Key Points

  • Alcohol-attributable cancer deaths in the United States more than doubled between 1990 and 2023, rising from roughly 11,400 to more than 23,100 per year.1
  • The cancer connection extends well beyond the liver: colorectal, esophageal, breast, pancreatic, and prostate cancers all carry meaningful alcohol-attributable mortality.1
  • Cannabis was detected in 21% of US overdose deaths from 2021 to 2025, but was listed as the cause of death in fewer than 1% of cases and was the only drug involved in nine deaths nationwide.3
  • Among adolescents aged 12 to 17 in overdose deaths where cannabis was detected, 88.6% also had illicitly manufactured fentanyls present.
  • A Canadian cohort study found lower one-year mortality for people who started methadone compared with matched people who started buprenorphine-naloxone after an opioid overdose, but the mortality gap largely disappeared when researchers looked only at days of active treatment.4
  • Dr. Sylvie Stacy says the study’s most important message is about the cost of unplanned treatment discontinuation, not which medication is superior.

Addiction News Weekly Episode 1.17

In This Episode

Episode Transcript

Welcome to Addiction News Weekly by Rehab.com, where we break down the biggest stories in addiction, recovery, and public health this week.

Alcohol as a Group 1 Carcinogen: Cancer Deaths Beyond the Liver

Alcohol-attributable cancer deaths have doubled since 1990, and the cancers involved are not the ones most people would guess. Research led by the Sylvester Comprehensive Cancer Center at the University of Miami, published in The Lancet Regional Health Americas, found that annual alcohol-attributable cancer deaths in the United States climbed from 11,361 in 1990 to 23,126 in 2023.1,2 Men aged 55 and older carried the largest share, and the increases showed up across cancer types, age groups, and regions.1

Public understanding of alcohol and cancer tends to stop at the liver. The data does not. Among older men, liver cancer accounted for the highest alcohol-attributable mortality, followed by esophageal and colorectal. Among women, breast cancer led, and that pattern shifts with age. For men between 20 and 54, colorectal cancer was the leading alcohol-attributable cause of cancer death. For women in that range, breast cancer ranked first, then colorectal.1

Dr. Chinmay Jani, the study’s corresponding author and chief fellow in hematology and oncology at Sylvester, said the most surprising finding was the breadth of alcohol’s impact across cancer types, and noted that its contribution to colorectal, esophageal, breast, pancreatic, and prostate cancer is far less understood by the public than the liver connection.1,2

One piece of context that rarely makes it into the conversation: the International Agency for Research on Cancer classifies alcohol as a Group 1 carcinogen, the same category as tobacco smoke and asbestos.1 Jani also noted that the lowest safe dose of alcohol is not known, and that reducing consumption to the lowest amount feasible may lessen both cancer risk and broader health damage.

For anyone weighing a decision about drinking, cancer risk is a legitimate reason to seek care, and researchers describe alcohol as a modifiable risk factor. Cutting back is rarely a matter of simply deciding to. Treatment ranges from medically supervised detox for people with physical dependence through outpatient and residential care. Three FDA-approved medications, naltrexone, acamprosate, and disulfiram, are used alongside counseling. Programs that screen for medical conditions and coordinate with primary care or oncology can address both concerns at once.

Cannabis in Overdose Deaths: What the CDC Data Shows

A CDC report published September 3rd in the Morbidity and Mortality Weekly Report found cannabis involved in 21% of US overdose deaths.3 However, cannabis was listed as the cause of death in fewer than 1% of those cases. The analysis drew on the State Unintentional Drug Overdose Reporting System, which combines death certificates with post-mortem toxicology from 31 states and Washington, D.C.3

Among 209,166 overdose deaths, cannabis was detected in 43,880. It was listed as causing death in 0.8% of fatalities, and it was the only drug involved in nine deaths nationwide. The pattern points to polysubstance use rather than cannabis alone. Most deaths where cannabis was detected also involved illicitly manufactured fentanyls or stimulants like cocaine and methamphetamine.3

The age breakdown is where this gets useful. Detection was highest among adolescents aged 12 to 17 at 42.7%, the highest of any age group, even though teenagers report lower cannabis use than other age groups overall. Among those teen deaths where cannabis was detected, 88.6% also involved illicit fentanyls and 69% involved stimulants. Adults 50 and older had the lowest detection rate at 16.7%.3 The CDC also noted the true rate of cannabis involvement may be higher because toxicology testing for cannabinoids is not performed in every case.

So what does a finding like this actually mean for someone in treatment? Cannabis rarely causes a fatal overdose on its own. Its presence in toxicology can point to other drug use that carries much higher risk. The practical takeaway is to tell a treatment provider about every substance you use, cannabis included, because that gives the clinical team a clearer picture of the risk. And when comparing programs, ask how they assess polysubstance use and what they offer when opioids are part of the picture.

Methadone vs. Buprenorphine-Naloxone: What the Ontario Study Really Means

A study published in JAMA Network Open used linked health data from Ontario to compare people who started methadone with matched people who started buprenorphine-naloxone.4 Everyone had visited an emergency department for opioid overdose within the previous year. The final group was 5,882 people, half in each treatment. Within one year, 5.6% of the methadone group had died, compared with 7.1% of the buprenorphine-naloxone group.4

Here is Rehab.com Medical Officer Dr. Sylvie Stacy with her take on this data.

I have a lot of new patients come to me very soon after they’ve had a non-fatal overdose. That’s a fairly common reason for folks to decide to start getting treatment. They’re often very shaken by that overdose. And it ends up being a narrow clinical window in which doctors can intervene. And whether we intervene by prescribing Suboxone or treating with methadone, both are great. And this study doesn’t change that. And it won’t cause me to start pushing more patients to take methadone over buprenorphine.

But it does prompt me to want to take an extra minute during my intake visits with new patients to really stress the importance of staying on treatment. For most patients, staying on treatment at least a year. And for all patients, at least until we mutually decide that it’s a good time to try tapering down and potentially stopping the medication.

The detail in this study that really is notable is related to whether subjects were actively taking their medication or had stopped or had a lapse in treatment. To reiterate: overall the study found that those who started methadone had a lower risk of dying over the following year than those who started buprenorphine. But when researchers looked strictly at the days that people were actively taking their medication, that mortality difference was no longer significant. Methadone and buprenorphine protected against death equally well while patients actually took them and stayed on them.

In other words, the survival advantage seen with methadone in the overall group was driven primarily by longer retention on methadone rather than a superior pharmacologic protection when compared to buprenorphine. The real takeaway from this study is not so much the difference in mortality between the two treatments but that it demonstrates how devastating unplanned treatment discontinuation and loss to follow-up can be for people who have an opioid use disorder.

Conclusion

Three findings, and each one is easy to misread in the same direction. Alcohol looks less dangerous than it is because most people associate it with the liver and not with five other cancers. Cannabis looks more dangerous than this particular data shows because detection in toxicology is not cause of death. And methadone looks decisively better than buprenorphine until you notice that the advantage mostly tracks how long people stayed in treatment.

If you or someone you love is looking for treatment, Rehab.com lists thousands of verified centers across the country and free confidential support is available anytime through the SAMHSA National Helpline at 1-800-662-4357. And if you are in crisis, you can call or text 988.

Those are the top stories in the news. For more, visit Rehab.com. I’m Kay. We’ll be back next week. And thank you for listening.

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Sources in This Episode

  1. Jani C, Lopes G, et al. Alcohol-attributable cancer mortality in the United States, 1990-2023: a secondary analysis of Global Burden of Disease data. Lancet Reg Health Am. 2026. doi:10.1016/j.lana.2026.101599
  2. Sylvester Comprehensive Cancer Center. Alcohol-Linked Cancer’s Toll Extends Far Beyond the Liver With Deaths Rising Across Age Groups. OncLive. September 3, 2026. https://www.onclive.com/view/alcohol-linked-cancer-s-toll-extends-far-beyond-the-liver-with-deaths-rising-across-age-groups. Accessed September 22, 2026.
  3. Centers for Disease Control and Prevention. Notes from the Field: Cannabis Detection Among Overdose Deaths – United States, 2021-2025. MMWR Morb Mortal Wkly Rep. 2026;75(34). https://www.cdc.gov/mmwr/volumes/75/wr/mm7534a2.htm. Accessed September 22, 2026.
  4. Kleinman RA, Larney S, Sule NO, Ma C, Hauck TS, Kurdyak P. Methadone vs Buprenorphine-Naloxone in Opioid Overdose Survivors. JAMA Netw Open. 2026. doi:10.1001/jamanetworkopen.2026.29313