discharge. The study included 669 hospitalizations at an urban safety-net hospital in San Francisco, with 520 unique individuals. Of this group, 13.8% resulted in early patient-directed discharge. Each doubling of a patient's daily dose of short-acting opioids was associated with an 8% reduction in the hazard of early patient-directed discharge (AHR 0.92 [95% CI, 0.86-0.99]). There was not a statistically significant association between time to first dose and patient-directed discharge.
This survey-based study in Germany sought to investigate the possible effects of sociodemographic factors and familiarity with cannabis on stigma toward individuals with cannabis use disorder (CUD). A professional survey institute completed a quota sampling web-based survey of 1,603 individuals, including 501 adolescents. Of the participants, 41.1% reported prior use of cannabis, with 11.6% reporting use in the past month and 36.2% reporting knowing someone with CUD. Participants were presented with two case vignettes of individuals with CUD, including an adult and adolescent vignette. The adolescent case was significantly more stigmatized compared to an adult case. Survey respondents who were more familiar with cannabis use and CUD reported less stigmatizing attitudes, with a more pronounced effect of familiarity for adolescents compared to adults.
Gambling disorder is a behavioral addiction with increasing prevalence, likely driven by expanded access to gambling, and remains underdiagnosed despite its potentially disabling consequences. Although more common in men, incidence among women is rising, with risk factors including comorbid substance use and psychiatric disorders, lower socioeconomic status, and engagement in other high-risk behaviors. Screening guidance is limited, as the US Preventive Services Task Force has not issued recommendations, while UK guidance supports case-finding through direct questioning, with diagnosis and severity determined using DSM-5-TR criteria. Evidence for treatment suggests short-term benefit from pharmacologic agents such as naltrexone and olanzapine and from psychotherapies including cognitive behavioral therapy and motivational interviewing. Long-term efficacy remains uncertain and support groups offer adjunctive psychosocial benefit despite limited empirical support.
Syringe service programs (SSPs) receive funding from the federal government. A July 2025 executive order put funding in question and threatened legal action for those who "knowingly distribute drug paraphernalia." This study used microsimulation to model the effect of SSP service reduction on the health of the estimated 3,694,500 persons who inject drugs in the US. Researchers modeled both low (11%) SSP service reduction and high (80%) service reduction projected to last until 2030 (5 years). The paper includes an extensive discussion of the data and assumptions used in the model. With low service disruption the model predicted 5,400 excess all-cause deaths with 2,200 excess overdose deaths. With high service disruption the model predicted 39,600 excess all-cause deaths with 15,600 excess overdose deaths. Reducing SSP funding will result in increased mortality.
There is interaction between the cannabinoid (CB) and opioid systems in the brain (eg, ventral tegmental area, nucleus accumbens, prefrontal cortex). Conditioned place preference (CPP) is an addiction model where animals spend increased amounts of time in areas of their cage associated with drug administration. Rimonabant, an agonist/antagonist at the CB1 receptor, attenuates CPP in mice for fentanyl, however its agonist properties produce undesirable side effects. This study investigated the effect of two CB1 receptor antagonists (AM4113 and AM6527) on CPP for fentanyl in mice and found that both attenuated CPP for fentanyl without the side effects of rimonabant. Analgesic potency was assessed by the time it took the mice to flick their tails out of hot water; the authors found that fentanyl's analgesia was not significantly reduced by either CB1 antagonist. These antagonists have potential in the treatment of OUD without affecting opioid analgesia.
- HHS request for comment on chronic disease of addiction 🔓 Federal Register
- Sports betting addiction could be Colorado's next public health crisis The Denver Post
- The presence of kratom, or 7-OH, has grown in Pittsburgh. Here's what doctors and lawmakers are doing to catch up. Pittsburgh Post-Gazette
- Overdoses in L.A. jails fueled by treatment wait times, staffers say Los Angeles Times
- Weight-loss drugs like Ozempic could work for addiction too – and we finally know how 🔓 The Conversation
- Cities and schools are testing wastewater for illicit drugs The New York Times
- Staggering amounts of fentanyl hit streets as the DEA watched and took no action 🔓 The Associated Press