The ASAM Weekly for July 28, 2026

This retrospective cohort study using target trial emulation evaluated the association between use of newer glucagon-like peptide-1 receptor agonists (GLP-1 RAs; semaglutide, tirzepatide) and alcohol-related hospitalizations among adults with alcohol use disorder (AUD) and type 2 diabetes (T2D) or obesity. The authors found that among adults with AUD and T2D or obesity, initiation of newer GLP-1 RAs was associated with a lower observed risk of alcohol-related hospitalization.

This national cross-sectional secret shopper study examined over-the-counter (OTC) naloxone availability from January to April 2024. Same-day OTC naloxone was available in 61.40% of pharmacies; however, 58.14% of those pharmacies reported it was behind the pharmacy counter. The mean cost of OTC naloxone was $52.07. Corporate chain pharmacies were more likely to carry OTC naloxone than pharmacies classified as food or mass merchandisers, independent, or medical affiliated.

This survey-based study assessed the acceptability of a wearable versus implantable device to detect and prevent opioid-related overdose. A total of 60 individuals who use opioids and 126 individuals in the addiction workforce were surveyed in a Midwest city. Both groups found the wearable device to be more acceptable, as did participants with a history of overdose, reported use of medications for opioid use disorder (MOUD), and intravenous opioid use. Among those in the addiction workforce, device acceptability was associated with less stigmatizing views of harm reduction.

Since the COVID pandemic there has been a shift from injection drug use to other routes of administration. This study investigated how non-fatal overdose risk changed during periods when individuals used various routes of administration (injecting, smoking, nasal inhalation/snorting). Researchers used data (2014-2022) from a previous study of AIDS and injection drug use in the Baltimore area. For heroin use, using all three routes had a higher overdose risk than only injecting (OR=2.4), only nasal inhalation (OR=2.9), or injecting and smoking (OR=4.22). For cocaine use, compared to injecting only, odds of overdose were higher for injecting and nasal inhalation (OR=3.9) or smoking and nasal inhalation (OR=3.7). The authors conclude that using drugs by multiple routes of administration carries a higher overdose risk than use by a single route. They speculate that those using a single route are better at estimating dose and perfecting safety practices.

While efforts have been made to increase access to naloxone, people still often don't carry it. To better understand why, researchers conducted a mixed-methods study among people who used non-prescribed substances. Researchers found that overall, 60.4% of those surveyed currently had naloxone with them, but the rate was higher among those reporting opioid use (72.6%) versus those using non-opioids (44.3%). Of note, 54% of those not carrying naloxone had witnessed an overdose in the previous 12 months and 20.4% had experienced one themselves. Reasons given for not carrying naloxone included not feeling personally at risk, stigma against those who injected substances, not wanting the responsibility of carrying it, or potential consequences such as negative police interactions. The researchers note additional efforts are still needed to reduce stigma and increase education.

Initiation of and retention in treatment with MOUD continues to be low and transportation is an often-cited barrier. A transportation assistance program (TAP) was implemented as part of the HEALing (Helping to End Addiction Long-term®) Communities Study (HCS) in Kentucky. Eight counties (5 urban, 3 rural) were included in the analysis, and the overall cost of the program was $437,481.69 in 2023. The urban counties accounted for 73% of the costs, covering 75.7% of individuals reached by the program. The average cost per person was $53.06 in urban counties and $61.94 in rural counties. Of note, while rural counties provided TAP to 24.3% of individuals in the program, they only accounted for 6% of the overall population, highlighting the significant need for transportation in rural areas.

The PhenX (phenotypes and exposures) is a directory of standardized measurement protocols allowing data to be compared across studies. This paper describes the PhenX Substance Use and Recovery (SUR) working group and the process of developing a toolkit for measuring recovery. The group developed a set of 15 protocols that measure various aspects of recovery from substance use disorders over 3 domains: biopsychological (eg, post-acute withdrawal, craving), socioecological (eg, social networks, recovery identification, recovery capital), and treatment and recovery services and satisfaction (eg, use of treatment services, mutual-help group involvement, happiness with recovery). The authors anticipate ongoing work to refine and potentially expand the group of protocols.

This cohort study of 11,286 youth participants assessed if within-person changes in problematic social media use (PSMU) among youths was associated with attention-deficit/hyperactivity disorder (ADHD) symptoms across 5 annual study waves, and do these associations differ by sex. Researchers found that within-person elevations in self-reported PSMU behaviors were associated with higher parent-reported ADHD symptoms the following year during mid-adolescence. These within-person associations differed by sex and were significant among males but not females. The findings suggest that assessment of social media use among youths with ADHD should prioritize problematic patterns and consider sex-specific risk.