Lead: Outpatient Direct Initiation of Injectable Buprenorphine in a Harm Reduction Agency and Primary Care Clinic: A Retrospective Case SeriesLead: Outpatient Direct Initiation of Injectable Buprenorphine in a Harm Reduction Agency and Primary Care Clinic: A Retrospective Case Series
This Week in Addiction Medicine from ASAM
Zach Caruso reviews new research on injectable buprenorphine, kratom regulations, cannabis edibles, polysubstance overdose trends, e-cigarettes and prenatal opioid treatment. The episode shares key data points that may shape clinical decisions and policy conversations in addiction medicine.
5:31•28 Apr 2026
Fresh Research Highlights in Addiction Medicine: Buprenorphine, Kratom, Edibles, Vaping and Prenatal Risks
Episode Overview
- Direct-to-inject weekly long-acting injectable buprenorphine showed mostly none to mild withdrawal and promising short-term treatment retention in an outpatient case series.
- Kratom-related poison centre cases increased sharply, and complete state bans were the only regulations linked with fewer severe outcomes and lower healthcare use.
- Cannabis edible advertising focused on psychological effects increased interest among recent users, while specific warnings raised perceived risk and sometimes reduced interest among non-users.
- Opioid-related polysubstance overdose deaths rose across all groups, with particularly large increases among Non-Hispanic Black men and women and differing patterns by drug combination.
- E-cigarette use was associated with a significant reduction in combustible cigarette consumption, and prenatal buprenorphine exposure showed a lower overall risk of neurodevelopmental disorders than methadone, though specific disorder risks were unclear.
“The majority of patients had no pre-DTI withdrawal symptoms, no or mild withdrawal symptoms post DTI, and were retained on buprenorphine at 30 days.”
What insights can experts and survivors share about addiction? This news-focused episode of "This Week in Addiction Medicine from ASAM" gives a rapid-fire tour of recent research that busy clinicians, policy people, and curious laypeople will find handy. Hosted by Zach Caruso, the lead story examines “outpatient direct initiation of injectable buprenorphine” in harm reduction and primary care settings. Rather than insisting on sublingual buprenorphine first, this “direct-to-inject” (DTI) strategy starts people straight onto weekly long-acting injectable buprenorphine.
You’ll hear how, among 23 patients with data, “the majority of patients had no pre-DTI withdrawal symptoms, no or mild withdrawal symptoms post DTI, and were retained on buprenorphine at 30 days,” suggesting this approach may help reduce barriers to starting treatment. From there, the episode shifts through several big-picture issues.
A US national analysis looks at kratom regulations, finding that kratom-related poison centre cases rose 65-fold between 2010 and 2023, and that “complete kratom bans” were the only regulations linked with significantly fewer severe outcomes and hospitalisations. Another study focuses on cannabis edibles advertising: taste and psychological-effect messages, warnings about intoxication or addiction risk, and how these shape young adults’ interest in use.
Racial and gender inequities in polysubstance overdose deaths get a stark spotlight, with opioid-involved deaths rising across all groups and particularly steep increases among Non-Hispanic Black men and women. A major e-cigarette review reports that e-cigarette use is associated with a mean reduction of 4.7 combustible cigarettes per day at six months. Finally, a cohort study compares prenatal buprenorphine and methadone exposure, finding a relative risk of 0.81 for neurodevelopmental disorders with buprenorphine, though specific disorder risks weren’t statistically clear.
If you care about evidence-based addiction care, what might these findings change in how you think about treatment, policy, and harm reduction?
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