We open with a topic that is near and dear to my heart: I often get asked about e-cigarettes as tobacco cessation aids, and now we have a JAMA Special Communication summarizing expert recommendations.
Next, we move to opioids and increasing access/adherence, for example via hospital discharge treatment initiation for alcohol/opioid withdrawal, through post-carceral support groups, and through state laws requiring addiction programs to offer FDA-approved MOUD. (The Orange County Register has a fascinating new four-part series on methadone, starting with this first issue.) On the other hand, medications not approved for OUD like gabapentin are common in our patients, especially for nonmedical use. In addition to treatment, we also feature results from an international survey on treatment and harm reduction services for opioid use disorder as well as post-carceral access to vending machine naloxone. Speaking of harm reduction, we feature a pilot trial of contingency management for stimulant use in a low-barrier syringe service program.
To close, we highlight another important emerging question: how addictive is social media? Meta reaches $18 billion settlements in social media addiction cases.
From hospital discharge protocols to legal reckonings, this week highlights how addiction medicine touches every corner of modern health. The landmark $18 billion settlement reminds us that the mechanisms of compulsion, whether pharmacological or behavioral, require our clinical vigilance, ethical grounding, and advocacy. As our field continuously refines its approach to tobacco cessation, MOUD access, and nonmedical prescription drug use, we hope these updates strengthen your daily practice. Thank you for your continued leadership and compassionate, evidence-based care on the frontlines.
Smita Das, MD, PhD, MPH
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM; John A. Fromson, MD; Sarah Messmer, MD, FASAM; Jack Woodside, MD; and Contributing Editor: Jessica Gregg, MD, PhD, FASAM
Lead Story
Journal of the American Medical Association
This Special Communication summarizes the evidence on the use of e-cigarettes for smoking cessation and provides recommendations for clinicians on how to engage in conversations with adult patients who currently smoke cigarettes. Specifically, advice is provided on (1) integration of e-cigarettes into patient-centered shared decision-making conversations on the risks and benefits of various pharmacologic smoking cessation treatments; and (2) practical guidance on the use of e-cigarettes for smoking cessation. The authors include one overarching recommendation: integrate e-cigarettes into conversations on the risks and benefits of all evidence-based pharmacologic treatments for smoking cessation. In support of this recommendation, specific guidance is provided regarding how to discuss potential misperceptions and suggested questions are offered to guide patient conversations. Evidence-based best practices are also provided for using e-cigarettes to quit smoking.
ASAM Publications Council Call for Applications
ASAM is seeking up to 3 members to serve on the Publications Council beginning in January 2027. Council members should have experience in addiction medicine and familiarity with the writing and publishing process. The Publications Council is charged with overseeing ASAM publications. The Council approves publication editors, evaluates proposals for new publications, ensures adequate publisher performance, and regularly furnishes the Board of Directors with updates on publication activities.
Please first log into your ASAM member portal and click to apply.
The closing date is September 21, 2026.
Research and Science
Substance Use and Addiction Journal
Researchers evaluated the association between initiation of treatment for opioid use disorder (OUD) and patient-directed discharge (PDD) among those with OUD and alcohol use disorder (AUD). Overall, in a retrospective study less than half of patients (43.7%) ever received buprenorphine, but those who did receive buprenorphine were less likely to undergo PDD (6.9% vs 15.5%). In addition, those who initiated buprenorphine early (<24 hours) had lower PDD rates (5.9%) than those who initiated later (24-72 hours; 11.4%). Those who initiated buprenorphine were less likely to be readmitted at both 30 days (11.0% vs 25.1%) and 90 days (24.1% vs 46.0%). These findings support guidelines recommending early initiation of buprenorphine for opioid withdrawal and not delaying until after treatment of AUD.
Drug and Alcohol Dependence
People released from incarceration are at higher risk of overdose from opioids, particularly in the period immediately after release. Naloxone-on-release programs are a potential strategy to reduce that risk, and researchers evaluated a no-cost vending machine distribution and an overdose education video program in the Los Angeles jail system. Of those surveyed, 18.6% obtained naloxone at release and 26.7% watched the video. Factors associated with obtaining naloxone included lifetime use of stimulants and speedballs, past 3-month use of heroin, and having witnessed an overdose. Notably, personal history of overdose and watching the video were not associated with obtaining naloxone. Barriers to obtaining naloxone included limited time during release and lack of knowledge about its availability. Although additional research is needed, low-barrier strategies such as vending machines are a viable option.
Psychiatric Services
This study involved a probability-based national sample of 1,552 adults and examined public attitudes regarding state licensure laws requiring addiction treatment programs to offer Food and Drug Administration-approved medications for opioid use disorder (MOUD). Of the respondents, 74% supported licensure laws requiring addiction treatment programs to offer MOUD. No differences were detected by race or personal experience with addiction or overdose. Although political conservatives were less likely than moderates or liberals to support licensure laws, support was greater than 66% across the ideological spectrum. Support was high even among respondents reporting high social stigma toward or discriminatory beliefs about people with opioid addiction. Robust public support suggests that licensure policies supporting addiction treatment programs could be a promising approach for states to reduce overdose deaths.
International Journal of Drug Policy
This global survey-based study evaluated opioid availability, treatment facilities, and harm reduction services in different countries. The survey was conducted through the International Society of Addiction Medicine's Global Expert Network (ISAM-GEN) and included responses from national addiction societies from 39 countries (15 from Europe, 14 from Asia/Oceania, 6 from the Americas, 4 from Africa). Nonmedical use of prescription opioids was most commonly reported (87% of respondents), followed by heroin (80%). The most commonly reported available treatment setting was community-based outpatient treatment (92%) and the least reported was shelter-based care (28%). Opioid agonist treatment options included methadone (75%), buprenorphine (70%), and morphine (11%); 16% reported no access to opioid agonist treatment. Harm reduction interventions were much less accessible, including naloxone distribution (31%), safe consumption rooms (20%), and drug checking (15%).
Journal of Addiction Medicine
Prescriptions for gabapentin have increased from 24 million in 2010 to 59 million in 2024 with nonmedical use (NMU) increasing in tandem. NMU occurs mostly in individuals with substance use disorders, particularly OUD. Gabapentin combined with opiates increases the risk of respiratory depression and overdose. This study surveyed 181 individuals with a history of opioid use and gabapentin use, and 150 reported NMU of gabapentin. Sources of gabapentin include sharing with others (50%), purchase from a dealer (44%), and a doctor (39%). Therapeutic NMU use was reported by 85% for relieving opiate craving, withdrawal, or physical pain. Recreational use was reported by 75% for sedation or a high, and 38% said it improved the opioid high. Average dose for recreational use was 2,400 mg, often taken several times a day (the Neurontin package insert suggests titration to 1,800 mg daily).
Drug and Alcohol Dependence
This study followed 328 people with problematic opioid use after release from jail (mostly in Chicago) who received a 3-month intervention promoting both MOUD and mutual help group (MHG) attendance with outcomes assessed at 3 and 6 months. At 3 months each day of MOUD use was associated with 0.3 days of opioid abstinence, and each day of MHG attendance was associated with 0.4 days of opioid abstinence. However, there was a significant relationship between the two such that the effects of MHG attendance on abstinence were strongest for those receiving little or no MOUD (OR=20 for abstinence). At 6 months each day of MOUD was associated with 0.1 days of opioid abstinence, and each day of MHG attendance was associated with 0.3 days of opioid abstinence. At 6 months the relationship between MOUD and MHG attendance was no longer significant. This study demonstrates benefits of both MOUD and MHG attendance on opioid abstinence.
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Preventive Medicine
This randomized, parallel-group, 12-week pilot trial evaluated health education (HE) plus contingency management (CM) for either session attendance or stimulant abstinence in a syringe service program in Vermont. A total of 27 individuals with moderate or severe stimulant use disorder were randomized (14 to the abstinence arm, 13 to the attendance arm). Individuals randomized to the CM abstinence arm had a higher percentage of stimulant-negative tests (22.6%) than those randomized to the CM attendance arm (3.2%).
