The ASAM Weekly for October 13, 2026

Psilocybin has shown benefit for treating depression in clinical trials, and in recent years its use has increased among the general population. In this study, researchers utilized the National Survey on Drug Use and Health (NSDUH) to evaluate the association of past-year psilocybin use among those with major depression and mental health treatment use. Overall, among persons with a past-year major depressive episode, 7.3% reported psilocybin use. Researchers found that psilocybin use was not associated with any difference in mental health treatment use, including inpatient, outpatient, and prescription medication. They did find that psilocybin use was associated with perceived unmet mental health treatment needs. The authors note that given the increase in psilocybin use, clinicians should be mindful that patients may have higher psychiatric burden and unmet treatment needs.

This convergent parallel mixed-methods qualitative study evaluated factors associated with declining or accepting buprenorphine in the emergency department. The study consisted of 82 adult participants with opioid use disorder in four emergency departments, of which 23% declined buprenorphine. Motivators for accepting buprenorphine included opioid withdrawal management, desire to be substance free, wanting to return to “normal life”, fear of overdose or death, and caring for children. Barriers included concern about precipitated withdrawal or adverse effects, not wanting to be physically dependent on buprenorphine, and housing or logistical barriers. Treatment readiness as measured by the Stages of Change Readiness and Treatment Engagement Scales (SOCRATES) was similar between those who accepted and declined buprenorphine.

Medication for Opioid Use Disorder (MOUD) treatment during pregnancy improves outcomes for mother and infant. This study investigates pregnancy outcomes in the later postpartum period (days 42–365) using data from TennCare (Tennessee Medicaid) between 2007 and 2020. Almost all (98%) patients received buprenorphine since TennCare did not cover methadone during this period. Of 9,360 pregnancies, there were 39 deaths (0.42%), and 109 patients (1.16%) had at least one overdose. The median number of days of MOUD was 88, and longer duration of MOUD was associated with lower risk of death or overdose, with the longest duration of MOUD reducing the risk by half (aHR 0.52). Those receiving MOUD only post-partum had a higher risk of death or overdose than those receiving MOUD both before and after delivery (HR 1.71). These results demonstrate the importance of supporting MOUD both during pregnancy and postpartum.

Alcohol associated liver disease (ALD) has a 5-year mortality of over 50%. This study examined trends in prescribing medications for alcohol use disorder (MAUD) in patients diagnosed with ALD between 2015 and 2024. FDA-approved MAUDs (disulfiram, acamprosate, and naltrexone) rose from 4.7% in 2015 to 18% in 2024. Off-label MAUDs (topiramate, baclofen, gabapentin) increased from 26% in 2015 to 42% in 2024. In 2024, gabapentin was the most prescribed (39%), followed by naltrexone (13%) and acamprosate (8%). Patients with ALD without cirrhosis in 2024 were more likely to receive FDA-approved MAUD (29%) compared to patients with cirrhosis (15%), likely due to concern about hepatotoxicity of naltrexone. However, recent studies have reduced this concern. Rates of off-label MAUD use were similar for patients with and without cirrhosis. Despite significant increases, less than half of ALD patients receive MAUD.

This prognostic study in 616 patients with complete opioid outcome data examined if a postoperative opioid prediction calculator developed in a gynecologic oncology population can be accurately expanded to a diverse population. The original calculator showed moderate threshold-specific discrimination but overpredicted use at higher thresholds of pill use in the expansion cohort. A prespecified preoperative model showed moderate discrimination after internal validation, with calibration intercepts near 0 and slopes from 0.93 to 1.15. These findings suggest that individualized estimates of opioid use and threshold probabilities may support postoperative prescribing across a broad range of gynecologic surgeries; external institutional validation of the updated model is needed.

This study investigated whether alcohol use disorder (AUD) is associated with altered brain metal concentrations that could be potentially relevant to dementia risk. Researchers directly measured iron, copper, and zinc in the hippocampus, caudate, and substantia nigra of 40 donors balanced by sex and AUD diagnosis, using total reflection X-ray fluorescence and age-adjusted analyses. The most robust finding was elevated caudate iron in women with no significant elevation in men, whereas hippocampal iron was modestly lower in donors with AUD. Caudate copper was elevated across sexes but not after excluding donors with cirrhosis, while substantia nigra diagnosis-by-sex interactions for iron and zinc were attenuated or eliminated after adjustment for tissue composition. These findings provide direct evidence of regional and sex-specific trace-metal differences associated with AUD, particularly elevated caudate iron in women, but require replication and do not establish a causal link to ferroptosis or dementia.