The ASAM Weekly for August 11, 2026
Street Addiction Medicine: Bringing a Patient-Centered Approach for Opioid and Stimulant Use Disorder to the Unhoused
By Katia Cnop, DO
Barriers to care for unhoused persons are steep, multifaceted, and both individual and structural. These barriers compound into late and more severe clinical presentations with subsequent fragmented follow-up, including access to addiction medicine services.
Street medicine provides high-quality, longitudinal care comparable to that of a primary care clinic, while bridging longstanding gaps in health care access for this marginalized population. This reimbursable model has a simple ethos: we go to the people. This means utilizing a multidisciplinary team, often comprised of medical providers, nurses, community health workers, and social workers to provide comprehensive health care on the street, in patients’ lived environments. USC Street Medicine has emerged as a leader in the street medicine field, and our approach to address street medicine will be discussed in this piece.
Addiction
Cocaine use disorder (CUD) is an increasingly widespread concern worldwide. Various pharmacological treatments have been investigated for CUD, but their efficacy remains unclear, and none have been licensed for treatment. This systematic review and network meta-analysis assessed the comparative effectiveness, safety, and acceptability of pharmacological interventions for the treatment of CUD and prevention of relapse. The authors found no convincing evidence for the effectiveness of any pharmacological treatments for cocaine use disorder.
Journal of Psychopharmacology
Researchers conducted a secondary analysis of the Accelerated Development of Additive Pharmacotherapy Treatment for methamphetamine disorder (ADAPT-2) trial to assess potential mediators of the impact of naltrexone + bupropion (NTX-BUP) on methamphetamine use disorder (MUD). In the original study, NTX-BUP was associated with decreased methamphetamine use defined by 3 negative toxicology screens, as well as decrease in cravings, depressive symptoms, and impulsivity. In this analysis, the researchers found that the decrease in cravings was the primary mediator for decrease in self-reported use (56%) and negative toxicology (45%). The indirect effects via depressive symptoms and impulsivity were nonsignificant and smaller. The authors note that reduction in cravings could be a potential surrogate for assessing treatments and a potential target for treatment.
Targeting pain to improve opioid use disorder treatment outcomes: Results of a randomized trial
Journal of Substance Use & Addiction Treatment
This is a randomized controlled trial comparing the delivery of a telehealth Psychosocial Pain Management Intervention (PPMI, n=98) to Enhanced Usual Care (EUC, n=102) for patients with opioid use disorder on buprenorphine who reported pain within the last 3 months. The PPMI intervention uses elements of cognitive behavioral therapy for pain management and relapse prevention; EUC included non-specific aspects of pain management delivered over 2 brief remote sessions, including brochures on chronic pain and buprenorphine treatment, in addition to standard substance use counseling and buprenorphine treatment. The primary outcome was retention on buprenorphine at 3-month follow-up; secondary outcomes were retention at 12 months, substance use at 3 and 12 months, and pain levels and pain-related functioning at 3 and 12 months. There was not a statistically significant difference in 3-month retention, pain outcomes, or substance-related outcomes in the intent-to-treat analysis. However, in the per-protocol sample (n=137), there was a statistically significant difference in 3-month retention (20.2% not retained in the EUC group compared to 7.5% in the PPMI group).
Alcohol
Sex differences in the escalation of drinking after brief abstinence have been documented. The possibility that changes in alcohol metabolism may explain these differences has not been previously examined. This study tested whether short-term abstinence alters the alcohol elimination rate (AER) across sex and compared 3 methods for its estimation. Sex differences in alcohol consumption following short-term abstinence are likely not explained by changes in AER. When comparing methodologies, the selection of a methodology should be consistent within analyses and selected based on experimental design.
JAMA Network Open
This is a prospective cohort study of 194 individuals enrolled in an opioid treatment program in an American Indian Health Facility in Washington state from June 2024 to December 2025. Inclusion criteria were as follows: age 25 or older, had a cervix, and either overdue for cervical cancer screening or unsure of their last screening. Of the study participants, 174 were eligible for cervical cancer screening; of this group, 90.8% completed HPV self-collection. Of those who completed screening, 81% had HPV-negative results, and there were no unsatisfactory test results. Thirty patients had HPV-positive results; of this group, 12 completed follow-up testing, 16 are currently engaged in completing follow-up, and 2 were lost to follow-up.
Drug and Alcohol Dependence
For this study, researchers used data from the TriNetX Research Network, a global electronic health record network of nearly 2 million patients. Patients with type 2 diabetes mellitus, initiating GLP-1 RA therapy (n=614,333) were selected, of which 4,217 had a previous diagnosis of cannabis use or cannabis use disorder (CUD). With a median 2.6-year follow-up, cannabis was associated with increased mortality (HR 1.64, p<.001), increased major adverse cardiac events (HR 1.42, p<.001), and major adverse kidney events (HR 1.55, p<.001). Patients with CUD had a higher mortality than those with non-disordered cannabis use (HR 2.20) indicating a dose response effect. GLP-1 RA therapy is known to improve mortality (-12%), cardiovascular events (-14%), and kidney outcomes (-18%); however, cannabis use may diminish these benefits.
Substance Abuse Treatment, Prevention, and Policy
In this literature review of the treatment of insomnia in OUD, 15 studies met inclusion criteria. Studies varied widely in intervention, timing (early versus late recovery), and outcomes, making comparison difficult. During detoxification, opioid agonists (eg, extended-release tramadol) improved insomnia. One study from China found that neurotransmitter precursors (such as tyrosine) improved insomnia in detoxified patients with OUD. Naltrexone was associated with an increase in insomnia known as “naltrexone sleeplessness.” Yoga did not improve insomnia. Improvements in insomnia were seen with exposure therapy for patients with OUD and PTSD. Guanfacine (an alpha agonist similar to clonidine) increased insomnia.
Addiction
There is good evidence that harm reduction interventions (HRI) and medications for opioid use disorders (MOUD) reduce risk of bloodborne infections including HIV and hepatitis C (HCV), but it is not clear that they will reduce risk of skin and soft tissue infections (SSTIs). Researchers conducted a systematic review and meta-analysis of HRIs to assess potential impact on SSTIs. Overall, the results were mixed and inconsistent, without clear evidence of reducing SSTI risk. The researchers note methodological weakness of some of the studies and narrow focus on SSTIs for interventions. Given the behaviors associated with SSTI risk, which differ from risk for HIV and HCV, additional research is needed including with interventions focused on reducing SSTI risk.
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- VA launches trial to test GLP-1 medication for alcohol use disorder in veterans 🔓 Military Times
- What else do we lose when people give up booze? The New York Times
- Let science decide psychedelic therapy’s future The Boston Globe
- The music festival trying to make drug use safer The New York Times
- These NYC centers allow heroin and crack use in-house. Nearly 5 years in, is it helping? 🔓 CBS News
- Hospital staff said he was faking it and released him. He died from an overdose soon after 🔓 National Public Radio (NPR)