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The ASAM Weekly for September 16th, 2025

This Week in the ASAM Weekly

This week, we have a collection of science and news articles that touch upon bread-and-butter topics but with a little bit of a twist. First, there’s Fentanyl-Hunter, a heroic name for a platform combining artificial intelligence and a multilayer molecule network (with mass spec) that’s on a continual quest to find fentanyl variants in both biological (ie, urine) and environmental (ie, wastewater) samples (Science Advances). Coming to a city near you! 

Next, nicotine is becoming the new tobacco, but with a harm reduction update. The FDA is planning to fast-track reviews of nicotine pouches, under pressure from the White House, while Big Tobacco is promoting them as less harmful products (Reuters). What this means is that even though we’ve been used to vilifying Big Tobacco, we may have to learn how to work with it. For example, experts are concerned that some smokers still believe nicotine causes cancer, which doesn’t help with tobacco cessation—or selling nicotine pouches either— but Big Tobacco just might be that well-resourced partner with an economic incentive to dispel those nicotine-cancer myths. But let's be careful, such a partnership could open the door to the start of a nicotine-wellness industry (STAT). 

Psychedelics are also still making headlines but in a less splashy, more interesting way. A study found that a single dose of LSD could significantly improve anxiety symptoms, with effects lasting up to 12 weeks (USA Today). Also, several NFL players are getting attention for using psychedelics to self-treat traumatic brain injury. What’s interesting is that the players have an incentive to heal, while the league may see an opportunity to improve its image (WIRED).  

Another frequently discussed aspect of addiction is how the addiction process shows up in many areas of human behavior. A study on repetitive self-harm makes the case that for some people, at some point, the act of self-harm is no longer a choice (PLOS One). Similarly, love has long been described as an addictive experience, in both good and bad ways, but there is an urge in modern life to pathologize and package the pain of love into clinical terms. At some point, though, we have to let things just be and not overpathologize them. Otherwise, we could end up with love songs about DSM* criteria—and nobody wants that (Psychology Today).  

Thanks for reading, 

Nicholas Athanasiou, MD, MBA, DFASAM 
Editor in Chief

with Co-Editors: Brandon Aden, MD, MPH, FASAM; John A. Fromson, MD; Sarah Messmer, MD, FASAM; Jack Woodside, MD

*Diagnostic and Statistical Manual of Mental Disorders

Lead Story 

Machine learning– and multilayer molecular network–assisted screening hunts fentanyl compounds🔓

Science Advances

Fentanyl and its analogs are a global concern, making their accurate identification essential for public health. This article introduces Fentanyl-Hunter, a screening platform that uses a machine learning classifier and multilayer molecular network that covers more than 87% of known fentanyls to select and annotate fentanyl compounds using mass spectrometry (MS). Fentanyl-Hunter identified fentanyl members in biological and environmental samples. During biotransformation, 35 metabolites from four widely consumed fentanyl derivatives were identified. Norfentanyl was the major fentanyl compound in wastewater. Retrospective screening of these biomarkers across more than 605,000 MS files in public datasets revealed fentanyl, sufentanil, norfentanyl, or remifentanil acid in more than 250 samples from eight major countries, indicating the potential widespread presence of fentanyl.

Research and Science 

Higher Incidence of Moderate and Severe Congenital Heart Disease in Patients With Neonatal Abstinence Syndrome 

Neonatal Network 

Opioid receptors develop in the fetal brain, heart, gut, and kidneys between 10 and 20 weeks of gestation. There has been evidence of an association between prenatal opioid exposure and congenital heart disease (CHD). This study used results from a clinical database for 26,284 newborns with neonatal abstinence syndrome (NAS) and found 2.3% had moderate or severe CHD. For neonates without NAS (n=4,968,715), the incidence of moderate or severe CHD was 1.1%. This difference was statistically significant with p<0.001. The types of CHD were atrioventricular septal defect (OR=1.5), aortic coarctation/hypoplastic arch (OR=1.5), double-inlet left ventricle (OR=2.0), pulmonary valve stenosis (OR=2.5), and pulmonary artery stenosis (OR=4.3). The database did not allow accounting for confounding variables such as exposure to other substances. 

Initiation and Dose of Methadone Monotherapy vs Combination Therapy, 2015 to 2023🔓

JAMA Network Open 

Ontario, Canada, has recognized that increased opioid potency has resulted in increased tolerance. In 2020 Ontario changed recommendations for methadone initiation to include increased methadone dosing and addition of slow-release oral morphine (SROM). This study reported methadone dosing patterns between 2015 and 2023 for 73,633 methadone initiation episodes. Prior to 2018 methadone was usually initiated as monotherapy and at doses less than 30 mg. After 2018 an increase in initiation at 30-40 mg was observed. Following the new recommendations in 2020 an increase in combination therapy with SROM was observed. However, for those still receiving methadone monotherapy after 2020, 46% received no dose increase in the first 2 weeks. Although increased methadone dose and combination with SROM was reported the limited uptake of rapid dose titration represents a missed opportunity.

Retention rates and cost-effectiveness of telehealth vs. in-person buprenorphine treatment for opioid use disorder (OUD)

Journal of Substance Use and Addiction Treatment 

Researchers used a retrospective cohort design reviewing patient records to evaluate telehealth versus in-person opioid use disorder (OUD) treatment with buprenorphine. The findings showed no statistically significant difference in retention, although males were much less likely to remain in treatment overall (OR=0.48). An economic evaluation showed an incremental cost of $3,750 for every 1% increase in retention achieved by in-person treatment. The authors advise that telehealth is a cost-effective alternative to in-person treatment, but additional research should evaluate long-term outcomes and the differences in retention found between males and females.   

Learn More 

Exploring the addictive processes in repetitive self-harm through a grounded theory approach: “It always felt like a choice until it didn’t”🔓 

PLOS One 

This study explores to what extent repetitive self-harm can be conceptualized as an addictive behavior. Researchers employed the principles of Constructivist Grounded Theory to guide the collection and analysis of data from 15 adults with current or past experience of repetitive self-harm. Thirteen categories were identified within the data that depicted participants’ journeys with self-harm over time. The study provides a conceptual model of processes that maintain engagement in repetitive self-harm, discussed in relation to addiction literature. Clinical practice could consider working alongside patients to identify where they feel they are within the self-harm cycle in relation to changing their self-harm behaviors. 

Efficacy of a personalised alcohol approach bias modification smartphone app in people accessing outpatient alcohol use disorder treatment: A randomised controlled trial🔓 

Addiction 

Approach bias modification (ApBM) is an intervention in which patients “avoid” alcohol-related images, often in a video game-like setting using a joystick and has been shown to be effective to reduce post-treatment relapse in residential alcohol use disorder (AUD) treatment. In a randomized controlled trial, researchers evaluated a smartphone app-based ApBM intervention among patients receiving outpatient AUD treatment. Across multiple outcomes, including standard drinks consumed during the 4th week of intervention, past-week drinking days, and heavy drinking days at 8- and 16-week follow-ups, researchers did not find a significant difference between intervention and control groups. The only difference noted was past-week standard drinks consumed at 16-week follow-up.  

“There’s a lot of people who love them, so why call ‘em junkies?”: clinician and patient perspectives about words used to describe people who use drugs🔓 

Addiction Science and Clinical Practice 

This is a qualitative study utilizing structured in-person interviews to explore stigmatizing language in the care of people who use drugs in Boston. Thirty-four people, including both clinicians and people who use drugs, were interviewed to evaluate perceptions of person-first language. The Consolidated Framework for Implementation Research was used to frame interview questions, with person-first language being the evidence-based intervention. Participants all agreed that language matters and emphasized the negative impact of stigmatizing language. People who use drugs strongly preferred non-stigmatizing language; however, clinicians expressed more challenges with adopting person-first language consistently. Some clinicians struggled with person-first language due to a lack of familiarity/training, the “wordiness” of some phrases, and difficulty changing learned semantic patterns. Participants highlighted that the actions of providers made a strong impact as well as the words used, and patients easily pick up on negative attitudes.