AMA: All-hands-on-deck needed to end disturbing trends on overdose deaths

CHICAGO—With a report issued Thursday detailing the horrific toll of the nation’s overdose and death epidemic, the American Medical Association (AMA) calls for an all-hands approach — policymakers, public health experts, educators, faith leaders, and employers – to help save lives.

While physicians and other health care professionals have reduced opioid prescribing in every state—by nearly 50% nationally – that by itself cannot reverse the trend of drug-related overdose deaths. In fact, for the first time, in 2021 drug-related overdose deaths exceeded 100,000—primarily due to illicitly manufactured fentanyl, methamphetamine and cocaine. Overdose deaths are amplified by underlying social needs including housing and transportation.

“No community has been – or will be – spared the pain of this epidemic. The spiking mortality numbers – with young people and Black and Brown Americans dying at the fastest growing rates – add yet another urgent call to remove health inequities from the nation’s health care system. We know policymakers have not exhausted all remedies. Until we have, we must keep advocating for humane, evidence-based responses,” said Bobby Mukkamala, M.D., chair of the AMA Substance Use and Pain Care Task Force [LINK].

The report calls for a campaign to include:

• Policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and remove barriers – such as prior authorization — to evidence-based care. States should require health insurance companies and other payers to make non-opioid pain care alternatives more accessible and affordable.
• Medical and other health care professional licensing boards to help patients with pain by reviewing and rescinding arbitrary restrictions on opioid therapy—as now recommended by the Centers for Disease Control and Prevention.
• State officials to remove punitive policies against pregnant individuals and parents who have a substance use disorder. State departments of corrections and private jails and prisons need to ensure that all individuals with an opioid use disorder or mental illness receive evidence-based care while incarcerated — and are linked to care upon release. This includes ensuring access to medications for opioid use disorder (MOUD).
• Employers to review their health insurance and benefits plans to ensure employees and their families have access to pain specialists and affordable access to comprehensive pain care, physicians who provide MOUD, and psychiatrists who are in the employer’s network.
• Public health officials to help control infectious disease spread through supporting comprehensive syringe services programs, reduce overdose through widespread, community-level distribution of naloxone and fentanyl test strips and pilot projects in support of overdose prevention centers.
• Faith leaders to help destigmatize substance used disorders and harm reduction by educating their members and holding overdose awareness events.

“What is becoming painfully evident is that there are limits to what physicians can do. We have dramatically increased training and changed our prescribing habits, reducing the number of opioids prescribed while increasing access to naloxone, buprenorphine and methadone. But illicitly manufactured fentanyl is supercharging this epidemic. We need help from leaders across sectors to combat this public health crisis,” said Dr. Mukkamala.

The use of prescription drug monitoring programs (PDMPs) also continued its upward trajectory with physicians and other health care professions surpassing the 1 billion mark for the first time. PDMPs are electronic databases that track controlled substance prescriptions and help identify patients with uncoordinated care who might be receiving multiple prescriptions from multiple prescribers.

State-by-state data for opioid prescriptions, MOUD, naloxone and PDMP use can be found here: [LINK]

Read the report by clicking here.

HIGHLIGHTS FROM THE REPORT: 

• Physicians have taken action to reduce opioid prescribing, increase use of PDMPs, increase provision of MOUD, increase naloxone prescribing

• • 46.4 percent decrease in opioid prescribing between 2012-2021—every state in the nation has seen a significant decrease
  • More than 1.1 Billion queries of state PDMPs in 2021—a 23 percent increase from 2020
  • From 2012 to 2021, prescriptions for buprenorphine to treat OUD increased 104 percent; from 2020-2021, however, it only increased 1.6 percent
  • From 2016 to 2021, naloxone prescriptions dispensed from pharmacies increased from almost 134,000 to nearly 1.2 million prescriptions. Naloxone dispensed from pharmacies increased 31 percent from 2019-2021. But—naloxone access remains greatly limited by prescription status, and community-based distribution hampered by Rx status

• Epidemic is worsening—racial, ethnic inequities underscore increased mortality for Black and Brown Americans; Policymakers continue lack of meaningful policy enforcement against health insurance companies

• • 107,000+ Americans died of a drug-related overdose in 2021—mainly due to illicitly manufactured fentanyl, which is being found in 75+ percent of counterfeit pills and other substances
  • Young people, Black and Brown Americans dying at increasing rates; inequities in treatment becoming worse
  • Health insurance companies found to repeatedly violate state and federal mental health and substance use disorder parity laws
  • Of the 40.3 million people aged 12 or older with a substance use disorder, 93.5 percent received no treatment; more than 27 million people aged 18 or older with a mental illness received no treatment.

The report calls for key policy actions to focus on increasing access to evidence-based care for patients with a mental illness, substance use disorder, pain and those who need harm reduction services to improve outcomes and reduce mortality and other harms, including:

Implement policies to remove all barriers to evidence-based care for mental illness and substance use disorders, including parity enforcement, network adequacy

Remove arbitrary restrictions on pain care, including all policies based on misguided 2016 CDC opioid prescribing guideline

Increase access to a broad array of evidence-based harm reduction services, including naloxone, fentanyl test strips, syringe services programs.

More information from the AMA is available here.