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The ASAM Weekly for March 18th, 2025
This Week in the ASAM Weekly
Advancing Reduction of Drug Use as an Endpoint in Addiction Treatment Trials
Nora D. Volkow
Director, National Institute on Drug Abuse
For many people trying to recover from a substance use disorder, perhaps for the majority, abstinence may be the most appropriate treatment objective. But complete abstinence is sometimes not achievable, even in the long-term, and there is a need for new treatment approaches that recognize the clinical value of reduced use.
According to a recently published analysis of data from the 2022 National Survey on Drug Use and Health, two thirds (65.2 percent) of adults in self-identified recovery used alcohol or other drugs in the past month1. There is increasing scientific evidence to support the clinical benefits of reduced substance use and its viability as a path to recovery for some patients. Reducing drug use has clear public health benefits, including reducing overdoses, reducing infectious disease transmission, and reducing automobile accidents and emergency department visits, not to mention potentially reducing adverse health effects such as cancer and other diseases associated with tobacco or alcohol.
The FDA has historically favored abstinence as the endpoint in trials to develop medications for substance use disorders. Abstinence has been evaluated using absence of positive urine drug tests, absence of self-reported drug use, and regularly attending sessions where drug use is assessed. But abstinence is a high bar comparable to requiring that an antidepressant produce complete remission of depression or that an analgesic completely eliminate pain. Recognizing this limitation, the FDA encourages developers of opioid2 and stimulant3 use disorder medications to discuss with the FDA alternative approaches to measure changes in drug use patterns.
Read the full editorial here.
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Benzodiazepine Tapering Webinar Series
Registration is now open for the American Society of Addiction Medicine (ASAM)’s Benzodiazepine Tapering Webinar Series, which was designed to support implementation of the Joint Clinical Practice Guideline on Benzodiazepine Tapering: Considerations When Risks Outweigh Benefits.
Lead Story
Health Affairs
During the COVID-19 pandemic, the Drug Enforcement Administration (DEA) temporarily allowed for prescribing of controlled substances via telehealth and extended the policy through the end of 2025. Due to concerns around potential adverse outcomes resulting from this policy, there is some debate about making it permanent. The authors utilized commercial and Medicaid claims data to assess newly diagnosed substance use disorders (SUD) after initiation of stimulants via telehealth versus in-person visits to inform this policy decision. In unadjusted analysis, patients initiated on stimulants via telehealth visits had higher rates of non-ADHD psychiatric comorbidities and new diagnoses of SUD in the year following initiation. In the adjusted analysis, controlling for psychiatric comorbidities, the authors did not find a difference in SUD outcomes. They recommend additional research to inform policy decisions around this issue.
Research and Science
The Journal of Clinical Investigation
This cohort study used electronic health records from the US Department of Veterans Affairs between 2008 and 2023 to compare changes in Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores among patients prescribed glucagon-like peptide-1 receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 inhibitors (DPP-4Is), and unexposed comparators. Patients who received GLP-1RAs had greater reduction in AUDIT-C scores than those who received DPP-4I or were unexposed. In addition, the reduction in drinking was more pronounced in those with a prior diagnosis of alcohol use disorder (AUD) or hazardous drinking. The study did not find any difference between those who received DPP-4Is and those who were unexposed. These findings are consistent with prior pre-clinical evidence and support GLP-1RAs as potential treatment for AUD. 
Relationship Between Methadone Induction Dosing and Retention in Treatment in Opioid Treatment Programs
Journal of Addiction Medicine
This study compared methadone dose during induction and retention in treatment at 30 days. Researchers examined records for 14,489 patients from a network of 64 OTPs in 12 states. The overall retention at 30 days was 88%, and the average methadone dose on day 7 of induction was 53 mg (ranging from less than 30 mg to over 70 mg). Patients who were male, younger, and unemployed were less likely to be retained at 30 days. After adjusting for these and other confounders, a higher methadone dose at day 7 was associated with increased 30-day retention (p<0.0001). The authors note that some studies have shown increased mortality during methadone induction, and they call for studies to examine the effect of increased methadone dose and mortality. They conclude that early dose escalation decreases dropout.
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Opportunities and Needs to Advance Prevention of Substance Use Disorders
JAMA Pediatrics
Overdose deaths among US youth continue to rise, despite increased access to opioid use disorder medications and overdose reversal treatments. Although prevention is crucial, few preventive interventions have been developed or implemented. Four key areas of opportunity to strengthen prevention efforts include: (1) improving the prevention delivery system through best practices for building a sustainable behavioral health prevention infrastructure; (2) developing new interventions (eg, digital) that focus on late adolescence or young adulthood; (3) systematic assessment of interventions for their efficacy and safety-targeted guidance from organizations to integrate research into practice; and (4) cross-disciplinary collaboration to identify and standardize criteria for evidence-based preventive intervention (EBPI).  The authors emphasize the essential need for understanding the biological, psychological, and social mechanisms of how interventions work, along with research on genetics, brain development, and social factors.
Sports Gambling and Drinking Behaviors Over Time
JAMA Psychiatry
There has been a widespread expansion of sports gambling in the United States over the past 6 years. This survey study examined how the frequency of sports gambling corresponds to alcohol use and related problems over time. Researchers found an association between the trajectories of sports gambling frequency and alcohol-related problems, suggesting that as one increases or decreases, corresponding changes are likely in the other. Consistent with a rapidly growing body of research, this study demonstrates that sports gamblers are at unique risk of alcohol-related harms, both generally and over time. 
Drug and Alcohol Dependence
Veterans in residential AUD treatment (n=44) were randomized to receive 20 sessions (over 2 weeks) of either active or sham intermittent theta burst transcranial magnetic stimulation (iTBS) to the dorsolateral prefrontal cortex. During the 6-month follow-up, those with active iTBS had a greater length of continuous abstinence (p = .049) and 4 times the odds of continuous abstinence during the entire 6 months (p = .050).  Among those who resumed drinking, those with active iTBS had fewer drinking days (p = .01) and fewer drinks per drinking day (p = .002). The authors concluded that iTBS promoted improved clinical outcomes during the 6 months post-treatment.
In The News
STAT
FDA Advises Consumers Not to Inhale Nitrous Oxide Products🔓
US Food and Drug Administration
America's Marijuana Legalization Experiment Is Going Up in Smoke 🔓
Newsweek
Federal Agency Dedicated to Mental Illness and Addiction Faces Huge Cuts
The New York Times
Drug overdoses have caused more U.S. deaths than Covid
STAT
As more states approve recreational marijuana, AAA warns against driving under influence 🔓
WSB Atlanta