ÄÛ²ÝÊÓƵ Weekly for October 14th, 2025
This Week in the ASAM Weekly
With all the headlines about an opioid shame-game and the gubernatorial debate in New Jersey (), it’s hard not to feel a little nostalgic for the headlines of a decade ago. Here’s an example from , when the opioid epidemic was mostly framed by local perspectives or personal stories—underscoring the humanity of it all.
News coverage has grown since then, expanding its coverage of opioids and more closely following research trends. For example, the socioeconomic implications of opioid addiction are now a well-told story, one in which the regions hardest hit economically also bear the brunt of the opioid crisis. But there’s actually a global paradox — wealthier regions experience higher burdens from opioids ().
Cost is likely a big reason for this paradox, especially in America. Large scale interventions for opioid addiction are expensive and community leaders have to make decisions with limited resources and limited information about cost-effectiveness (). A news article from illustrates this point well: the challenge for politicians is knowing which interventions will work in which communities, and then finding the resources to fund them.
But not all addiction news these days is about politics or macroeconomics. There is still the occasional article about the addiction education gap () and still many quality pieces on treatment barriers, for example those affecting pregnant people (). The even has an interesting article about their quasi-scientific study demonstrating the addictiveness of TikTok.
But particular attention should be paid to an article from Utah's longest running newspaper that happens to profile several lives shattered by kratom. It’s a stylistic throwback to the opioid crisis articles from a decade ago, with an uncanny sense of deja vu ().
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
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NEW! The ASAM Handbook of Addiction Medicine, 3rd Edition, is here!
Written for generalists, nurses, physician assistants, and other clinicians, the third edition offers concise, evidence-based guidance for the evaluation and management of substance use disorders. This fully updated edition provides clear, practical coverage of major drug classes, treatment modalities, and medical considerations, with an emphasis on patient-centered care. Each chapter concludes with review questions to reinforce key concepts and support clinical learning.
Lead Story
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JAMA Psychiatry
This male Swedish cohort study included 573,855 participants and assessed whether there is an association between IQ and risk for alcohol use disorder, and if so, what the nature of this association might be. The study found that IQ at age 18 years was associated with subsequent alcohol use disorder risk. Mendelian randomization analyses suggest a causal association, albeit with context-dependent differences; genetic liability for cognitive performance also predicted alcohol use disorder in a US-based sample. Results suggest that there was a clear impact of genetic liability for cognitive performance on alcohol disorder risk, but the association varies based on the sociocultural context.
Research and Science
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JAMA Network Open
This cohort study, examining 273 individuals who smoked cigarettes daily, examined whether exposure to retail marketing in people’s daily environments is associated with critical health risk behaviors such as smoking. Individuals reported significantly greater cravings and smoked more cigarettes on days when their smartphone-logged tobacco retail exposure was higher than usual. These findings suggest that tobacco retail exposure is associated with smoking dynamically across time, with important implications for public health.
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BMC Public Health
This study analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 2017-2021, including age-standardized mortality rates (ASMRs) and disability-adjusted life years (DALYs) in 204 countries and territories. The study found that global OUD mortality increased by 12.4% from 2017 to 2021, with the Americas as the epicenter. Areas with a higher socio-demographic index (SDI) had 17.8-fold higher mortality rates and 13.9-fold greater DALY rates than low-SDI regions. The study also highlights that disability was mitigated by evidence-based harm reduction policies in high-SDI countries, whereas low-SDI regions saw increasing DALYs.
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Drug and Alcohol Dependence
Researchers evaluated the cost of implementing 15 evidence-based practices (EBP) in rural and urban settings as part of HEALing Communities Study, including overdose education and naloxone distribution (OEND) and increased medication for opioid use disorder (MOUD). The average cost of intervention was $147,500 for OEND and $345,400 for MOUD. While overall cost of interventions was greater in urban communities, the per capita was greater for rural communities. The authors note that understanding these costs and differences can help inform selection of interventions for communities based on need and resources.
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Addiction Science and Clinical Practice
Chronic pain is a common comorbidity among persons with opioid use disorders and researchers conducted a secondary analysis of 3 trials assessing association between pain and treatment outcomes with buprenorphine (BUP). The researchers found that while pain decreased during treatment, persons with more severe pain had lower abstinence rates, lower quality of life, more depression, opioid withdrawal and cravings. The researchers did find that pain was not associated with differences in treatment retention. The authors suggest evaluation of pain at baseline and during treatment could better inform patient experience and help to optimize treatment.
Learn More
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Substance Abuse Treatment, Prevention, and Policy
This systematic review of 23 articles examines barriers to treatment for patients with MOUD in pregnancy. Patient-related barriers identified in the review included fear of stigma/judgement, concerns for the risk to the fetus and neonatal opioid withdrawal syndrome (NOWS), fear of child protective service involvement, the belief that MOUD “replaces one drug with another,” family pressure/opinions, and intimate partner violence, as well as logistical barriers such as transportation or childcare needs.
Provider-related barriers included hesitancy and discomfort with treating OUD in pregnant individuals, biases and negative attitudes towards
patients with OUD, time constraints, and knowledge deficits. Health-system barriers included geographic access to care, complex healthcare systems, limited clinic hours, insurance coverage gaps, and financial barriers.
Journal of Addiction Medicine
This case report describes a 25-year-old woman with ketamine use disorder (KUD) that improved after treatment with oral naltrexone. She had used cannabis 1-3 joints daily since age 15. She had been taking sertraline 200mg daily for major depression since June 2019. In November 2020 she began using ketamine and by February 2022 she was using 1-3 grams daily intranasally. She lost interest in socializing and other activities and lost 19 kg of weight over 24 months. Attempts to quit resulted in intense cravings, tremors, sweating, and abdominal cramps. She also had symptoms of ketamine uropathy. In January 2023 she sought treatment and received psychoeducational group therapy and naltrexone 50mg orally daily. Over 2 months her cravings were minimal, weight, mood, and abdominal cramps improved, and she abstained from ketamine. The authors note other case reports of naltrexone treatment of KUD and call for further research.
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BMC Medical Education
This paper describes the experience of 24 residents and 10 medical students on a 2-week elective with an inpatient opioid use disorder (OUD) consultation service that sees 45-60 consults monthly. The rotation reduced the proportion of healthcare practitioners who felt they did not have adequate training in OUD from 96% to 20%. After the rotation, over 90% felt prepared to diagnose OUD and treat OUD and opioid withdrawal with medications. Following the elective, 96% felt as comfortable talking with a patient with a SUD as one without a SUD, although about half would feel uncomfortable revealing to a colleague that they had a SUD. Almost all disagreed with the statement, “Patients with SUD will never recover enough to have a good quality of life.” The authors conclude that those completing this elective were confident in managing OUD and had little stigma towards these patients.
In the News
NJ.com
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Maryland Matters
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Deseret News
The New York Times
The Washington Post
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World Health Organization (WHO)
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The Conversation
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Fort Worth Star-Telegram