FACTS AND STUDIES –
Dec. 22, 2025 – Each year, I review the most important addiction science in medical, neuroscience, and public health journals. In 2025, research addressed questions experts grapple with daily: What are realistic goals of treatment? How should we conceptualize recovery in an era of fentanyl? Are addictions neurobiologically reversible? Where do emerging therapies fit into evidence-based care?
1. Rethinking Medication Treatment Goals for Opioid Use Disorder
McLellan and Volkow confront one of the most persistent, emotionally-charged addiction questions: What are acceptable treatment outcomes? We have no cures, so what are we trying to achieve with medications for opioid use disorder? The authors propose a three-stage framework—protection, remission, and recovery. Protection emphasizes survival and overdose prevention; remission focuses on stabilization of cravings/use; recovery encompasses long-term health and functioning.
A person can be in recovery but treated with methadone, buprenorphine, or naltrexone. The authors contend that medication tapering should not be a default goal, and long-term or even lifelong treatment with methadone or buprenorphine may be appropriate for many patients.
2. Fentanyl: Not Just an Opioid Problem
Using national poison center data from 2015–2023, Fitzgerald et al. document a dramatic rise in nonfatal fentanyl exposures involving stimulant co-use. Cocaine-fentanyl exposures increased nearly sevenfold, while methamphetamine-fentanyl exposures rose more than sixfold. The findings underscore a fundamental change in illicit drug use and supply: Polysubstance exposure is the norm. Emergency physicians, addiction specialists, and public health systems must adapt to increasingly complex intoxication and withdrawal syndromes rather than single-substance models. This study reinforces fentanyl contamination as a supply-chain/overdose problem affecting all drug classes.
