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The ASAM Weekly for February 25th, 2025
This Week in the ASAM Weekly
Ever wonder what it’s like to be part of the ASAM Weekly editorial team? Besides rubbing elbows with the addiction medicine elite and receiving e-mail accolades on a regular basis, the editorial team helps drive attention to important topics in the field — 52 weeks a year.
We identify, summarize, and (sometimes) editorialize salient articles. It’s no coincidence, and without the help of AI, that we are highlighting several publications on gambling this week. One is getting the kind of news coverage expected from JAMA these days (NPR) while raising the alarm about increasing public harms secondary to gambling. It might be a stretch to yell ‘fire’ just yet, but internet search endpoints are definitely the tip of the iceberg (JAMA Internal Medicine). Maybe the US should try monetary limits like Europe (Harm Reduction Journal)? Either way, you should be paying attention.
There are times — such as during Black History Month — when the editorial team feels more attention should be paid but not enough is being written. The opioid crisis has disproportionately harmed Black Americans (The New York Times), and political winds do not change that. A local news story provides a much-needed historical view on the “double stigma of being Black and using drugs” (Public News Service), while the Journal of Addiction Medicine published a first-of-its-kind meta-analysis on racial and ethnic inequities for MOUD in pregnancy.
As ASAM Weekly editors, we also get the chance to make sense of science that borders on pop culture. Semaglutides are being hyped as cure-all medications, but there really is good potential for their use in AUD (JAMA Psychiatry). Alcohol is a known carcinogen and yet labeling beverages is somehow still up for debate — worldwide (The Lancet Public Health). Attention to alcohol’s harms in the meantime may be fueling an unfettered (and unregulated) growth in consumption of cannabis cocktails (Newsweek). Even dentists are chiming in with cannabis munchies + cottonmouth = cavities (Journal of the American Dental Association).
So, if you’ve ever wondered what it’s like to be a part of the ASAM Weekly, now’s your chance to find out. Apply here to become an ASAM Weekly Co-Editor and join us in driving attention to what’s driving addiction.
Thanks for reading,
Nicholas Athanasiou, MD, MBA, DFASAM
Editor in Chief
with Co-Editors: Brandon Aden, MD, MPH, FASAM; Jack Woodside, MD; John A. Fromson, MD
ASAM Weekly is looking for a Co-Editor to join the ASAM Weekly Team.
Please click here for details and to apply.
ASAM Criteria Fourth Edition Assessment Guide
The ASAM Criteria® Fourth Edition Level of Care Assessment Guide, developed by ASAM and pilot tested by UCLA Integrated Substance Use and Addiction Programs (ISAP), is a streamlined tool that helps clinical interviewers collect just enough information to make an appropriate level of care recommendation. The Guide promotes standardized decision-making by helping clinicians apply ASAM’s Dimensional Admission Criteria. It also supports identification of immediate needs and documentation for utilization review.
Lead Story
Once-Weekly Semaglutide in Adults With Alcohol Use Disorder 🔓
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.
Research and Science
Limit-setting in online gambling: a comparative policy review of European approaches 🔓
Harm Reduction Journal
Online gambling presents unique risks, including always available, high event frequency gambling at multiple sites simultaneously. All but 3 of 30 European countries have policies that seek to limit gambling. Most common are preset limits on wagers, deposits, or losses. Some have limits on time spent or require mandatory breaks. In all but Germany, limits are set by the gambler and can be raised; however, this can be monitored as a sign of potential problem gambling. In Finland and Norway, there are maximum loss limits of 300 Euros a day or 1000 Euros a month. Germany has a mandatory monthly deposit limit of 1000 Euros, and exceptions are granted only with monitoring for at-risk or addictive gambling behavior. The authors conclude that online gambling limit-setting is common in European countries, but only a few have mandatory limits.
The American Journal of Emergency Medicine
At San Francisco General Hospital, 113 patients using fentanyl had buprenorphine initiated in the emergency department between 2019 and 2021. COWS scores were recorded for 45% of these patients, with a median COWS score of 11. Three patients (2.6%) had buprenorphine precipitated opioid withdrawal (BPOW) and two received opioid infusions in the ICU. The first patient did not have a COWS score recorded, had BPOW after two 1 mg doses of buprenorphine, and received a hydromorphone infusion. The second patient had a COWS score of 5, had BPOW after two 8 mg doses of buprenorphine (COWS 26), and received a fentanyl infusion. The authors conclude the first patient received a buprenorphine dose too low to provide benefit (their protocol calls for an initial 8 mg dose) and the second had a COWS below the 8 required by their protocol. They conclude that BPOW incidence is low in a cohort of patients who use fentanyl.
Growing Health Concern Regarding Gambling Addiction in the Age of Sportsbooks
JAMA Internal Medicine
This time series study of US states with legalized sports betting assessed how sports betting in the US evolved since the Murphy v National Collegiate Athletic Association decision of the US Supreme Court, and what association this had with gambling addiction help-seeking. Researchers found that sportsbooks (physical or online places where individuals can place wagers on the outcomes of sporting events) have expanded from a single state to 38 states, with wagers increasing from $4.9 billion in 2017 to $121.1 billion in 2023. Pre/post analyses revealed substantial national increases in online searches for gambling addiction after Murphy v National Collegiate Athletic Association, with pronounced increases in states that introduced online sportsbooks. These findings emphasize the need for public health efforts to study and address the potential harms associated with the rapid growth of sports betting.
Journal of Addiction Medicine
There has been a significant rise in deliveries impacted by opioid use disorder (OUD), doubling between 2010 and 2017, during the opioid epidemic. In this meta-analysis, researchers examined racial and ethnic disparities in receipt of medication for OUD (MOUD) during pregnancy. The study found that Black pregnant people were 65% (OR=0.35) less likely and Hispanic pregnant people were 40% (OR=0.6) less likely to receive MOUD than White pregnant people. The authors note structural and interpersonal racism likely play a role, including pointing to the disproportionate impact of punitive policies criminalizing substance use during pregnancy in communities of color, as well as lower access to OUD treatment facilities and providers in communities of color. The authors endorse an urgent need for interventions and policy to address these disparities.
Learn More
Labels warning about alcohol-attributable cancer risks should be mandated urgently 🔓
The Lancet Public Health
Evidence linking alcohol consumption to an increased risk of various cancers has been mounting with the US Surgeon General publishing an advisory on alcohol in January 2025 summarizing the data and a need to act. While the WHO and European Union have published reports calling for alcohol labeling identifying this risk, only Ireland and South Korea have implemented requirements for such labeling. Given the overall limited awareness in the general population of the linkage to cancer and findings that there is no lower threshold of alcohol intake to eliminate the risks, this commentary argues that warning labels are needed urgently.
Frequent recreational cannabis use and its association with caries and severe tooth loss
The Journal of the American Dental Association
Limited evidence has shown a linkage between regular cannabis use and higher incidence of dental caries, potentially related to xerostomia and consumption of cariogenic foods and drinks associated with cannabis use. The study used the National Health and Nutrition Examination Survey (NHANES) to examine the relationship between frequent recreational cannabis (FRC) use (at least once per month over last year) and untreated coronal caries, untreated root caries, and severe tooth loss. FRC was associated with increased odds of all 3 outcomes: 1) untreated coronal caries (aOR=1.17), 2) untreated root caries (aOR=1.55), and 3) severe tooth loss (aOR=1.41). The authors note the need for education for dental care professionals about this potential issue for their patients.
The Consequences of Silencing the “Voice of CDC”
The New England Journal of Medicine
On January 21, 2025, the Trump administration ordered federal health agencies like the CDC, FDA, and NIH to pause public communications until February 1, 2025, unless critical. This led to a two-week delay in the CDC’s Morbidity and Mortality Weekly Report (MMWR), with a truncated issue released on February 6 that lacked full reports, including one on H5N1 influenza, raising concerns about timely public health communication. MMWR, a vital tool for public health information since 1961, has provided timely reports on health crises like HIV, E. coli outbreaks, and the Covid-19 pandemic. This pause in communication disrupted critical health data dissemination, including warnings on emerging threats like H5N1 influenza and tuberculosis. The situation highlights the importance of expert-driven, timely health updates to protect public health and prevent potential crises.
In The News
Searches for gambling addiction help go up after states legalize sports bets 🔓
National Public Radio
Harm reduction efforts fall short for Black men in Indiana 🔓
Public News Service
An Effective Treatment for Opioid Addiction Exists. Why Isn’t It Used More?
The New York Times Magazine
FDA Grants Fast-Track Designation To Cannabis Withdrawal Syndrome Drug 🔓
Forbes
Cannabis Cocktails Are on the Rise. Could They Replace Alcohol? 🔓
Newsweek
Embracing Vaping Will Save Lives Lost from Smoking
The New York Times
The Conversation