Non-Opioid Overdose & Emerging Trends
Last week, I opened with the encouraging news that overdose deaths are plateauing, citing opioid studies. This week, our focus shifts to non-opioid substances and polysubstance overdose.
Unfortunately, . I love to plug the ASAM/AAAP guidelines for treating stimulant use disorder; complementing this guidance, a new JAMA Network Open RCT investigates the efficacy of . Interestingly, another substance, cannabis, is , especially among youth, underscoring treatment of cannabis use disorder as a good avenue for early intervention. (We also touch on this week.)
Youth & Developmental Research
On the theme of youth, recent studies highlight critical vulnerabilities across development:
- The confirms that co-use of substances is associated with increased consumption doses. (Nicotine stands out prominently, a finding aligned with recent concerns over .)
- A links youth substance use to lower income, younger age, and being Black, Hispanic, or Indigenous.
- Diving even earlier into development, as demonstrated by MRI in a sample aged 7–21 years old.
Implementation & Purpose in Addiction Medicine
As an addiction community, we know these associations exist; this week’s issue strengthens that conviction and calls us to action. Proven interventions such as consistently improve outcomes. As part of the workforce implementing these essential changes, we impact everything from acute overdose to youth health.
Given how painful the intersection of youth and overdose is, I close with an uplifting piece from MedPage Today on , reminding us of the power of authenticity and empathy. As Dolly famously put it: “Find out who you are and do it on purpose.”
Smita Das, MD, PhD, MPH
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM; John A. Fromson, MD; Sarah Messmer, MD, FASAM; Jack Woodside, MD; and Contributing Editor: Jessica Gregg, MD, PhD, FASAM
The National Institute on Drug Abuse (NIDA) has issued a Request for Information (RFI) inviting feedback on the 2027-2031 NIDA Strategic Plan.
To view the RFI and submit feedback, please see:
To ensure consideration, responses must be submitted by:
September 21, 2026, 11:59:59 PM EST
Lead Story
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Addictive Behaviors Reports
Drug overdose deaths (DOD) peaked in 2022 before a decline in rates driven by a decrease in opioid-related deaths. We are now in the “fourth wave” of the overdose epidemic, represented by DOD involving polysubstance use. As the decline in DOD has been driven largely by the decline in deaths related to fentanyl, researchers sought to assess if DOD due to stimulants alone (without opioids) were also in decline. Researchers found that DOD rates related to cocaine without opioids (1.7% increase) and methamphetamines without opioids (2.4% increase) remained stable or increased between 2023 and 2024. Notably there was some regional variation with the greatest increase in DOD rates seen in the Northeast (3.7% for cocaine and 26.7% for methamphetamines). The authors note that stimulant-specific interventions may be needed to address the ongoing DOD epidemic.
ASAM Publications Council Call for Applications
ASAM is seeking up to 3 members to serve on the Publications Council beginning in January 2027. Council members should have experience in addiction medicine and familiarity with the writing and publishing process. The Publications Council is charged with overseeing ASAM publications. The Council approves publication editors, evaluates proposals for new publications, ensures adequate publisher performance, and regularly furnishes the Board of Directors with updates on publication activities.
Please first log into your ASAM member portal and click to .
The closing date is September 21, 2026.
Research and Science
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JAMA Network Open
This is a prospective randomized clinical trial of a care navigation intervention including contingency management compared to usual care in Denver, Colorado, from April 2023 to December 2024. The primary study outcome was linkage to treatment within 30 and 90 days of enrollment. The navigation intervention was client driven and trauma informed, and included navigation support for communication, transportation, disability, food and clothing assistance, housing, SUD treatment, other health care, and employment. Navigators attempted to meet with participants weekly, and participants could earn incentives for these meetings for up to 12 weeks. A total of 192 participants were enrolled (96 randomized to each arm), with a median age of 39; 85% were unstably housed, and 67% reported a prior diagnosis of a mental health disorder. Of those in the intervention arm, 63% engaged in 2 or more navigation sessions, with a median of 5 sessions received. Despite this engagement with the care navigator in the intervention arm, there was no significant difference in linkage to treatment at 30 or 90 days between groups.
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Morbidity and Mortality Weekly Report
Data were obtained from CDC’s State Unintentional Drug Overdose Reporting System (SUDORS) for 209,166 overdose deaths between 2021 and 2025. Cannabis was detected in 21% of deaths (which was stable over time) and was listed as involved in causing death in 0.8%. Only 9 deaths had no other drug detected indicating cannabis-caused deaths are rare. Cannabis was detected most often in those aged 11–17 years (43%) and least often in those aged >50 years (17%). Since cannabis is not routinely tested for in overdose deaths, these figures are likely underestimates. Cannabis use among youths presents an opportunity for early intervention to prevent cannabis use disorder and other substance use.
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Addiction
This study compared the 12-month prevalence rates of cannabis use disorders (CUD) in a sample of people prescribed medical cannabis in Australia by a medical or nurse practitioner, according to whether they use conventional DSM-5 11-items for CUD versus 9-items for prescription cannabis use disorder (Pr-CUD). Researchers found that DSM-5 CUD diagnostic criteria developed for illicit cannabis use may not be appropriate for people using medical cannabis under prescribed conditions. CUD rates are statistically significantly reduced when the Pr-CUD framework is applied to people only using cannabis products in accordance with the conditions identified on their prescription (including dose, route of administration, and indication). This has considerable clinical and policy implications in settings where medical cannabis is legally available under a prescription model.
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Journal of Adolescent Health
Nicotine, alcohol, and cannabis are the most commonly used substances among adolescents. Their use often co-occurs. Using data from 6 waves of the Adolescent Brain Cognitive Development Study, the patterns and doses of substance co-use in this vulnerable population were assessed. The average dose of nicotine was significantly higher when co-used with alcohol or when co-used with cannabis in year 6; nicotine trends were similar in years 4 and 5. In year 6, the average dose of alcohol was higher when co-used with cannabis or co-used with nicotine compared to single use of alcohol. The average dose of cannabis was not significantly different when used singularly or co-used with either alcohol or nicotine in the study years examined.
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Journal of Addiction Medicine
This retrospective cohort study evaluated the impact of a multidisciplinary Addiction Consult Service (ACS) at Vanderbilt University Medical Center from 2018 to 2025 on inpatient initiation of medications for alcohol use disorder (MAUD); MAUD prescribed at discharge; and 30-day readmission, ED presentation, or death. A total of 4,428 admissions were included in the analysis (2,214 received ACS, 2,214 were propensity matched with no ACS). ACS consultation was associated with a 32.8% higher rate of MAUD initiation while inpatient, a 7.4% higher rate of MAUD prescriptions at discharge, and a 5% reduction in 30-day readmission, ED presentation, or death as compared to usual care.
Learn More
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Drug and Alcohol Dependence
These researchers studied the relationship between brain anatomy and prenatal alcohol exposure (PAE). Participants aged 7–21 years received brain MRI scans. Of 123 total participants, 58 had PAE (>7 drinks/week or >2 binges/pregnancy), and of these 31 had diagnosed fetal alcohol spectrum disorder. Local gyrification index (LGI) reflects the amount of cortex in the sulcus. LGI decreased with age in 2 brain regions in PAE but increased in unexposed controls. LGI increased with age in one brain region with PAE but was unchanged in unexposed controls. With PAE, sulcal depth was decreased in one brain region compared to controls. Of interest, PAE had no effect on cortical thickness. Lower gyrification is associated with lower intelligence. Sulcal depth is a sensitive marker for cortical abnormalities and is seen in major depression, Parkinson’s, and Alzheimer’s. The authors conclude that brain maturation is disrupted by PAE.
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Journal of Community Psychology
Individual- and community-level factors have been associated with patterns of substance use, and to better understand them and their potential interaction researchers looked at substance use-related emergency department (ED) visits among youth in North Carolina. Individual-level variables included income, age, race, and sex, while at the community level researchers primarily examined income status. At the individual level, factors associated with increased likelihood of ED visit for substance use were being male, being White, and being low-income. At the community level, being from a high-income area was associated with increased likelihood of alcohol- and opioid-related ED visit. However, researchers found significant interaction between community- and individual-level factors such that Black and Hispanic youth from low-income communities were particularly at risk.
In the News
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The Washington Post
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STAT
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Fierce Healthcare
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MinnPost
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Spotlight PA
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The Conversation
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MedPage Today
