Â鶹´«Ã½ÔÚÏß

This Week in the Â鶹´«Ã½ÔÚÏß Weekly

A challenge with addressing addiction at the population level is making decisions based on the evidence available. For example, new data indicate that alcohol consumption and binge drinking are dropping among Americans, but the evidence doesn't exactly tell us why. One explanation is that health education has finally started breaking through to the public (), but again, the important question is why? 

Like we’ve seen with tobacco, the public seems to listen best when there are clear (or ominous) outcomes related to substance use, like cancer or overdose deaths (). But when we can’t clearly quantify the harms—like with cannabis use—it becomes difficult to clearly articulate them for the public (). â¶Ä¯&²Ô²ú²õ±è;

Even when we know that harms exist, it helps to build a story around an identifiable culprit or cause. Obesity is associated with cancer and countless other diseases, and ultra-processed foods (UPF) are potent substances, infused with corporate greed. Only recently is the public becoming aware of the science (and existence) of food addiction, which links UPFs to obesity and the difficulties people face abstaining from them (). 

Sometimes, when a good storyline builds quickly it can drive attention away from other evidence. For example, a policy article in  discusses a new theory about the drop in overdose deaths pointing toward a supply shock in China. It’s a fascinating 3-page report, but one that could undermine the public’s (and politicians') attention for harm reduction or addiction treatment.  

In the end, the public benefits when there’s a story explaining the who and the why that comes with evidence connecting the causes and the outcomes. This past week, HHS made a $2 billion “mistake” and reinstated funding  for mental health and substance use treatment after facing fierce backlash (). Until we’re provided with better evidence that explains what happened, the public is left to speculate about the causes (dismissing scientific evidence), the outcomes (morbidity and mortality), the who (politicians), and the why (greed).  

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 

Apply to be the Â鶹´«Ã½ÔÚÏß Weekly Editor in Chief!

ASAM Weekly, with a circulation of 70,000 readers, is conducting a search for a new Editor in Chief (EIC). The EIC will serve a 1-year term from July 1, 2026, to June 30, 2027, with the option to renew for additional years. Benefits and compensation offered.

Lead Story

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. 

Research and Science

Journal of Addiction Medicine

Using the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) data set, this study identified methamphetamine-related deaths among US residents aged 15 or older from 2005 to 2023 and calculated mortality rates over time for the 9 US Census Divisions. From 2005 to 2023, methamphetamine-related deaths increased substantially across all 9 US Census Divisions, although with variability between regions. The highest mortality rates in 2023 were in the Pacific (Alaska, California, Hawaii, Oregon, Washington), East South Central (Alabama, Kentucky, Mississippi, Tennessee), and Mountain (Arizona, Colorado, Idaho, New Mexico, Montana, Utah, Nevada, Wyoming) divisions of the country. 

🔓

Addiction

This study analyzed data from the CannTeen study, a 12-month observational longitudinal data set of adult and adolescent cannabis users in London, to assess the association between quantity of THC and risk of cannabis use disorder (CUD). The Enhanced Cannabis Timeline Followback (EC-TLFB) was used to determine standard THC units. CUD diagnosis and severity was assessed via the Mini International Neuropsychiatric Interview. The study found that THC units showed good discrimination between individuals with no CUD versus any CUD, with a risk threshold of 8.26 units per week in adults and 6.04 units per week for adolescents. 

Journal of Addiction Medicine

This study of perinatal outcomes associated with opioid use during pregnancy linked data from California vital statistics and hospital discharge data from 2008 to 2020. Out of over 5 million pregnancies, 13,749 had an opioid-related diagnosis, and the prevalence more than doubled from 0.14% in 2008 to 0.33% in 2020. Individuals with this diagnosis had a higher incidence of hypertension, opioid overdose, and preterm birth. The risk of serious maternal morbidity (22 diagnoses such as embolism, cardiac arrest, etc.) was higher with opioid use (RR=1.84). In offspring, death during the first year (RR=1.72) and NICU admission (RR=2.80) were more common. There were similar increased risks for respiratory distress syndrome, small for gestational age, hypoglycemia, and major anomalies. Opioid-related diagnosis during pregnancy was associated with significantly increased maternal and neonatal morbidity. 

🔓

Harm Reduction Journal

Individuals receiving medications for opioid use disorder (MOUD) may continue to use non-prescribed opioids and benefit from harm reduction services (HRS). Researchers interviewed patients receiving methadone or buprenorphine and found that overall, 37% reported non-prescribed opioid use in the prior 6 months, and 61% used HRS at least once. There was no difference in non-prescribed opioid use between the methadone and buprenorphine groups, but the buprenorphine group was more likely to report using, recommending, and feeling welcome at HRS sites. The authors note these differences in use and perception about HRS may be related to differences in treatment settings for methadone and buprenorphine, and tailoring HRS interventions to these settings.

🔓

JAMA Psychiatry

This randomized clinical trial assessed if yoga, as adjuvant therapy, can accelerate opioid withdrawal recovery and improve autonomic regulation in patients with opioid use disorder. Of 59 male participants with opioid use disorder, those receiving yoga alongside standard buprenorphine treatment achieved withdrawal stabilization 4.4 times faster than controls (median, 5 vs 9 days) and showed significant improvements in heart rate variability, anxiety, sleep, and pain measures. Yoga significantly enhanced opioid withdrawal recovery through measurable autonomic and clinical improvements, supporting its integration into withdrawal protocols as a neurobiologically informed intervention.

Learn More

🔓

Pharmacological Research

In this paper, the authors discuss ultra-high processed food (UPF) as an addictive substance, including how it can alter the reward pathways and lead to behavior like other substance use disorders. The authors review the clinical addiction framework and the associated neurobiological and behavioral changes that occur with substance use disorders. There is preclinical evidence that UPF consumption induces changes similar to other SUDs, including acting on reward pathways inducing dopamine release and dysregulation of the mesolimbic dopamine system, binge behavior, and even withdrawal. The authors note that while understanding of food addiction has improved, more research is needed. 

In the News

🔓

British Broadcasting Corporation (BBC)

🔓

MedPage Today

🔓

CT Mirror

The New York Times

 ðŸ”“

The Conversation

🔓

WATE