Guest editorial on street addiction medicine for opioid and stimulant use disorder in unhoused populations, naltrexone and bupropion mediators, and pain management in OUD treatment.

Dr. Katia Cnop of USC Street Medicine examines patient-centered approaches to opioid and stimulant use disorder care for people experiencing unsheltered homelessness, including direct-to-inject buprenorphine protocols, stimulant use disorder treatment, and the barriers that street medicine programs are working to overcome.

Is there anything better than a brand-new federal dataset? The Substance Abuse and Mental Health Services Administration (SAMHSA) recently released findings from the 2025 National Survey on Drug Use and Health (NSDUH) and they do not disappoint. From fresh figures for our slides to encouraging drops in conditions such as alcohol use disorder (AUD) rates, this report gives us the clearest snapshot yet of the post-pandemic behavioral health landscape.

Methamphetamine use disorder remains a significant public health issue with high rates of morbidity and mortality and the absence of any United States Food and Drug Administration (FDA)-approved treatments. Therefore, the original report from the NIDA Clinical Trials Network (CTN) ADAPT-2 trial was an important milestone, demonstrating that extended-release naltrexone plus bupropion outperformed placebo in adults with moderate to severe methamphetamine use disorder. Yet, overall improvement remained modest, with only 16.5% of participants meeting the initial treatment response threshold.

Methamphetamine use disorder remains a significant public health issue with high rates of morbidity and mortality and the absence of any United States Food and Drug Administration (FDA)-approved treatments.

Alcohol is our lead this week, anchored by a compelling new study tracking "Trends in Alcohol-Related Deaths in the United States Over 55 Years." While recent 2020s data offered some encouraging signals regarding use and impact, this long-term analysis reveals that alcohol-related mortality has increased substantially over more than five decades, with specific demographics bearing a disproportionate burden.

Initiating buprenorphine for opioid use disorder (OUD) in outpatient settings is more difficult for patients using fentanyl. There are research and published literature supporting this trend.

Explore how long-acting injectable buprenorphine (LAIB) provides a barrier-free way to initiate OUD treatment for patients using fentanyl.

From the rescheduling of cannabis and the surging prevalence of nicotine pouches like Zyn, to the structural setbacks face-to-face with the alcohol industry, our field is moving at a breakneck pace.

One last commentary as EIC.