This Week in Addiction Medicine from ASAM

Lead: Medication Availability for Alcohol Use Disorder in Substance Use Disorder Treatment Facilities

Medication Availability for Alcohol Use Disorder in Substance Use Disorder Treatment Facilities
JAMA Network Open
This study examined the availability of medications for alcohol use disorder (MAUD) in SUD treatment facilities (SUDTF) from 2017 to 2023.  Data was obtained from SAMSA’s Mental Health and Addiction Treatment Tracking Repository. The percentage of counties with a SUDTF offering MAUD increased from 34% in 2017 to 50% in 2021. This increase leveled out between 2021 and 2023 perhaps related to the pandemic. Counties with a MAUD-offering facility were more likely to be metropolitan (57% vs 25%, p<.001) with substantially more population (mean 220,100 vs 26,650, p<.001), and fewer uninsured residents (8.5% vs 10.7, p<.001).  They call for policies supporting MAUD-offering facilities, particularly in underserved counties.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
 

Lead: Public Views About Opioid Overdose and People With Opioid Use Disorder

Public Views About Opioid Overdose and People With Opioid Use Disorder
JAMA Network Open
This study completed a national web-based survey of 1552 adults in the United States in April 2025 to assess perceptions of opioid overdose deaths and opinions of people who use opioids. Those who responded to the survey primarily identified as female (60.5%) and aged 30-44 (33.7%). Political views varied, with 28.9% conservatives, 39.6% moderates, and 31.5% liberals. Most respondents viewed opioid overdose deaths as serious (88.2%). Respondents felt that people who use opioids (81%) and pharmaceutical companies (72.7%) were most responsible for reducing overdose deaths, with more liberals identifying pharmaceutical companies as responsible while moderates and conservatives more often identified individuals as responsible. 38.3% of respondents reported they were unwilling to have a person with OUD as a neighbor and 58.4% were unwilling to have a person with OUD marry into their family, with higher percentages of conservatives than liberals endorsing these beliefs.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Did the illicit fentanyl trade experience a supply shock?

Did the illicit fentanyl trade experience a supply shock?
Science
In the United States overdose deaths (ODDs) from synthetic opioids peaked in mid-2023 and then began a sharp decline decreasing by over one third by the end of 2024. One possible explanation is a decrease in fentanyl supply. The purity of fentanyl powder rose in 2022, cresting at 25% in early 2023, but by the end of 2024 purity had fallen to 11%. From 2019 to 2024 the rate of ODDs correlated with the purity of fentanyl in both powder and pills. Drug seizures also peaked in early 2023 and then decreased by 37% in 2024. Analysis of Reddit posts by drug users found increased mentions of “drought” in 2023 that remained high at the end of 2024. All these indicators suggest a reduction in fentanyl supply beginning in 2023. In 2023 China took aggressive action against suppliers of synthetic opioid precursor chemicals, likely a result of meetings between Presidents Biden and Xi. This suggests international cooperation can help reduce ODDs. 
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Barriers to Buprenorphine Initiation in Patients Using Fentanyl

Barriers to Buprenorphine Initiation in Patients Using Fentanyl
JAMA Network Open
This is a survey study of 396 buprenorphine-prescribing clinicians in the US to determine if they faced problems initiating buprenorphine among patients using fentanyl, and whether their practice had changed as a result. Participants were selected from a stratified random sample of X-waivered clinicians registered with the DEA who had prescribed buprenorphine in 2022, with representation across all regions nationally. 72.8% of participants reported difficulty with buprenorphine initiation (either precipitated and/or prolonged withdrawal). Clinicians with waivers to treat larger numbers of patients, those reporting fentanyl use by their patients, and those in outpatient settings were more likely to report challenges with buprenorphine initiation. 67.3% of participants reported they had modified their standard buprenorphine treatment protocols for patients using fentanyl.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Productivity Losses From Substance Use Disorder in the U.S. in 2023

Productivity Losses From Substance Use Disorder in the U.S. in 2023
American Journal of Preventive Medicine
Information on morbidity-related productivity losses attributable to substance use disorder is limited. This study estimates morbidity-related productivity losses attributable to substance use disorder among U.S. adults aged ≥18 years in 2023. It found that total morbidity-related productivity losses attributable to substance use disorder in the U.S. are substantial, amounting to $92.65 billion in 2023. Inability to work cost accounted for $45.25 billion, followed by absenteeism cost of $25.65 billion, presenteeism cost of $12.06 billion, and cost of household productivity loss of $9.68 billion. Given that these estimates depend on the prevalence of substance use disorder and the amount of lost productive time, evidence-based prevention efforts and policies addressing them can help reduce these losses.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Expanding Access to Buprenorphine and Methadone: Global Perspectives and Policy Recommendations

Expanding Access to Buprenorphine and Methadone: Global Perspectives and Policy Recommendations
Substance Use and Addiction Journal
This is a narrative review of methadone and buprenorphine regulations, prescriber eligibility, dispensing models, and coverage across eight countries: the United States, Canada, the United Kingdom, Russia, France, Iran, Australia, and Portugal. The study identified several key barriers to MOUD: requirements for daily supervised dosing, restricted community prescribing, and stigmatizing drug scheduling. The authors highlight policies that improved MOUD access without compromising safety such as: 1) community pharmacy dispensing supports in the U.K. and Australia, 2) liberal buprenorphine prescribing in primary care in France, and 3) decriminalization and expansion of low-threshold public health models in Portugal and Iran.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Very Low Nicotine Content Cigarettes for Smoking Cessation: Examining a Facilitated Extinction Approach and Dosing Schedule

Very Low Nicotine Content Cigarettes for Smoking Cessation: Examining a Facilitated Extinction Approach and Dosing Schedule
Drug and Alcohol Dependence
Very low nicotine cigarettes (VLNC, 0.4 mg nicotine/g tobacco) have been shown to reduce smoking behavior when compared to normal nicotine cigarettes (NNC,17 mg nicotine/g tobacco). Participants (n=208) were randomly assigned to 4 experimental groups, immediate versus gradual (over 5 weeks) transition to VLNC, and standard counseling versus facilitated extinction counseling (weekly for 5 weeks). Facilitated extinction had participants smoke only in relevant contexts (e.g., places, affects, triggers). The immediate nicotine reduction group reported less smoking satisfaction and lower completion rates (72% immediate reduction versus 88% gradual reduction, p=.02). Abstinence (biochemically verified) at 2 months post study was 29%. There were no significant differences between the 4 study groups. VLNC were beneficial in smoking cessation.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Fatal Opioid Overdoses by Historical and Contemporary Neighborhood-Level Structural Racism

Fatal Opioid Overdoses by Historical and Contemporary Neighborhood-Level Structural Racism🔓
JAMA Health Forum 
This cross-sectional study of 796 census tracts prior to the COVID-19 pandemic (2017-2019) and 792 census tracts during the COVID-19 pandemic (2020-2022) in Chicago, Illinois, assessed the extent to which there is a spatial association between neighborhood-level structural racism and opioid-involved overdose deaths. Researchers found that neighborhoods exposed to high levels of structural racism in the past (historical redlining) and present (contemporary segregation) had the highest fatal overdose incidence rates before the COVID-19 pandemic (2017-2019). Neighborhoods that experienced high levels of contemporary racism had the highest fatal overdose incidence rates during the pandemic (2020-2022). 
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM
 

Lead: State Laws Banning Prior Authorization For Medications For Opioid Use Disorder Increased Substantially, 2015–23

State Laws Banning Prior Authorization For Medications For Opioid Use Disorder Increased Substantially, 2015–23
Health Affairs
While medications for opioid use disorder (MOUD) is effective treatment, most patients with OUD don’t receive it and prior authorization (PA) has been a barrier to access. Researchers looked at state policies trying to address this barrier, specifically for private health insurance, between 2015 and 2022. Some states adopted “full prohibitions” against PAs while others adopted “partial prohibitions” that allowed PA under some circumstances. Overall, the number of states with at least some prohibition increased from 2 in 2015 to 22 in 2023. In addition, 7 states adopted “full prohibitions” initially, while 15 adopted “partial prohibitions”, with 4 of those 15 transitioning to “full prohibitions” later. Additional research will be needed to assess the impact of these prohibitions, but this study elucidates the current landscape of policy.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM

Lead: Rapid vs Standard Induction to Injectable Extended-Release Buprenorphine

Rapid vs Standard Induction to Injectable Extended-Release Buprenorphine
JAMA Network
This industry-sponsored, multicenter, open-label randomized clinical trial with 729 participants, assessed if  rapid induction (RI) for initiating extended-release buprenorphine is as safe and effective as standard induction (SI) in individuals who inject opioids or use fentanyl.  RI was well tolerated and had higher retention than SI at extended-release buprenorphine injection 2 overall and in fentanyl positive participants. Administering the second extended-release buprenorphine injection 1 week after the first was well tolerated in both the RI arm and SI arm. These findings suggest support RI for extended-release buprenorphine induction in high-risk patients and demonstrate the feasibility of administering the first 2 doses at least 1 week apart.
 
Read this issue of the ASAM Weekly
Subscribe to the ASAM Weekly
Visit ASAM