The ASAM Weekly for July 7, 2026

This randomized clinical trial of 340 adults with opioid use disorder (OUD) taking buprenorphine examined the comparative effectiveness of 2 psychosocial treatments — cognitive behavioral therapy (CBT) and peer recovery support (PRS) — on opioid abstinence when used as adjunctive therapy to office-based buprenorphine treatment in adults with OUD. Researchers found that neither PRS, CBT, nor a combination of these psychosocial interventions yielded differential effects on opioid abstinence. These results suggest that adjunctive psychosocial interventions may not enhance buprenorphine treatment outcomes in the early stages of treatment.

Researchers sought to assess the use of extra-medical medications for opioid use disorder (EM-MOUD) among those receiving prescribed or dispensed buprenorphine or methadone. For persons reporting receipt of MOUD in the last 6 months, researchers assessed dose, length in treatment, and report of EM-MOUD. Overall, researchers found 18% person-level prevalence of EM-MOUD use, with those who reported use of multiple substances, injection drug use, withdrawal sickness, past-6-month incarceration, or homelessness more likely to use EM-MOUD. Among those who received methadone, dose was not associated with EM-MOUD use, but those in treatment ≥6 months had lower reported use (OR=0.33). Duration of treatment for buprenorphine was not associated with a difference in EM-MOUD use, but those prescribed higher doses (>16 mg) were more likely to report EM-MOUD use (OR=2.94). Of note, researchers could not assess prescribed MOUD and EM-MOUD use and if it was concurrent.

Millions of Americans engage in non-medical opioid use without meeting criteria for moderate or severe opioid use disorder (OUD). These individuals may benefit from interventions that reduce risky opioid use and prevent progression to OUD. Researchers conducted a cluster randomized clinical trial utilizing a collaborative care intervention consisting of brief advice from the primary care provider, interactions with a nurse care manager, and remote health coaching. The researchers did not find a statistically significant difference in mean days of risky opioid use between groups. However, participants in the intervention group had lower rates of moderate-to-severe OUD at both 6 months (1.1% vs 11.4%) and 12 months (3.4% vs 5.3%). In addition, high-risk prescription opioid use declined in both groups but was significantly lower in the intervention group at 12 months (6.8% vs 16.7%).

This cross-sectional analysis of approximately 8 million Medicaid enrollees in 10 states explored if racial and ethnic differences in the use of medications for opioid use disorder among Medicaid enrollees are associated with geographic availability. Increased geographic availability of methadone and naltrexone was associated with increased use among non-Hispanic White enrollees, but not non-Hispanic Black or Hispanic enrollees. Availability of buprenorphine was not associated with differential use. Increasing geographic availability of medications for opioid use disorder is likely a necessary but not sufficient strategy for addressing variation in access to care.

This paper describes the phenomenon of compulsive tanning and its similarities to SUDs. Individuals continue UV exposure despite knowing of the risk of skin cancer and photoaging. Compulsive tanning has also been linked to distorted body image and appearance preoccupation, and behaviors such as mirror checking. The first use of sunbeds before age 35 is associated with a 75% increased melanoma risk. UV damage to skin DNA promotes pro-opiomelanocortin (POMC) transcription. POMC is processed into melanocyte stimulating hormone and b-endorphin, potentially producing opioid effects. Naltrexone results in reduced UV exposure, and withdrawal symptoms of dysphoria, anxiety, and irritability have been reported. There are several screening tools, including modified DSM criteria and CAGE questions. The authors suggest cognitive behavioral therapy and sunless tanning products as a harm reduction strategy.

This paper reviews the evidence for injury to the hippocampus associated with opioid use and OUD. Opioid-associated amnestic syndrome (OAS) is indicated by amnesia, mostly anterograde and mild retrograde; hippocampal abnormalities on scans; and opioid use, particularly fentanyl overdose. There is increased metabolism and possibly seizure activity in the hippocampus. The amnesia can persist for weeks or months with subsequent hippocampal volume loss. OAS is rare but many cases may go undiagnosed. The CHANTER syndrome following opioid overdose involves edema of the cerebellum, hippocampus, and basal ganglia, likely from toxic or ischemic injury, and can result in compression injury. There is increasing evidence linking OUD with reduced hippocampal volume and increased risk of dementia. The authors are concerned that the full scope of these effects may not be seen for years to come.

This survey-based study used data from the Canadian National Questionnaire on Overdose Monitoring, a national online cross-sectional survey, to assess public perception of safe consumption sites (SCS). Participants (n=2,866) responded to the survey between July 2022 and May 2023. Overall, SCS were positively viewed, supporting the belief that SCS reduce overdose risk, decrease risk of infection, and improve access to health care and other services. Participants felt that SCS decreased public drug use and led to fewer discarded needles, while also improving safety for health care providers.

In this community-engaged qualitative study, the authors completed semi-structured interviews with 18 youth (ages 14 to 20) in Massachusetts to understand their experiences with cannabis-related school-based discipline. Four key themes were identified: (1) there is extensive surveillance of student cannabis use, (2) disciplinary responses vary across settings and student demographic groups, (3) students feel that cannabis-related discipline is harmful and disproportionately severe, and (4) students advocate for harm reduction and transparency in the handling of cannabis offenses within schools.