The ASAM Weekly for October 27, 2026

ADHD and SUDs have shared genetic vulnerability, and 20% of people with an SUD have co-occurring ADHD. This study assessed the risks and benefits of stimulant treatment in patients with both diagnoses. Researchers found 7 studies that met inclusion criteria, of which 6 were randomized controlled trials. Among patients with co-occurring SUD and ADHD, comparing those prescribed stimulants to those not prescribed stimulants produced no evidence for a difference in substance use, SUD symptoms, substance abstinence, or ADHD treatment adherence. Only 2 of 5 studies showed improvement in ADHD symptoms with stimulant treatment. One study found significantly longer SUD treatment retention in those prescribed stimulants. Although there was no clear evidence of harm associated with treatment involving stimulants, the authors caution that significant limitations in the quality of evidence result in low confidence for all these conclusions.

Researchers used latent class analysis to develop opioid overdose risk profiles in a long-term cohort of adults with heroin dependence. The researchers identified 3 risk profiles: high-risk, moderate-risk, and low-risk. The high-risk group was characterized by overdose within the past year, higher number of lifetime overdoses (11+), and polysubstance use. Those in the low- and moderate-risk groups did not have an overdose in the last year, while those in the moderate-risk group were more likely to report recent heroin use and polysubstance use than the low-risk group. In addition, history of depression and trauma were associated with the moderate- and high-risk groups. Researchers note risk assessments should account for these factors, not just current opioid use.

Urine drug testing (UDT) can assist with clinical care and is frequently used in opioid use disorder (OUD) care. Researchers investigated the association between opioid-positive UDT results and the use of medications for OUD (MOUD). Utilizing national laboratory testing data and pharmacy and claims data, researchers found that 32.1% of patients tested positive for opioids, but only 9.4% of those who tested positive received MOUD post-test. Even among those with an OUD diagnosis, only 15.7% of those who had a positive test received MOUD. In addition, only 31.0% of all those who received MOUD remained adherent; those who had opioid-positive UDTs had lower odds of remaining adherent (OR=0.51). While the authors note positive UDT can help guide treatment, work is needed to link patients to care and care coordination with support to sustain treatment.

This retrospective cohort study of 399,500 Medicaid-insured opioid-naïve adults evaluated the incidence of new OUD or overdose diagnosis after treatment for acute low back pain. Researchers used data from the Transformed Medicaid Statistical Information System Analytic Files from 25 states between January 2016 and December 2019. The cumulative incidence of OUD or overdose diagnosis was 2.3% at 13 months. Higher-dose opioid initiation (>50 mg of morphine equivalents) was associated with the greatest risk of OUD or overdose (increase by 146.6%), while nonpharmacologic therapies (such as chiropractic care or physical therapy) were associated with reductions in risk of OUD or overdose diagnosis.

In 2022 the FDA warned about tooth decay, cavities, and tooth loss with oral buprenorphine (BUP) formulations. This literature review discusses the evidence, proposed mechanisms, and possible remedies around this issue. The rate of dental adverse events with sublingual BUP/naloxone is 22 per 1,000 person-years, compared to 12 with transdermal BUP, and 11 with naltrexone. Methadone (MTD) is also associated with dental caries (2-3 times the general population), attributed to reduced saliva and delivery in sucrose syrup. Oral BUP formulations contain a citric acid buffer to improve absorption, and the resulting acidic oral environment erodes enamel. People receiving MOUD with BUP or MTD also have increased preference for sweets (which is blocked by naltrexone). Suggested remedies include new buffering systems, fluoride treatments, post-dose water rinsing, and transition to non-oral delivery.

This cohort study of 229,847 Medicaid-enrolled adolescents and young adults with opioid use disorder (OUD) explored the extent to which these individuals receive evidence-based care and progress through key stages of treatment (ie, initiation, engagement, receipt of addiction medication, and retention). Researchers found that approximately half of those enrolled initiated treatment and one-third engaged in care. Overall, 1 in 6 received medication for OUD (46% of those engaged in care), and 1 in 32 had 180 days or more of medication retention. These findings suggest large gaps exist across the OUD cascade of care for adolescents and young adults, highlighting the need for policies and care models that expand medication access and improve treatment retention.

While benzodiazepines remain commonly prescribed medications in the United States, benzodiazepine dispensing decreased nationally by over 25% from 2013 to 2024. Declines in benzodiazepine prescriptions occurred across patient age groups and most prescriber types—including pain medicine specialists, primary care providers, and psychiatrists—while an increasing proportion of benzodiazepines were dispensed by advanced practice providers. Coupled with decreases in the mean benzodiazepine dose dispensed from 2013 to 2024, these patterns suggest greater caution in benzodiazepine prescribing over the last decade.

The National Drug Abuse Treatment Clinical Trials Network (CTN) is an NIH/NIDA-funded clinical research program bringing together academic scientists and community-based treatment providers to conduct research on SUD care. This is a program-level portfolio analysis of all CTN studies funded between 2020 and 2024. During that time, 200 studies were funded by the CTN, with a predominant focus on SUD treatment (particularly OUD) in specialized SUD treatment programs. Over time, additional treatment settings such as primary care have been included. A total of 1,296 peer-reviewed manuscripts have been published citing CTN support.