The ASAM Weekly for September 9th, 2025
This Week in the ASAM Weekly
There are many layers across which substance use affects people: statistical, geographical, individual, societal, familial, criminal, tribal, personal, financial, cultural, political, institutional, etc. Obviously, no two layers are the same and because of this, the US is experiencing a shift in narratives around addiction.
In Boston, a discussion about mandatory treatment is re-emerging. Harm reductionists point to a huge drop in overdose deaths, while parents point to homelessness and drug use at their doorsteps (WBUR). Keith Humphreys writes in The New York Times that mandatory treatment can be a realpolitik path towards relief, when balancing individual and societal rights, but only if enough resources are provided. (In an ideal world, we’d also consider the family’s rights when debating the rights of the individual vs. society.)
Stigma, as we know it, shows up in many of the layers mentioned above. A study evaluating correctional officers and OUD treatment highlights the effectiveness of lived-experience narratives shaping attitudes, but the study may not have considered a more impactful influence—the narrative of one’s tribe (ie, chain of command) (Health & Justice). This is important because one’s sense of identity is so closely shaped by stigma that the effects of both stigma and addiction can be devastatingly insidious (USA Today).
On another layer, the individual’s sense of well-being is often at odds with the need for financial well-being. Alcohol pricing policy can be incredibly effective but is unlikely to be embraced in the current cultural mood of the US (The Lancet Public Health). And one should question the institutional reasons why HHS pulled a study that strengthened the link between alcohol and cancer—much to the delight of the alcohol industry (The New York Times).
As addiction specialists, we have a responsibility to shape the narratives around addiction. Whether we’re saying it’s “a brain disease” or “just like any other chronic illness,” we must be mindful of the many layers across which people experience substance use. Not all talking points will work on all layers, all the time. But as Lipi Roy alludes, there might be a more universal experience from which to frame our discussions:
“All people who use [substances] deserve to do so safely.” (Forbes)
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
Evaluation of a Novel Patient-Centered Methadone Restart Protocol 🔓
JAMA Network Open
Restarting methadone for patients who have had a gap in treatment is often a frustratingly slow process for both the patient and provider. This cohort study examined outcomes for patients of a public, safety-net opioid treatment program before (n=786 patients) and after (n=780 patients) implementation of a 2022 clinical protocol focused on individualized methadone restart doses based on opioid tolerance. Preimplementation restart doses were 32.8% lower than the last prior methadone dose, whereas postimplementation restart doses were only 3.4% lower than the last prior methadone dose. There was no significant change in patient safety (emergency department visits within 7 days after restart and all-cause mortality within 7 and 90 days after restart) or 90-day retention in care.
Research and Science
The Lancet Public Health
Using a microsimulation model, this study aimed to simulate the effect of beverage-specific price increases on alcohol use within subgroups of the adult US population defined by sex, educational attainment, and alcohol use category. Four national policy scenarios were compared with a reference scenario without price change in 2019: a uniform price increase of 10% (scenario 1), a uniform price increase of 30% (scenario 2), a beverage-specific price increase of 30% for beer and spirits and 10% for wine (scenario 3), and a beverage-specific price increase of 50% for beer and spirits and 10% for wine (scenario 4). Scenario 4 had the strongest effect on alcohol use overall and most effectively reduced consumption in high-risk groups; males and females with high alcohol use and low educational attainment reduced their alcohol use by –17.30%.
Pediatrics
This Clinical Report from the American Academy of Pediatrics summarizes existing literature and provides information on how to screen for symptoms of iatrogenic opioid withdrawal as well as mechanisms for opioid withdrawal prevention in children. Opioid use is prevalent in both pediatric inpatient and outpatient settings. Abrupt discontinuation of opioids can lead to drug-specific withdrawal symptoms. For patients receiving prolonged opioid therapy (more than 5 days), it is best to develop a plan to taper the opioid therapy while minimizing withdrawal symptoms. The plan should include a patient's support structure, eg, family member, prescribing physician, primary care pediatrician, and other care team members such as physical and emotional therapists. Use of an opioid-tapering strategy should be employed alongside a validated score for assessing withdrawal symptoms. Nonopioid adjuncts should be used for analgesia, when possible, to minimize opioid exposure.
Health and Justice
Access to medications for opioid use disorder (MOUD) remains a critical issue in the criminal legal system (CLS). This study examined the effectiveness of informational and narrative messages to address misinformation and improve attitudes toward MOUD among CLS professionals. Individuals enrolled across the US (n=502) received one of 4 message conditions: no message control, informational message, first-person narrative message, or dialogue message. Both narrative (first-person and dialogue) messages and informational messages produced an improvement in attitudes toward MOUD, with slightly more improvement from narrative messages. Dialogue messages also increased support for MOUD in the CLS. However, none of the messages significantly decreased negative attitudes toward MOUD, suggesting that additional educational strategies are needed.
Journal of Substance Use and Addiction Treatment
Researchers utilized electronic health records to compare patients with intentional and unintentional overdose and assess for associated psychological and physical health conditions. The researchers found that intentional overdose was associated with past-year alcohol use disorder (OR=1.94), suicidal thoughts and behaviors (OR=3.63), psychiatric disorders (OR=2.92), and involvement of multiple substances in overdose. In addition, patients with intentional overdoses tended to be younger and less likely to have chronic medical conditions. The researchers note these findings could help enlighten the evaluation of patients presenting with nonfatal overdoses and identify those with intentional overdose and thus a higher risk of suicide.
Learn More
Women’s Health
Women suffer negative consequences of alcohol use disorder (AUD) but are less likely to seek treatment compared to men. The researchers conducted a systematic review, including 25 publications, to assess factors associated with women seeking AUD treatment. The authors identified factors at the individual, societal, and organizational levels that influenced uptake of care. Factors hampering initiation of AUD treatment include low perception of need, internalized shame, co-occurring mental health issues, and financial barriers. The authors also note women are more likely to seek care in primary care settings than men and it is important for these settings to identify patients with AUD and have knowledge of treatment options. Finally, the authors support women-focused treatment as a way to reduce barriers.
Drug and Alcohol Dependence
There have been case reports of cerebrovascular incidents in young users of anabolic androgenic steroids (AAS). This study used arterial spin labeling (ASL) MRI to measure cerebral blood flow at the capillary level in 41 weightlifting AAS users and 45 control weightlifters not using AAS. There were no statistically significant differences between the groups in overall cerebral blood flow in gray matter and white matter. However, arterial transit time from the neck to the gray matter shows greater variability in AAS users compared to controls (P<0.001). This variability reflects the efficiency of blood flow to the gray matter and may indicate early vascular dysfunction. The degree of this variability correlated with total years of AAS use. The authors concluded that these findings in AAS users may indicate an increased risk for cerebrovascular pathology.
Journal of Affective Disorders
This study used The FDA Adverse Event Reporting System to identify medications with reports of memory impairment, amnesia, and dementia. The researchers only used reports in which the medication was the primary suspect and calculated the Reporting Odds Ratio to assure the significance of the associations. Many of the medications listed are of interest to addiction medicine practitioners. Gabapentin, pregabalin, and topiramate are associated with memory impairment and amnesia, and pregabalin is associated with dementia. Varenicline and oxycodone are associated with amnesia. Paroxetine is associated with memory impairment, and 8 antidepressants are associated with amnesia. Several benzodiazepines and zolpidem are associated with memory impairment and amnesia. The authors caution that association does not prove causality and that further research is needed to prove the medications are causing the memory disorders.
In the News
Opinion | Forced Drug Treatment Isn’t Horrific. It’s a Relief.
The New York Times
Overdose Deaths Dropped 25%. But There’s Much More To Do🔓
Forbes
Jim Irsay's openness, secrecy about addiction offer lessons🔓
USA Today
More Fentanyl Shows Up in Random Workplace Tests
The Wall Street Journal
Desperate for solutions to addiction crisis, some in Boston call for more involuntary commitments🔓
WBUR
Fortune
Federal Report on Drinking Is Withdrawn
The New York Times
The ASAM Weekly
Editors & Staff
Editor-in-Chief: Nicholas Athanasiou, MD, MBA, DFASAM
Emeritus Editor: William Haning, MD, DFAPA, DFASAM
Publications Chair: Nicholas Athanasiou, MD, MBA, DFASAM
Co-Editors: Brandon
Aden, MD, John A. Fromson, MD, Sarah Messmer, MD, Jack Woodside, MD
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