American Society of Addiciton Medicine

The ASAM Weekly for June 4th, 2024

by ASAM Weekly Editors

This Week in the ASAM Weekly

The lead article this week presents a historical perspective to the nascent culture of fentanyl smoking in San Francisco: a result of drug market adaptations and innovations in social behavior. Inherent in this is a risks-benefits assessment, which although understudied, will likely drive the spread of this culture to the rest of the country (Plos One). This may also be related to the spread of fentanyl distribution, which was initially concentrated east of the Mississippi, but is now largely dominated in Western states (International Journal of Drug Policy).

Several articles demonstrate the importance of prevention. A commentary from the American Journal of Psychiatry explores predictors of cannabis use disorder and the concerns we should focus on to reduce the risks related to adolescent use. A research letter in JAMA Internal Medicine raises awareness that cannabis poisonings nearly doubled in older adults after legalization in Ontario, Canada. And an editorial in the Canadian Journal of Emergency Medicine advocates for better prevention efforts around driving off-road vehicles while under the influence in light of cannabis legalization in Canada.

These articles touch upon the effectiveness of prevention, which raises an interesting consideration when one of the biggest of Big Tobacco companies petitions the FDA to monitor the potential harms of a synthetic nicotine analogues (Reuters). 

Thanks for reading,

Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM, Jack Woodside, MD, John A. Fromson, MD

Continuing Education Committee

The Continuing Education Committee is seeking additional members to diversify the committee's professional representation in order to provide interprofessional education. Call for applications is open until July 1, 2024.

Lead Story

Innovation and adaptation: The rise of a fentanyl smoking culture in San Francisco 🔓

Plos One

This is a qualitative study describing the growing practice in the San Francisco area of smoking rather than injecting fentanyl. Fentanyl salts are stable up to 350°C making heating and inhalation more effective than for heroin. Some of the increase in smoking is driven by users’ difficulty finding accessible veins. There is also the perception that smoking presents less of a risk of overdose compared to injection. It is unclear if smoking is safer and overdose deaths continue to rise in San Francisco. Over time a brown residue accumulates that contains a high concentration of drug. The smoking equipment is often used for both methamphetamine and fentanyl so this residue contains an unknown mixture of the history of the drugs consumed. The residue is valued for potency but presents a new overdose risk due to the unknown amounts of drugs it contains.

ASAM Clinical Algorithm Subcommittee

The ASAM Clinical Algorithm Subcommittee is looking for members to collaborate on refining the 4th Edition clinical algorithms for ASAM Criteria-based assessment tools! Click the link below to learn more and apply.

Applications Deadline Extension: June 30, 2024 

Research and Science

National and regional trends in fentanyl seizures in the United States, 2017–2023

International Journal of Drug Policy

Given previous studies have demonstrated a relationship between drug seizures and overdose rates this study examined trends in fentanyl seizures between 2017 and 2023 by region for possible public health implications. Overall, the number of fentanyl seizures increased by 1703% between 2017 and 2023, and while in 2017 the seizure rates were lowest in the West, they increased the most in this region, accounting for 42.8% of all seizures in 2023. The percentage of fentanyl seized that was in pill form increased over the study period, with the majority of pill seizures occurring in the West (74.3%). Of note, overdoses involving pill form of fentanyl tripled in the west over this time period. The authors note using drug seizure data in semi-rapid time could indicate potential locales or ‘hot spots’ for targeted intervention. 

Prescription Opioid Dose Change Prior to Fatal Opioid-Detected Overdose

Journal of Studies on Alcohol and Drugs

The authors looked at cases of opioid overdose deaths in which the person had received a prescription for opioids in 30 days prior to death to examine patterns of opioid prescribing as potential risk for overdose. Overall, they found that 41.9% of decedents had the prescribed opioid in their system, while the other 58.1% had only non-prescribed opioids. Overall, the authors found the prescribed opioid morphine milligram equivalent (MME) daily dose increased exponentially in months prior to death, but there was significant variability in the trajectories. Given the findings, the authors note risk of overdose is multifactorial and additional research is needed to better understand potential relationship between opioid dosing patterns and risk of overdose. 

Effect of paternal-maternal parenting styles on college students’ internet addiction of different genders: The mediating role of life satisfaction 🔓

Plos One

This study aimed to understand the current situation of paternal-maternal parenting style, life satisfaction, and internet addiction among college students and explored the influence of paternal-maternal parenting styles and life satisfaction on the internet addiction of male and female college students. A questionnaire survey was administered to 967 college students in China. The study reveals that the mediating effect of life satisfaction on parenting styles and internet addiction among college students is influenced by gender, and the relationship between different parenting styles and internet addiction also varies. These findings indicate that paying attention to the role of the family, especially the parenting style of fathers, is crucial for preventing internet addiction in the future. Prevention and intervention should be treated differently for male and female students.


CO*RE REMS/ASAM Striking a Balance: Podcast Series

This free series consists of three 45-minute podcasts designed to empower clinicians to confidently manage opioid analgesics, from patient assessment and therapy initiation to modification, discontinuation, and patient counseling. 

Learn More

Alcohol and drug impairment in off-road vehicle crashes 🔓

Canadian Journal of Emergency Medicine

This editorial accompanies a study of the involvement of substances in off road vehicle (ORV) injuries in Nova Scotia, Canada. Off road vehicles include all-terrain vehicles (ATVs) and snowmobiles. The study found that 85% of those injured tested positive for at least one substance. In order of decreasing frequency, the substances were, alcohol (58%), opiates (21%), stimulants (18%), and cannabis (12%). Major trauma due to ORVs in Nova Scotia increased 60% between 2018 and 2022. The author calls for efforts to intoxicated driving of ORVs.

The Developmental Trajectory to Cannabis Use Disorder 🔓

American Journal of Psychiatry

The increase of cannabis use, particularly with the evolution of high potency products, and of cannabis use disorder (CUD) are a growing health care concern. While the harms of adult use and potential medicinal properties of cannabis continue to be debated, it is becoming evident that adolescent cannabis use is a critical window for CUD risk with potential lifelong mental health implications. This article discusses mental health consequences of adolescent cannabis use, factors that contribute to the risk of developing CUD, and what remains unclear in the changing legal landscape of cannabis use. Preclinical models are crucial to provide translational insight about the causal relationship of cannabis to CUD-related phenotypes and conclude by highlighting opportunities for clinicians and allied professionals to engage in addressing adolescent cannabis use.

Edible Cannabis Legalization and Cannabis Poisonings in Older Adults 🔓


This retrospective, population-based, cross-sectional study examined the association between edible cannabis legalization and emergency department visits for cannabis poisoning in older adults residing in Ontario, Canada. The findings align with national US data showing that edible cannabis accounts for an increasing proportion of cannabis poisoning in older adults. Overall, this study shows the health outcomes of cannabis legalization and commercialization for older adults and highlights the consequences associated with edible cannabis. Jurisdictions with legalized cannabis should consider measures to mitigate unintentional exposure in older adults and age-specific dosing guidance.

Empowering Pharmacists: Strategies for Addressing the Opioid Crisis through a Public Health Lens 🔓


This commentary describes ways in which pharmacists can play a role in addressing the opioid crisis. Pharmacists can provide education about the risks of opioids and discourage their use. They can deliver naloxone training and distribute naloxone. It is important to identify and address stigma and implicit bias in pharmacy personnel. It encourages pharmacists to engage with policymakers and help guide legislation. Legislative changes could allow pharmacists to distribute sterile syringes and initiate MAT. Pharmacists can play an important role in public health research.