Overdose, harm reduction, and novel drug trends take center stage in this week's issue. It is encouraging that expanded harm reduction strategies over the past decade have helped curb overall overdose death rates in the United States; even with this encouraging news, it is reassuring that the CDC is launching a new channel to track overdose deaths and provide resources. Because fatal overdoses overwhelmingly occur when drugs are used in isolation, expanding community-based interventions remains critical. Recent research highlights additional levers for impact, including examining supply dynamics (as shown in a San Francisco study) and scaling drug checking services (featured in a Minnesota study). Meanwhile, Philadelphia's public health response to medetomidine offers a compelling look at managing novel adulterants. If someone has survived an overdose, a study in JAMA suggests starting methadone may be associated with a lower risk of death in the subsequent year.
Tobacco and alcohol, on the other hand, continue to be public health concerns. It may be time to expand alcohol screening and brief intervention to reduce mortality. Young people are susceptible to nicotine risks, and age verification protocols may help make a dent in the nearly 70% of unauthorized e-cigarette sales in the US as reported by The New England Journal of Medicine. And for adolescents struggling with SUDs, protocols like ADAPT offer promise in treatment.
From emerging drug trends to foundational harm reduction and prevention strategies, this week's research underscores the critical need for adaptable, evidence-based care. We hope these insights inform and support your ongoing work in the field. Until next week, thank you for reading ASAM Weekly.
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
NEJM Evidence
Data were obtained from SUDORS (State Unintentional Drug Overdose Reporting System) for 2022-2024. Of 191,577 overdose deaths, 76% occurred in isolation with no opportunity for rescue. Of the deaths in isolation, 73% were in a house or apartment and 23% elsewhere (car, sidewalk, bar). There was a person nearby (but not present) for 29% of the deaths in a house or apartment and 13% of the deaths elsewhere. The authors suggest improved overdose education and reversal agent availability could increase rescues by these nearby persons. For deaths in complete isolation, technologies that monitor vital signs (phone apps, wearable devices) could alert first responders.
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
Health & Justice
This cross-sectional study surveyed 716 people who use drugs in San Francisco between September 2023 and September 2024 to assess if the number of self-reported drug sources was associated with drug distribution arrests in the surrounding area (within 250 meters). People who use drugs in geographical areas with moderate (2-54 arrests) and high (55-269 arrests) exposure to drug distribution arrests reported 78% more drug sources over the last 3 months compared to those in the low (0-1 arrests) exposure group. The study highlights how law enforcement disruption of the drug market can lead to multiple drug sources and potentially increased overdose risk in nearby areas.
Harm Reduction Journal
This observational cohort study utilized longitudinal surveys and community-based drug checking results to assess expectations of the sample being tested, perceived supply stability, and perceived reasons for supply change. A total of 57 participants were recruited from a community-based syringe service program offering drug checking services in Minnesota, with 305 drug samples tested. Fentanyl was the most detected drug (72% of samples), followed by methamphetamine (58%). Of samples that tested positive for fentanyl, 66% of participants expected this result; for those that were positive for methamphetamine, 46% expected this result. Xylazine was detected in 9 samples, all of which were unexpected. Participants reported multiple sources of drugs, with about 4 of every 5 weekly drug purchases coming from a different source. The study highlights that people who use drugs often do not know what is in the supply.
Addiction Science and Clinical Practice
The presence of medetomidine, an alpha-2 agonist, as an adulterant in the fentanyl drug supply has increased significantly in Philadelphia and though still concentrated in the northeast, it is spreading. Medetomidine presents unique issues: 1) severe withdrawal syndrome with hypertension, tachycardia, and intractable vomiting often requiring ICU care, 2) lack of clinical recognition of withdrawal and management skills, and 3) no available laboratory testing. Philadelphia hosted a summit to discuss this public health concern, with case discussion, exchange of knowledge about recognition and management of withdrawal, and discussion of public health and policy needs. The authors present a summary of this meeting, including details about recommended medication (alpha-2 agonist) to use to manage withdrawal and guidance for recognizing and monitoring withdrawal.
JAMA Network Open
After a nonfatal overdose, 1-year mortality is 8.6%. Both buprenorphine-naloxone (BupNx) and methadone (M) have been shown to reduce this risk. This study compared the effectiveness of these two medications. The subjects were residents of Ontario, Canada, who initiated BupNx or M between 2017 and 2023 and who had a prior year emergency department visit for overdose. A randomized clinical trial was simulated by matching subjects for confounding covariates. Of the 5,882 individuals included, 6.4% died during the 1-year follow-up, including 5.6% of those starting M and 7.1% of those starting BupNx. The death rate for M was significantly lower (HR, 0.78, p=.01). Time to treatment discontinuation was 25 days for M and 16 days for BupNx, a significantly lower hazard of discontinuation for M (HR, 0.78, p<.001). Starting M was associated with a reduced risk of death and longer treatment duration compared to BupNx, although treatment duration was short for both groups.
JAMA Health Forum
This decision analytical model and microsimulation study examined the potential impact of expanding alcohol screening and brief interventions in primary care on premature mortality from major alcohol-related causes of death in US adults. Researchers found that expanding delivery of alcohol brief interventions to an additional 8 million interventions per year was projected to reduce annual alcohol-related potential years of life lost per 100,000 adults by −51.3 in men and −34.1 in women by 2030 compared with the status quo. These findings suggest that substantially expanding alcohol screening and brief interventions in primary care may reduce premature mortality and help narrow the socioeconomic gap in alcohol-related mortality in the US.
NEJM Evidence
The US e-cigarette marketplace is dominated by unauthorized products. This Public Health Alerts report uses retail scanner data from a large retail sample to estimate the proportion of unauthorized e-cigarette product sales in US brick-and-mortar stores. The authors found that as of December 2025, 69.4% of e-cigarette product sales in convenience and grocery channels were estimated to be unauthorized. Most unauthorized products were disposable devices in flavors that may appeal to young people. More complete data on products and sales in untracked channels such as vape shops could better inform monitoring and enforcement efforts.
Learn More
Neuroscience and Biobehavioral Reviews
Many of the therapeutic cornerstones of treatment for substance use disorders in adults have lower efficacy for adolescents. The authors discuss some of the unique neurodevelopmental aspects of adolescents, including hormonally-mediated striatal development, cognitive development, development of self, and shifts in social networks that likely impact treatment response. The authors present an example of a treatment program developed with an approach accounting for these factors. Components of the approach include use of peer interactions to promote beneficial behavioral change, while still recognizing and including parental connection. While additional research is being conducted on this specific therapy program, the authors support new approaches that incorporate developmental research to treat adolescents.
