The ASAM Weekly for September 22, 2026

This retrospective cohort study examined characteristics associated with abandonment of newly prescribed buprenorphine, defined as a prescription that was written but not dispensed or filled, and trends in abandonment among adults from 2020 to 2024 to inform efforts to improve buprenorphine access. Researchers found the proportion of abandoned newly prescribed buprenorphine prescriptions for opioid use disorder increased from 2020 to 2024. Over 1 in 3 patients’ first buprenorphine prescriptions were abandoned in 2024, representing a missed opportunity for treatment initiation and engagement. Hispanic patients had a higher proportion of prescription abandonment, possibly due to language and pharmacy-level barriers, such as limited retail pharmacies in Hispanic communities and neighborhoods. Increasing opioid overdose death rates among Hispanics highlights the importance of expanding access among this population.

Extended-release buprenorphine (BUP-XR) has a plasma half-life of 43-60 days and may be detected in plasma up to 22-38 months, providing a self taper. This study enrolled 11 participants who had received BUP-XR for at least 12 months with opioid use disorder (OUD) symptoms controlled and who intended to discontinue medications for OUD (MOUD). Participants submitted weekly reports and attended monthly in-person visits for 6 months. All had successfully discontinued MOUD, however one required an additional BUP-XR injection to control withdrawal symptoms; the others had only mild to moderate withdrawal not requiring treatment. Several (n=7) reported anxiety or depression. There were reports (n=7) of increased motivation and energy, reduced worry, and improved relationships. Many (n=8) found help by surrounding themselves with sober peers. Longer duration of BUP-XR treatment contributed to success. The average treatment duration was 2 years, ranging from 12 months (n=3) to 33 months (n=2).

This cross-sectional online survey of 600 US pediatric prescribers from June to September 2025 evaluated legal awareness, clinical knowledge, prescribing confidence, parental consent concerns, and beliefs around MOUD for adolescents. Of respondents, 52% reported ever prescribing buprenorphine for adolescent OUD; of note, the study utilized snowball sampling which likely oversampled providers with an interest in MOUD. Buprenorphine prescribers were more likely than non-prescribers to work in an office-based solo practice and have between 5-10 years in practice. Providers who reported greater legal clarity around adolescent prescribing were more likely to prescribe buprenorphine. The study also found that pediatric providers reported a need for more training regardless of whether or not they had previously prescribed buprenorphine.

Data were obtained from 4 cohort studies with diverse populations and geographic locations, to determine the risk of non-fatal overdose (NFOD) associated with various combinations of polydrug use. Of 7,573 people, 14% reported an NFOD in the past 6 months. Overall, 14% used opioids plus stimulants, 17% used opioids alone, and only 3% used opioids plus drugs other than stimulants. The risk of NFOD with opioids plus stimulants was more than double the risk with opioids alone (RR=2.4). The risk of NFOD using non-opioids was about half the risk of using opioids alone (RR=0.51). The authors speculate that the increased oxygen demand of tachycardia from stimulants could increase the effects of respiratory depression from opioids. They call for increased education about the risks of using opioids and stimulants together.

This observational cross-sectional study evaluated co-use of sedatives and opioids within the past 30 days among adults assessed for SUD treatment in the US. The study data came from 856 assessment sites in 46 states from January 2017 to June 2024 in which the Addiction Severity Index-Multimedia Version (ASI-MV) self-assessment tool was completed by individuals presenting for SUD treatment; 79,600 who reported past 30-day use of opioids were included. The study evaluated co-use of opioids and sedatives among 3 groups with different patterns of opioid use: 1) prescription opioids only, 2) illicit opioids only, and 3) both prescription and illicit opioids. Individuals who reported use of both prescription and illicit opioids had the highest rates of co-use of sedatives – 29.9% – compared to 17.5% of participants in each of the other groups. Being non-Hispanic White and having psychiatric conditions were also associated with increased rate of opioid and sedative co-use.

Primary and family care physicians are often the first or only health care points of contact for people with opioid use disorder seeking care, and in the era of fentanyl providers may be less comfortable with initiating buprenorphine. In this paper, after a review of the literature and clinical practice guidelines, the authors provide an overview of induction strategies and clear guidance to help providers choose the appropriate strategy. The authors review standard induction, micro and macro induction strategies for sublingual buprenorphine, as well as standard and rapid induction for extended-release injectable buprenorphine. The guidance includes triage questions to steer strategy selection and dosing recommendations for each strategy.

This systematic review and meta-analysis addresses the literature gap and public health implications of the prevalence, user characteristics, associated factors, and co-use with other substances of oral nicotine pouches (ONPs) among adolescents. Analysis showed that the ever use of ONPs was more prevalent than the current use. Key user characteristics were male gender, older age, and Hispanic ethnicity. Furthermore, ONP use was strongly associated with the co-use of other tobacco products and substances. ONP use among adolescents reflects rising experimentation, demographic disparities, and emerging health risks, underscoring the urgent need for targeted regulation and research.

The use of psychoactive substances among gay, bisexual, and other men who have sex with men (gbMSM), often termed “chemsex,” is a known risk for poor health outcomes, specifically sexually transmitted infections (STIs). Researchers assessed trends in “chemsex” among gbMSM in 2 national cohorts of men with HIV in treatment or enrolled in pre-exposure prophylaxis (PrEP). Overall, 17.2% of men reported at least one episode of “chemsex,” with higher rates among those enrolled in PrEP (21.4%). Older men (>48 years) reported less use, and “chemsex” was associated with increased risk of STI and more non-steady partners. Patterns of use included one-time, episodic, or consistent use, with those reporting consistent use more commonly using methamphetamines. COVID-19 and the mpox epidemic did not appear to have any impact on overall trends. The authors suggest integrated substance use treatment is needed for gbMSM seeking HIV or PrEP services.