The ASAM Weekly for October 6, 2026

Cannabis use has increased among older adults (≥65 years) and to better describe cannabis use and cannabis use disorder (CUD) in this population researchers used the annual National Survey on Drug Use and Health (NSDUH) from 2021 to 2024. Overall, 8.9% of older adults reported past 12-month use and 6.0% reported past 30-day use. Among those who reported past 12-month use, 11.4% met criteria for CUD (76% mild, 20.1% moderate, and 3.9% severe). Those with lifetime arrest, past-year mental illness, tobacco use, other drug use, frequent cannabis use (>300 days in last year), and males were more likely to have CUD. Of note, 19.9% of older adults reporting cannabis use reported it had been recommended by a doctor. The authors suggest clinicians should be screening for unhealthy cannabis use in this population and early intervention could be of benefit as many have mild CUD.

This cluster randomized clinical trial of 400 adults who smoked cigarettes in their homes across 40 sites examined if a brief smoke-free home intervention increased voluntary adoption of smoke-free homes in permanent supportive housing sites. Researchers found the intervention did not significantly increase smoke-free home adoption for at least 90 days, but it did increase any adoption attempts of at least 1 day. The rate of smoking abstinence was higher in the intervention than the control group, but few participants achieved this outcome. The findings suggest higher-intensity interventions are needed to maintain smoke-free homes and support smoking cessation in permanent supportive housing.

This is a descriptive study of the implementation of two harm reduction and stigma reduction programs in tertiary care emergency departments in Massachusetts. The evaluation was guided by the Consolidated Framework for Implementation Research (CFIR). The programs offered education, take-home naloxone, fentanyl test strips, and harm reduction equipment. Having a strong champion was important to both programs, along with understanding the legal context around harm reduction supplies and the existence of partnerships with harm reduction organizations. Material costs were low; however, personnel and training costs were more significant. Stigma and competing priorities were listed as potential barriers.

The funds from 1998 tobacco settlements lacked restrictions on use, and only 7% went to tobacco-related programs. The opioid lawsuits are expected to provide over $50 billion over two decades. Some states have structures to avoid diversion of funds, such as monitoring and public reporting of expenditures and advisory committees to oversee use of funds. However, other states provide little oversight. One obstacle is that funds will be distributed directly to counties and municipalities which provides flexibility but also complicates monitoring. The definition of opioid abatement is broad and could, for example, allow law enforcement to use funds for needs other than overdose prevention. Advisory committees often lack individuals with knowledge of SUDs, overdose, recovery communities, and others aware of local needs. The authors conclude that “without robust oversight and accountability” this could be a missed opportunity for public health.

This is a retrospective cohort study of all opioid use disorder-related hospital admissions (n=11,846) at two academic hospitals in Pennsylvania from January 2020 to September 2025. Researchers examined cohorts over time to evaluate trends in withdrawal management after the emergence of medetomidine in the unregulated drug supply. Prior to medetomidine’s emergence, 5.8% of admissions received dexmedetomidine; however, after medetomidine’s emergence in quarter 2 of 2024 this rose to 19.8% and then to 31.7% by quarter 3 of 2025. Admissions involving dexmedetomidine also had higher rates of opioid withdrawal treatment and oral alpha 2 agonists. ICU admission occurred in 99.5% of cases for dexmedetomidine administration and monitoring.

People with substance use disorders (SUD) often have comorbid conditions including problem gambling, which can in turn lead to poorer SUD outcomes. As patients with comorbid SUD and problem gambling are more likely to seek treatment for SUD than gambling, researchers assessed gambling behavior among patients in residential SUD treatment in California. Overall, 37.6% of patients reported past-year gambling; of those 47.5% met criteria for “problem gambling.” Those who met criteria for problem gambling were more likely to participate in games of skill (cards), online/electronic gambling, casino games, and often multiple gambling activities. Researchers note gambling is common among those with SUD, and SUD treatment providers should screen for and treat problem gambling.