The ASAM Weekly for January 13, 2026
This Week in the ASAM WeeklyExperience would tell us not to make predictions for 2026, but let’s try to make sense of the evidence anyway… Historically, US drug policy hasn’t always aligned with the evidence. A new study attempts to reconcile this with a multi-criteria decision analysis that ranks drugs by harmfulness but seems to be limited (by design) by the judgment of 17 experts (). Sometimes, though, experts can be driven more by experience than evidence—as in the case of involuntary treatment, where ethics, humanity, and hope will likely (hopefully) shape US policy for the better ().  It’s also possible that experts' experience shapes the evidence, even when they’re looking for evidence to shape our experience. For example, many clinicians find it increasingly difficult to start buprenorphine in the modern era of fentanyl, but a careful reading of the evidence should not discourage us from continuing to do so (). Rather it should encourage us to modernize our experience with extended-release formulations, at higher doses and with more rapid inductions (). &²Ô²ú²õ±è; The new year will likely also bring a change to how we understand our experiences. Large language models (LLM) offer an unprecedented level of knowledge and efficiency, one that risks bypassing the very nature of what makes us human: lived experience (). But since lived experience is so uniquely defined, it is not always evident how it fits into addiction medicine. A profile of an addiction doc pushed out of practice touches upon this well (regardless of the “facts” of the case), demonstrating how the practice of addiction medicine requires a balance of both the evidence and lived experience, and that the real “” will actually be about protecting this balance. Bring on the new year. Nicholas Athanasiou, MD, MBA, DFASAM
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Lead Story 🔓 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 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. Of the participants, 72.8% 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. In addition, 67.3% of participants reported they modified their standard buprenorphine treatment protocols for patients using fentanyl. Research and Science 🔓 JAMA Network Open This randomized clinical trial compares the efficacy and safety between 100-mg and 300-mg once-monthly extended-release buprenorphine doses for individuals with high-risk opioid use, including fentanyl.  The study included 436 participants with moderate to severe opioid use disorder and found that both the 100-mg and 300-mg maintenance doses improved opioid abstinence and were well tolerated without any new safety signals. In post hoc analyses, the 300-mg dose performed better than the 100-mg dose among participants who used fentanyl daily, 14 times or more per week, or both. These findings demonstrate that both 100-mg and 300-mg extended-release buprenorphine doses improved opioid abstinence among patients at high risk; the 300-mg maintenance dose may perform better for individuals with heavy fentanyl use. 🔓 Journal of Addiction Medicine E-cigarette use has increased significantly over the last couple of decades and is not without harms. Researchers conducted a systematic review to evaluate pharmacological treatments for e-cigarette use. This review included four studies with varenicline, two with nicotine replacement therapy (NRT), and one with cytisine. Varenicline was found to statistically reduce continued e-cigarette use (OR=2.52, p<0.001), but neither NRT nor cytisine showed a statistically significant reduction in use. The authors did find that the abstinence rates did trend down over time. Given these findings the authors suggest there is evidence for use of varenicline as treatment for e-cigarette use, but more studies are needed with respect to NRT and cytisine.  🔓 International Journal of Drug Policy The Rhode Island Prescription and Illicit Drug Study (RAPIDS) is a two-arm randomized clinical trial to assess the efficacy of a brief, theory-based overdose prevention intervention including fentanyl test strips (FTS). In this study, using survey data collected for RAPIDS, the authors examined the association between having experienced homelessness in the past month and the use of FTS. Recruited between September 2020 and February 2023, 505 people who use drugs in Rhode Island were included in the study. Of the participants, 59% reported experiencing homelessness in the past month, with 93.3% reporting having ever experienced homelessness. Participants reporting past-month homelessness were more likely to report FTS use in the past month at baseline compared to those with stable housing; however, this association was not appreciated in multivariate generalized estimating equations (GEE) analysis. Additionally, regular use of crystal methamphetamine was associated with recent FTS use, and participants recruited later in the study (in 2023) were more likely to use FTS. 🔓 Drug and Alcohol Dependence This study examined the success rate of gradual versus abrupt smoking cessation. Data were drawn from the Smoking Toolkit Study, a representative sample of the population of adults who smoke in England. Of the 27,390 participants, 45.5% had quit gradually and 54.5% had quit abruptly. Those who quit abruptly had higher odds of success than those who quit gradually (OR=1.70). Participants from lower socioeconomic grades were less likely to quit abruptly—53.2% versus 57.4% for higher socioeconomic grades. However, the relationship between the abrupt method and higher success was similar for both. Learn More Nature This commentary argues that academic journals should be subject to external regulation to enhance research integrity. Independent oversight could push publishers to crack down on low-quality papers and correct or retract papers quickly when required. The author suggests publishers voluntarily subscribe to an existing international quality-management standard (ISO-9001) so all journals are held to the same standards. This system “could help to balance the commercial interests of academic publishers with the needs of everyone who relies on quality information.” 🔓 Harm Reduction Journal US drug policy is often poorly aligned with scientific evidence with punitive approaches and classifying drugs based on abuse potential, dependence risk, and accepted medical use, but not harm. Researchers adapted a 2010 United Kingdom study to rate drug harms using health, social, and societal impacts criteria. Seventeen experts assessed 19 drugs across 18 criteria, providing a score on a scale between 0 and 100. Authors ranked fentanyl, methamphetamine, crack, and heroin as the most harmful substances. Notably, many Schedule I drugs, such as LSD and mushrooms, were rated least harmful, while alcohol and tobacco were considered much more harmful. Harm to the person using was almost universally scored higher than other criteria and was the driving force for much of the overall harm score. The authors note this supports a focus on health interventions over punitive strategies which focus on society. Drug and Alcohol Dependence This study examined treatment completion for 13,088 pregnant women admitted for cannabis use. Data were obtained from the SAMHSA Treatment Episode Data Set for the years 2020-2022. Overall, 28% completed treatment and 72% did not. Treatment completion was lower in states where cannabis was fully legalized (medical and recreational use) than in states where cannabis was illegal (aOR=0.33) and in states where it was partially legal (aOR=0.33).  This effect was larger in outpatient versus residential settings and for patients referred by the court. The authors speculate that cannabis legalization increases the social acceptability and reduces the perceived harm of cannabis use. In the News 🔓 ASAM The New York Times 🔓 University of Michigan News 🔓 Proceedings of the National Academy of Sciences (PNAS) 🔓 CBC News (Canadian Broadcasting Corporation) 🔓 MedPage Today 🔓 KFF Health News |