R. Gregory Lande, DO, COL (Ret) FACN, FAOAAM is a past president of the AOAAM. Dr. Lande retired from the US Army Medical Corps in recognition for which he received the Legion of Merit award. Dr. Lande then assumed a variety of administrative, clinical, academic, and research positions. Currently, Dr. Lande is a clinical supervisor, Editor-in-Chief of the Journal of Addictive Diseases, and a clinical professor at the Orlando College of Osteopathic Medicine. He is the author of over 100 articles, chapters, and books on a wide variety of medical and medical history subjects.

Now comes a novel approach that aims to simulate aspects of care in human addiction medicine. This newcomer, Artificial Intelligence (AI), is rapidly entering healthcare and, like other technological approaches, is raising questions that extend beyond safety, efficacy, and privacy to include ethical concerns and tensions over the boundary between human interaction and AI’s ability to co-opt aspects of clinical care.

AI brings with it a language foreign to clinical practitioners. Evaluating AI’s benefits and harms requires at least a rudimentary understanding of this new terminology. The following discussion does not aim to produce a clinician fluent in the language but instead to stimulate further reflection and study.

As it currently stands, there is a knowledge gap between those who use AI and those who develop it. This barrier contributes to silos or stovepipes that interfere with the free flow of information. Lowering the knowledge barrier helps clinicians understand both the capabilities and limitations of AI while preserving the essential role of clinical judgment.

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R. Gregory Lande, DO, COL (Ret) FACN, FAOAAM is a past president of the AOAAM. Dr. Lande retired from the US Army Medical Corps in recognition for which he received the Legion of Merit award. Dr. Lande then assumed a variety of administrative, clinical, academic, and research positions. Currently, Dr. Lande is a clinical supervisor, Editor-in-Chief of the Journal of Addictive Diseases, and a clinical professor at the Orlando College of Osteopathic Medicine. He is the author of over 100 articles, chapters, and books on a wide variety of medical and medical history subjects.

Alcohol Use Disorder (AUD) presents in a continuum of severity, with distinct profiles exhibiting unique drinking behavior, motivations, consequences, and neurobiological underpinnings (Citation1). This heterogeneity leads to diverse treatment outcomes, posing a challenge to developing effective, personalized intervention strategies. Recognizing this heterogeneity, contemporary research in substance use has adopted person-centered clustering methodologies to identify homogeneous subgroups with differential responses to targeted interventions (Citation2). The conceptualization of AUD as a heterogeneous disorder with distinct profiles has clinical implications. Previous studies using latent class analysis and other clustering methods have identified multiple profiles with variations in symptom severity, comorbid psychopathology, and neurobiological dysfunction (Citation3,Citation4). These findings suggest that a one-size-fits-all treatment approach may be inadequate, and identifying and characterizing profiles could facilitate precision medicine approaches to AUD treatment.

Data-driven clustering approaches have become powerful tools for identifying heterogeneity across diverse medical and psychiatric conditions (Citation5). Unlike hypothesis-driven categorical approaches, clustering algorithms use multivariate patient-level data to discover naturally occurring groupings without preconceived classification schemes, uncovering clinically actionable patient subtypes with distinct prognostic profiles. This study used k-means cluster analysis, an unsupervisedmachine learning algorithm that mathematically groups patients into distinct profiles based on their underlying similarities across baseline biopsychosocial variables to identify clinically meaningful profiles of AUD.

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Welcome to the AOAAM Board of Trustees

We are proud to recognize Dr. Parul Chhatpar on her appointment as the Resident Trustee for the American Osteopathic Academy of Addiction Medicine (AOAAM) Board of Trustees.

Dr. Chhatpar has demonstrated an outstanding commitment to addiction medicine, medical education, and patient advocacy throughout her training. Her passion for advancing evidence-based care and supporting patients with substance use disorders makes her a valuable addition to the Academy's leadership.

As Resident Trustee, Dr. Chhatpar will bring the perspective of physicians in training while helping shape the future of addiction medicine within AOAAM.

Congratulations, Dr. Chhatpar! We look forward to your leadership and the many contributions you will make to the Academy and the addiction medicine community.

An Interview with Adam Scioli, DO, FAOAAM - AOAAM's President Elect

At first glance, products labeled “natural” and sold at your neighborhood gas station or smoke shop may not seem dangerous. But behind the appealing packaging, potent kratom extracts—containing compounds like 7-hydroxymitragynine—are quietly being marketed as safe alternatives. In reality, they act on the brain’s opioid receptors, can be addictive, and may carry risks similar to those of opioids.

“This can damage just about every organ in the body,” cautions Dr. Adam Scioli, Chief Medical Officer at Caron Treatment Centers. “Patients respond to it very much like opioid use disorder.”

With kratom’s growing availability in everyday retail settings, it’s critical to understand the risks, debunk the “all-natural” myth, and protect individuals from a substance that could trigger serious health consequences.

Click here to view the full interview and learn more.

R. Gregory Lande, DO, COL (Ret) FACN, FAOAAM is a past president of the AOAAM. Dr. Lande retired from the US Army Medical Corps in recognition for which he received the Legion of Merit award. Dr. Lande then assumed a variety of administrative, clinical, academic, and research positions. Currently, Dr. Lande is a clinical supervisor, Editor-in-Chief of the Journal of Addictive Diseases, and a clinical professor at the Orlando College of Osteopathic Medicine. He is the author of over 100 articles, chapters, and books on a wide variety of medical and medical history subjects.

Artificial intelligence (AI) is rapidly transforming sectors such as business, military, and healthcare, offering innovative solutions for efficiency, diagnostics, and decision-making. However, its integration into addiction medicine has lagged other fields, despite the potential to address critical challenges in prevention, treatment, and recovery support. This gap stems from a combination of factors, including concerns over data privacy, ethical considerations, and the complexity of behavioral health. Even so, AI presents unique opportunities to serve as a collaborative tool that can bridge these gaps and advance addiction care. The Journal of Addictive Diseases is now calling for submissions that explore how AI can be harnessed to transform addiction medicine, emphasizing both its limitations and its promise.

Identifying critical research gaps

The priority is to identify critical research gaps in the application of AI within addiction medicine. While feasibility studies have laid the groundwork, they often lack the rigor needed to assess long-term outcomes or compare different AI-driven interventions. For instance, there is a pressing need for effectiveness studies that evaluate whether AI tools, such as predictive analytic models for the risk of return to use or chatbots for recovery support, translate into tangible improvements in patient care. Comparative analyses of AI applications across settings, such as outpatient clinics versus hospital systems, can also inform best practices and resource allocation.

A research agenda for AI in addiction medicine

To address these gaps, a structured research agenda is essential. This should prioritize questions that span the addiction care continuum: prevention, treatment, and recovery support. For example, how can AI enhance early detection of substance use disorders through pattern recognition in behavioral or epidemiologic data? What role can machine learning play in personalizing treatment plans for individuals with complex co-occurring conditions, such as suggesting treatment interventions? Similarly, AI tools could support recovery by providing real-time monitoring, such as using wearable devices, and suggest intervention strategies to prevent return to use.

PSCC-MOUD.org

Dear Colleague:

I want to alert you to an important development in the field of opioid use disorder treatment.

In December 2024, the FDA published a Federal Register notice to encourage manufacturers of buprenorphine-containing transmucosal products for the treatment of opioid dependence (BTODs) to change their labels to empower clinicians to use their own judgment in determining the appropriate dose for patients, including doses higher than 24 mg/day. The manufacturers of Suboxone and Zubsolv then submitted updated labeling language, which the FDA approved in May 2025.

Until recently, the FDA-approved labeling for BTODs had stated “Doses higher than 24 mg daily have not been demonstrated to provide a clinical advantage,” and it referred to dosage of 16 mg as a “target dosage.” This was misinterpreted by some clinicians and insurers as establishing 16 or 24 mg/day as the maximum allowable dose of buprenorphine. The new language eliminates reference to a target dosage and clarifies that doses higher than 24 mg/day may be appropriate for some patients.

In recent years, prescribers, patients, and professional societies have expressed the concern that misperception that there was a maximum daily buprenorphine dose has limited access to this medication for patients who may benefit from higher doses, for instance because of a history taking high-potency synthetic opioids like fentanyl. The worry that higher doses may be inefficacious or unsafe has inhibited many providers from prescribing clinically sufficient doses and has led some insurance providers to limit coverage for BTODs and/or impose prior-authorization requirements that may delay a patient from getting their medication.

As you know, buprenorphine and other medications for opioid use disorder (MOUD) are critical tools for treating opioid use disorder and for addressing the overdose crisis that continues to claim more than 80,000 lives annually in the U.S. This change in buprenorphine labeling will encourage prescribers to use their own best judgment in determining the best dosages for their patients and encourage insurers to cover those dosages, thus enabling more patients to receive dosages of this medication that are appropriate to their individual therapeutic need.

For further information on the buprenorphine labeling changes and the FDA’s rationale, please see: https://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-changes-labeling-transmucosal-buprenorphine-products-indicated-treat-opioid-use.

To review the newest labeling for the Suboxone and Zubsolv buprenorphine products, see: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm.

Thank you.

-NIDA Public Inquiries Team

The DO - April 2025 Issue

By R. Gregory Lande, DO - R. Gregory Lande, DO is a graduate of ATSU-KCOM. Dr. Lande is a veteran of the U.S. Army and his active professional career turned to successive state, federal and private work. Dr. Lande specializes in adult psychiatry, forensic psychiatry and addiction medicine.

In 1972, the United States Postal Service issued a commemorative stamp honoring osteopathic medicine in celebration of the AOA’s 75th anniversary, recognizing the profession’s growing contributions to American health care.

The United States Postal Service (USPS) frequently unveils new stamp designs that honor important figures, commemorate significant dates, support charitable causes or just appeal to collectors. Did you know that the USPS once honored osteopathic medicine with a commemorative stamp?

This historic event took place on Oct. 9, 1972, marking the 75th anniversary of the AOA and recognizing osteopathic physicians’ contributions to American health care. The ceremonial stamp was unveiled during the AOA’s annual convention at the Americana Hotel in Miami Beach, Florida. It was a momentous occasion for the osteopathic medical community as it reinforced its impact and growing influence on modern health care.

Substance Abuse and Mental Health Services Administration
December 11, 2023

OVERVIEW

On December 11, 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA), in partnership with the U.S. Food and Drug Administration (FDA) and the National Institute on Drug Abuse (NIDA), hosted a listening session to discuss the medical need, emerging data, and barriers to accessing higher doses of buprenorphine in the context of high potency synthetic opioid (HPSO) exposure. The meeting focused on gathering quantitative and qualitative data on the need for, effectiveness of, and safety of “high dose” buprenorphine (defined as > 24 mg of buprenorphine per day) in the treatment of opioid use disorders (OUD), to inform federal guidelines and policies. This document summarizes the recommendations and opinions of the participants and does not reflect an official position, policy, or set of recommendations from any federal or state agency.

More than 300 individuals registered for the virtual listening session, with over 200 attending the Zoom meeting. Participants represented a wide range of disciplines related to OUD services, including providers, academics, researchers, and those with lived experience. The meeting was structured around four panels:

• Setting the Context: The Current Landscape, Guidance, and Use of High Dose Buprenorphine
• New and Original Data on the Use of High Dose Buprenorphine
• Qualitative Data and Implementation Insights
• Identifying Barriers to Accessing High Dose Buprenorphine and Potential Solutions

Read the report.