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The American Medical Association’s Opioid Task Force report (PDF) released today shows a dramatic increase in fatalities involving illicit opioids, stimulants (e.g. methamphetamine), heroin and cocaine, and a similarly dramatic drop in the use of prescription opioids.
The changing landscape of the opioid epidemic poses challenges for the health care system, which must pivot to treat people in danger of overdose from all drugs. The AMA is calling on stakeholders—including health insurers and policymakers—to remove barriers to evidence-based care. Red tape and misguided policies are grave dangers to pain patients and those with an opioid-use disorder.
Physicians have reduced opioid prescribing, increased use of state prescription drug monitoring programs (PDMP), and increased the prescribing of naloxone. Physicians also have continued to educate themselves on safely prescribing, pain management, and recognizing signs of addiction. More than 50,000 physicians and other health care professionals have become certified to provide treatment for opioid use disorder in the past three years. Yet, illicit drugs are now the dominant reason why drug overdoses kill more than 70,000 people each year.
According to the U.S. Centers of Disease Control and Prevention (CDC), from the beginning of 2015 to the end of 2019:
“The nation needs to confront the fact that the nation’s drug overdose epidemic is now being driven predominantly by highly potent illicit fentanyl, heroin, methamphetamine, and cocaine, although mortality involving prescription opioids remains a top concern,” said AMA Opioid Task Force Chair Patrice A. Harris, M.D., M.A., who also is the AMA’s immediate past president. “If it weren’t for naloxone, there likely would be tens of thousands additional deaths. It is past time for policymakers, health insurers, pharmacy chains, and pharmacy benefit managers to remove barriers to evidence-based care for patients with pain and those with a substance use disorder.”
Key points from the 2020 report:
The report highlighted that despite medical society and patient advocacy, only 21 states and the District of Columbia have enacted laws limiting public and private insurers from imposing prior authorization requirements on substance use disorders’ services or medications, according to the Legal Action Center. Even fewer states have taken meaningful action to enforce mental health and substance use disorder parity laws. While access to legitimate opioid analgesics has decreased in every state, no state has taken meaningful action to require health insurers to increase access to non-opioid pain care or to remove arbitrary restrictions on access to opioid therapy. A recent survey from The American Board of Pain Medicine found 92 percent of pain medicine physicians said they have been required to submit a prior authorization for non-opioid pain care.
Specific actions that policymakers can take, include:
“We know that ending the drug overdose epidemic will not be easy, but if policymakers allow the status quo to continue, it will be impossible,” Dr. Harris said. “This is particularly important given concerns that the COVID-19 pandemic is worsening the drug overdose epidemic. Physicians will continue to do our part. We urge policymakers to do theirs.”