Â鶹´«Ã½ÔÚÏß

This Week in the Â鶹´«Ã½ÔÚÏß Weekly

Dear readers,

It’s that time of year again when we slow things down here at the Â鶹´«Ã½ÔÚÏß Weekly, re-wrap some of our favorites, and look forward to a new year. This week, we’re providing the top 10 most viewed scientific publications of 2025. 

Thanks for reading, and happy holidays to all!

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

Most Viewed Story of 2025 

🔓

Agency for Healthcare Research and Quality (AHRQ) 

The AHRQ Integration Academy developed the Medications for Opioid Use Disorder Playbook as a practical guide for providing medications for opioid use disorder (MOUD) and immediate care for patients with OUD in primary care and other ambulatory care settings. It is interactive, web-based, and has the latest guidance, tools, resources, and examples that address key aspects of MOUD implementation. The MOUD Quick Start Guide covers the essentials of low-threshold care, while the balance of the Playbook offers more in-depth resources and guidance for those practices interested in working toward more comprehensive, whole-person care. The low-threshold approach ensures immediate access to MOUD, eliminating barriers for both patients and providers. 

Addiction

Buprenorphine labeling identifies 16 mg as the “target dose,” supported by prior evidence that higher doses (≥16 mg) were associated with increased retention in treatment. Studies comparing doses above 16 mg to 16 mg, particularly in the era of fentanyl, have been very limited. The authors conducted a cohort study to look at retention for those receiving 24, 32, and 40 mg compared to 16 mg. Overall, higher doses were associated with increased retention, as follows: 1) 24 mg was more effective than 16 mg at 1 (aOR=1.52) and 18 months (aOR=1.17), 2) 32 mg was more effective than 24 mg at 6 (aOR=1.06), 12 (aOR=1.09), and 18 months (aOR=1.12), and 3) 40 mg was more effective than 24 mg at 12 (aOR=1.10) and 18 months (aOR=1.18). The authors suggest updates to label language and recommendations are prudent, while also supporting more research on long-term treatment with these higher doses.

 ðŸ”“

JAMA Network Open 

Injectable-only buprenorphine protocols represent an exciting new strategy for buprenorphine initiation, particularly in the fentanyl era. In this cohort study, 95 patients with moderate to severe opioid use disorder received care in a low-threshold setting in Seattle. Of patients included in the study, 79% were experiencing homelessness or living in permanent supportive housing. Patients selected a long-acting injectable (LAI) buprenorphine initiation protocol, which included 3 escalating doses of LAI buprenorphine over 3 days, with no sublingual buprenorphine and without cessation of fentanyl/opioid use. Seventy-five percent of the patients completed the protocol, and 64% received a second monthly dose of LAI buprenorphine. 

🔓

JAMA Network Open

The accumulation of fentanyl in fat is likely responsible for the risk of precipitated withdrawal when buprenorphine is initiated. Low-dose initiation (LDI) of buprenorphine attempts to minimize this risk. This retrospective study included 126 individuals making 175 LDI attempts in an outpatient setting. Patients chose either a 4-day or 7-day LDI protocol with buprenorphine monoproduct. Both protocols begin with buprenorphine 0.5 mg, increasing to 8 mg tid. Overall, LDI was successful in 34% of attempts (with no difference between the protocols), and one-month retention on buprenorphine was 21%. Repeated LDI attempts were less likely to be successful (second attempt aOR=0.3). Unhoused people had lower odds of success (OR=0.4). The authors conclude that people with OUD using fentanyl attempting outpatient LDI of buprenorphine had low odds of success. 

The New England Journal of Medicine  

Various providers of treatment for OUD have different goals. Some provide MOUD for protection from overdose and other harms while others pursue a goal of abstinence without the use of medications. The authors propose a cascade of care model that includes this range of goals. In the first stage—protection—MOUD provides immediate protection from overdose and other harms. The next stage—remission from OUD—involves reduction in OUD symptoms and can include MOUD, behavioral therapy, and AA/NA attendance. The final stage— recovery from all SUDs—involves sustained reduction in all SUD symptoms. This final stage includes significant, sustained reduction in the misuse of all substances, improvement in physical health, and improvement in social functioning. Rather than discharging patients for failure to progress towards recovery, providers would encourage patients to progress towards remission and recovery.

🔓

JAMA Network Open 

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 two overall and in fentanyl-positive participants. Administering the second extended-release buprenorphine injection one week after the first was well tolerated in both the RI and SI arms. These findings support RI for extended-release buprenorphine induction in high-risk patients and demonstrate the feasibility of administering the first two doses at least one week apart. 

&²Ô²ú²õ±è;🔓

JAMA Network Open

This cohort study of 11.6 million people who were studied for a median of five years investigated if individuals who have hospital-based (emergency department or hospitalization) care for a cannabis use disorder (CUD) were at increased risk of death. Researchers found that individuals with incident hospital-based care for a CUD were at a 2.8-fold increased risk of death within five years relative to the general population. These results suggest that individuals who require hospital-based care for a CUD may be at increased risk of premature death.

Substance Use and Addiction Journal

Xylazine in the unregulated drug supply produces significant morbidity. This paper describes utilizing a multidisciplinary team to develop inpatient setting protocols to manage patients with xylazine exposure. Protocols developed include the use of scheduled clonidine or tizanidine to manage withdrawal with hold parameters. As there is no FDA-approved immunoassay screen, the authors recommend assuming xylazine exposure in areas with high prevalence and limited testing. The team also developed guidelines for cases in which surgical interventions would be considered, when to culture wounds, antibiotic usage, and consistent wound care based on size and clinical characteristics. In addition, they developed standardized discharge instructions, including referral to substance use disorder treatment, harm reduction, and education around xylazine test strip use.

🔓

JAMA Psychiatry 

This randomized clinical trial explored if glucagon-like peptide 1 (GLP-1) receptor agonist semaglutide reduces alcohol consumption and craving in adults with alcohol use disorder (AUD). Relative to placebo, low-dose semaglutide reduced the amount of alcohol consumed during a posttreatment laboratory self-administration procedure. Over the course of 9 weeks of treatment, semaglutide led to reductions in some but not all measures of weekly consumption, significantly reduced weekly alcohol craving relative to placebo, and led to greater relative reductions in cigarettes per day in a subgroup of participants with current cigarette use. These results justify larger clinical trials of incretin therapies for AUD.

The American Journal of Psychiatry

This national retrospective cohort study found that veterans with stimulant use disorder who received contingency management (CM) were 41% less likely to die in the year following treatment initiation relative to matched comparison subjects. These findings provide the strongest real-world evidence to date that CM is associated with reduced all-cause mortality, underscoring its potential as a life-saving intervention in routine care. Results support expanding access to CM across health care systems and public health settings.