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The ASAM Weekly for October 28th, 2025

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This Week in the ASAM Weekly

Opioid overdose deaths have dropped significantly since a peak in 2023, encouraging many in the addiction treatment field to focus on what we’ve done right. But what if focusing (too much) on opioid overdose deaths is actually something we’ve done wrong (The Guardian)?

Overdose deaths are not the only negative outcome of opioid use disorder (OUD). It can also result in a multitude of medical complications, from cerebral aneurysms (Drug and Alcohol Dependence) to infective endocarditis (Addiction Science and Clinical Practice) and even hypoxic brain injury. Some experts estimate that millions of Americans have been affected by “such injuries, [which] manifest in quiet but life-altering ways” (The Guardian).

Furthermore, not all overdose deaths are caused by opioids. Stimulants increasingly play a role in overdose morbidity and mortality, but unlike opioids, we do not have an overdose reversal agent like naloxone or FDA-approved medications like buprenorphine. Focusing on one drug or substance leaves us vulnerable to another (Fort Worth Star-Telegram).

So while we focus on (and build upon) the successes of opioid overdose rates, we should continue to emphasize the fundamentals of a good addiction crisis response. For example, harm reduction services are also access points for addiction care (AJPM), and low-threshold treatment is beneficial for all kinds of people and all kinds of substance use disorders (SUDs) (Journal of Addiction Medicine). And both help reduce overdose deaths. 

Ultimately, an overemphasis on opioid overdose deaths could lead to a normalization effect for future addiction crises. ASAM President Stephen Taylor recently advocated on behalf of addiction treatment and forewarned about the dangers of gambling addiction, for which suicidality is a real concern (STAT). But without overdose deaths, how much of the public will pay attention this time? For now, that attention seems to be driven by external factors, like the popularity of the NBA and the infamy of the mafia (ABC News).

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

Lead Story 

Ultra-processed food addiction in a nationally representative sample of older adults in the USA 🔓

Addiction

Using a cross-sectional online and telephone survey of a nationally representative sample of older adults (aged 50 – 80 years) in the US, this study examined the prevalence of ultra-processed food addiction (UPFA) in older US adults and its association with various health domains. Researchers found that UPFA appears to be prevalent among older adults in the US, particularly among women who were in adolescence and early adulthood when the nutrient quality of the US food supply worsened. Addictive patterns of UPF intake appear to be associated with poorer physical health, mental health, and social well-being.

Research and Science

Experiences of a lived experience recovery organisation for those in abstinence-based substance use recovery: a thematic analysis 🔓

Substance Abuse Treatment, Prevention, and Policy

This study examined the role of a lived experience recovery organization (LERO) in Yorkshire, UK, in 12 participants pursuing abstinence-based recovery from SUDs. These individuals engaged in 15 weekly, semi-structured interviews about the LERO. A total of eight themes were identified. Feeling supported in recovery was a common theme with participants feeling the support was deeper and more sincere than in clinical treatment settings. The participants felt the LERO gave them a sense of community through shared experience and helped them regain social and emotional skills. They experienced the LERO as being fun in contrast to traditional treatment that “…can be quite serious.” The participants also believed the LERO helped to prevent relapse by filling time. The authors concluded that the LERO provided benefits alongside traditional clinical treatment.

Heat exposure and drug overdose mortality in the USA

Addiction

Heat exposure is known to be associated with an increase in all-cause mortality. Prior observational data suggest an association between heat exposure and increased overdose mortality as well. Given rising temperatures with climate change, researchers evaluated the association between overdose mortality and average monthly heat index in the United States between 1999 and 2020. Researchers found a one-degree Celsius increase was associated with a 0.0098 per 100,000 population increase in overdose mortality. Heat-associated increases in death due to opioids, cocaine, and psychostimulants were all statistically significant. The researchers estimated 150 excess drug overdose deaths per year due to heat exposure. 

Linkage to substance use disorder treatment through syringe services programs and the criminal legal system: A Cross-Sectional Study 🔓

American Journal of Preventive Medicine

This is a cross-sectional study of 835 people who use drugs in San Francisco between September 2023 and September 2024. Researchers surveyed participants’ harm reduction utilization at syringe services programs (SSPs), criminal legal system (CLS) involvement, and SUD treatment engagement. Individuals with recent SSP utilization had a significantly higher likelihood of SUD treatment. Individuals with recent CLS involvement did not have any higher likelihood of SUD treatment than those who did not. The study suggests SSPs are an important opportunity for linkage to care for people who use drugs.

Inpatient addiction care is associated with increased vaccinations, medication for opioid use disorder and naloxone prescribing among patients with infective endocarditis in a rural state 🔓

Addiction Science and Clinical Practice

This is a retrospective study of clinical and health service utilization data for 99 patients with injection drug use-associated infective endocarditis before and after an Integrated Medication for Addiction Treatment (IMAT) program was implemented. The study took place at a tertiary care hospital in Portland, Maine, with a large rural catchment area from January 2013 to January 2019. Primary outcomes examined included emergency department (ED) visits within 90 days and hospital readmissions within 30 days. Secondary outcomes included medication for OUD (MOUD) and naloxone prescriptions and vaccine receipt. There were no statistically significant differences in ED visits or readmission rates. However, the IMAT program was associated with a significant increase in MOUD and naloxone prescribing, hepatitis A vaccination, and Tdap vaccination.

Learn More

Evaluating the Impact of Low Threshold Bridge Clinic Expansion on Equitable Access to Substance Use Disorder Treatment

Journal of Addiction Medicine

Racial inequities in SUD treatment, and specifically buprenorphine treatment, contribute to overdose inequities. Bridge Clinics are a low-threshold, transitional treatment model that may improve treatment access. This report assesses the change in visit volume for Black and Hispanic patients and those with limited English proficiency (LEP) after the implementation of the Bridge Clinic expansion across four distinct sites. Comparing 2021 to 2023, total visits increased from 5,323 to 10,350 and unique patients increased from 1,893 to 3,316. Annual visits increased from 437 to 1,151 visits for Black patients; 566 to 1,609 for Hispanic patients; and 96 to 265 for LEP patients. The percent of visits grew significantly for Black, Hispanic, and LEP patients. Expanding low-barrier Bridge Clinics may increase SUD treatment visits for Black and Hispanic patients and those with LEP.

The association of opioid use disorder with cerebral aneurysm rupture

Drug and Alcohol Dependence

This study used electronic health record data from 142 health systems to examine the association between OUD and risk for cerebral aneurysm rupture. Patients with OUD (n=584,125) were matched with 1.8 million controls without OUD. Those with OUD had a higher risk of cerebral aneurysm rupture at a one-year follow-up than those without OUD (aHR 1.54, 95% CI 1.34-1.76). Among those with OUD 17% had been treated with MOUD and had a lower one-year risk of cerebral aneurysm rupture than those not treated with MOUD (aHR 0.75, 95% CI 0.55-1.01). This result for MOUD treatment was not quite statistically significant. The authors concluded that OUD is a significant risk factor for cerebral aneurysm rupture and that MOUD treatment offers some protection.

Trends in Dispensed Gabapentin Prescriptions in the United States, 2010 to 2024

Annals of Internal Medicine

Gabapentin prescribing increased more than three-fold between 2002 and 2015, with off-label use for neuropathic pain at least partially contributing. While gabapentin may often be used as an alternative to opioids for pain, it is not without side effects. Since 2016, changes in policy may have affected gabapentin prescribing; this study assessed prescribing trends between 2010 and 2024. Between 2010 and 2016 both the number of prescriptions and number of patients prescribed gabapentin more than doubled, and while both continued to increase between 2016 and 2024, they did so at a much slower rate of increase. Notably, prescribing to those aged 65 years and older increased more than among other age groups during this period.