Abandonment of prescribed buprenorphine for opioid use disorder, 2020-2024

JAMA Network Open

This retrospective cohort study examined characteristics associated with abandonment of newly prescribed buprenorphine, defined as a prescription that was written but not dispensed or filled, and trends in abandonment among adults from 2020 to 2024 to inform efforts to improve buprenorphine access.  Researchers found the proportion of abandoned newly prescribed buprenorphine prescriptions for opioid use disorder increased from 2020 to 2024. Over 1 in 3 patients’ first buprenorphine prescriptions were abandoned in 2024, representing a missed opportunity for treatment initiation and engagement.  Hispanic patients had a higher proportion of prescription abandonment, possibly due to language and pharmacy-level barriers, such as limited retail pharmacies in Hispanic communities and neighborhoods. Increasing opioid overdose death rates among Hispanics highlights the importance of expanding access among this population. 

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US drug overdose deaths involving stimulants without opioids continued to rise in 2024

Addictive Behaviors Reports

Drug overdose deaths (DOD) peaked in 2022 before a decline in rates driven by decrease in opioid-related deaths. We are now in the ‘fourth wave’ of the overdose epidemic, described by DOD involving polysubstance use. As the decline in DOD has been driven largely by decline in deaths related to fentanyl, researchers sought to assess if DOD due to stimulants alone (without opioids) was also seeing a 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 2022 and 2004.  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.

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US drug overdose deaths that occurred in isolation, 2022–2024

NEJM Evidence

Data were obtained from SUDORS (State Unintentional Drug Overdose Reporting System) for 2022-2024. Of 191,577 overdose deaths, 76% occurred in isolation with no opportunity for rescue. Of the deaths in isolation, 73% were in a house or apartment and 23% elsewhere (car, sidewalk, bar). There was a person nearby (but not present) for 29% of the deaths in a house or apartment and 13% of the deaths elsewhere. The authors suggest improved overdose education and reversal agent availability could increase rescues by these nearby persons. For deaths in complete isolation, technologies that monitor vital signs (phone apps, wearable devices) could alert first responders. 

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Nicotine e-cigarettes for cigarette smoking cessation: Recommendations to US-based clinicians

Journal of the American Medical Association

This Special Communication summarizes the evidence on the use of e-cigarettes for smoking cessation and provides recommendations for clinicians on how to engage in conversations with adult patients who currently smoke cigarettes. Specifically, advice is provided on (1) integration of e-cigarettes into patient-centered shared decision-making conversations on the risks and benefits of various pharmacologic smoking cessation treatments; and (2) practical guidance on the use of e-cigarettes for smoking cessation. The authors include one overarching recommendation: integrate e-cigarettes into conversations on the risks and benefits of all evidence-based pharmacologic treatments for smoking cessation. In support of this recommendation, specific guidance is provided regarding how to discuss potential misperceptions and suggested questions are offered to guide patient conversations. Evidence-based best practices are also provided for using e-cigarettes to quit smoking. 

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Oral Semaglutide for Alcohol Use Disorder: A Randomized Clinical Trial

The American Journal of Psychiatry

Accumulating preclinical and observational evidence suggests that glucagon-like peptide-1 receptor agonists, including semaglutide, reduce alcohol consumption. This phase 2 double-blind, randomized, parallel-arm trial evaluated the effects of oral semaglutide on alcohol craving and consumption among treatment-seeking adults with alcohol use disorder (AUD).  It found that semaglutide did not significantly reduce laboratory-assessed craving or drinks per day compared with placebo but significantly reduced heavy drinking days. Semaglutide also significantly reduced drinks per drinking day, naturalistic alcohol craving, and cannabis use days. Semaglutide reduced alcohol-related consequences at a significantly greater rate than placebo. Significantly more participants in the semaglutide group than the placebo group reduced their risk drinking level by one or more levels. These findings confirm previous results among non–treatment seekers with less severe AUD and suggest that continued development of semaglutide for AUD is warranted.

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Reflections on the preparation, implementation, and sustainability of a virtual SUD clinic: A public health response to the opioid epidemic

Journal of Substance Use and Addiction Treatment

This is an exploratory case study to identify barriers, facilitators, and implementation needs during the phases of implementation of a virtual SUD clinic offering low-barrier MOUD across the state of Texas. From January 2022 to September 2023, researchers conducted 10 individual and 11 group periodic reflections with 16 individuals (including clinic leadership, operation staff, and providers) to evaluate implementation activities, clinic processes, and events during the rollout of the virtual clinic. In the preparation phase, participants emphasized the importance of strong leadership, effective workforce and technology infrastructure, staff training, and mission alignment. During implementation, participants highlighted the need for strong interprofessional communication, continuous reflection and evaluation, and medication supply chain management, as well as the challenge of workforce turnover. In the sustainment phase, participants identified a need for diversified funding and intentional growth.

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Efficacy and safety of pharmacological interventions for the treatment of cocaine use disorder: A systematic review and network meta-analysis

Addiction

Cocaine use disorder (CUD) is an increasingly widespread concern worldwide. Various pharmacological treatments have been investigated for CUD, but their efficacy remains unclear, and none have been licensed for treatment. This systematic review and network meta-analysis assessed the comparative effectiveness, safety, and acceptability of pharmacological interventions for the treatment of CUD and prevention of relapse. The authors found no convincing evidence for the effectiveness of any pharmacological treatments for cocaine use disorder.

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2025 National Survey on Drug Use and Health (NSDUH)

SAMHSA

The 2025 National Survey on Drug Use and Health (NSDUH) shows encouraging trends among adolescents and young adults with broad declines across past-month nicotine, alcohol, and marijuana use, and binge drinking, as well as reduced rates of substance use disorders, major depressive episodes, and suicidality. 

Conversely, troubling overall increases occurred in past-month nicotine vaping and marijuana use, past-year use of marijuana and hallucinogens, and past-year marijuana use disorder. Interestingly, it is important to point out that these increases are driven by use among adults aged 26 or older. For each of these indicators, use among adults 26 or older all increased whereas use among youth 12 to 17 and young adults aged 18 to 25 either declined or remained stable. 

Furthermore, while youth mental health improved, suicide indicators among adults aged 26-49 and 50+ rose between 2021 and 2025.  These findings highlight the importance of ensuring a lifespan approach to suicide prevention and mental health promotion and treatment initiatives, including incorporating age-related changes in physical abilities and social environments into prevention strategies. 

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Association between GLP-1 receptor agonists and alcohol-related hospitalisations among adults with alcohol use disorder: Multi-target trial emulation study

BMJ Open

This retrospective cohort study using target trial emulation evaluated the association between use of newer glucagon-like peptide-1 receptor agonists (GLP-1 RAs; semaglutide, tirzepatide) and alcohol-related hospitalizations among adults with alcohol use disorder (AUD) and type 2 diabetes (T2D) or obesity. The authors found that among adults with AUD and T2D or obesity, initiation of newer GLP-1 RAs was associated with a lower observed risk of alcohol-related hospitalization. 

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Trends in alcohol-related deaths in the United States over 55 years: 1968-2023

Alcohol, Clinical and Experimental Research 

This study of alcohol-related mortality trends since 1968 used primarily death certificate data from the CDC WONDER database. Between 1998 and 2023 there were 1.3 million alcohol-related deaths. Overall age-adjusted mortality rates (AAMR) per 100,000 increased from 13 to 19. Rates increased from 1968 to 1980, declined from 1980 to 2000, and began an accelerating increase from 2000 to 2023, with a peak during COVID.  AAMRs were higher for males (increasing from 20 to 28) than for females (increasing from 7 to 11). AAMR declined by 50% for Black individuals (from 28 to 14) and nearly doubled for Whites (increasing from 11 to 21) resulting in a dramatic racial inversion. Among age groups, the highest mortality was for 65+, attributed to baby boomer heavy drinking plus frailty of age. The largest increases were seen in the Midwest with the Northeast remaining stable. 

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