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Consensus Statement of the Physician Leadership on National Drug Policy

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The Physician Leadership on National Drug Policy is an ad hoc group of physicians with experience in health, medical care, and policy development. In June 1997, this group developed and adopted a Consensus Statement on national drug policy toward illegal drugs (see Appendix). In the belief that elements of their Consensus Statement are aligned with current American Medical Association (AMA) policy, this group has asked for AMA endorsement of the Consensus Statement. In previous communications from the AMA, the Physician Leadership group was informed that their Consensus Statement would be considered in the context of an ongoing AMA/American Bar Association initiative intended to produce a joint policy paper on drug abuse. Because this paper has been delayed, and because the Physician Leadership group has requested that their Consensus Statement be evaluated on its own merits, the Council on Scientific Affairs (CSA) has reviewed the document.

Comparison of Existing AMA Policy with Main Elements of the Physician Leadership Consensus Statement

Introduction: Many features of the introduction to the Consensus Statement are consistent with AMA policies. 

The concept that "use of the criminal justice system and interdiction to reduce illegal drug use and the harmful effects of illegal drugs is not adequate to address these problems" is supported by a number of AMA policies including Policies H-95.954 and H-95.956 (AMA Policy Compendium).

The Consensus Statement acknowledges that "alcohol causes a substantial burden of disease and antisocial behavior which requires vigorous, widely accessible treatment and prevention programs;" this is supported by numerous policies (eg, H-30.958, H-30.972, H-30. 983, H-30.995, H-30.997). The AMA's continued role and policies regarding efforts to reduce tobacco use are well known. 

While acknowledging the "gravity of problems caused by tobacco and alcohol," the Consensus Statement focuses on illegal drugs "because of a need for fundamental shift in policy." The AMA's programmatic and advocacy activities have emphasized tobacco and alcohol issues. Almost all AMA policies referring to drug abuse and dependence include alcohol and alcoholism as part of chemical dependency, and advocate for development of national policies that include alcohol in substance abuse prevention, intervention, treatment, and research. More recently, nicotine dependence has been added to this focus. In terms of the burden of illness nationally, tobacco is the leading cause of premature death (400,000 lives annually), alcohol the third (100,000 lives annually), while illicit drug abuse causes 25,000 premature deaths annually. Most recently, the AMA actively advocated that alcohol and tobacco issues be included in the media educational campaigns accompanying the federal war on drugs.

The Six Provisions of the Physician Leadership Consensus Statement

• Bullet 1: Supported by Policies H-95.954; H-95.956, H-430.994, CSA Report 12 (A-99),
  and numerous AMA advocacy and program activities. 

• Bullet 2: Supported by Policies H-185.974, H-185.992, and a wide range of other policies in this area seeking to incorporate substance abuse treatment in federal, correctional, and medical services and reimbursement mechanisms. 

• Bullet 3: Supported by Policies H-30.983, H-95.981, H-295.987, and H-295.988. 

• Bullet 4: This wording is not found in current policy as such; however, several policies call for the AMA and physicians to collaborate with community groups and the government to address substance abuse problems (eg, Policies H-95.967 and H-95.981) 

• Bullet 5: AMA policy has supported such research (Policies H-95.975; H-95.976; H-95.981; H-95.995), as well as research into specific methodologies such as needle exchange and methadone maintenance. 

• Bullet 6: The AMA has recently examined a number of such issues (harm reduction, needle exchange, opiate replacement therapy/methadone maintenance) and is currently working with the American Bar Association to develop a joint policy paper that examines how national policy might shift from a (primarily) criminal justice approach to a medical and public health approach to drug abuse problems. Staff are also collaborating with the National Institute on Drug Abuse and several specialty societies in examining means to inform physicians about current drug abuse and genetics research. 

Conclusion

The main elements of the Physician Leadership on National Drug Policy Consensus Statement are consistent with AMA policy. Because of the large public health impact, programmatic and advocacy activities of the AMA appropriately emphasize tobacco and alcohol issues. These are not the focus of the Consensus Statement.

RECOMMENDATIONS

The following statements, recommended by the Council on Scientific Affairs, were adopted by the AMA House of Delegates as AMA policy at the 1999 AMA Interim Meeting:

1. The AMA endorses the 1997 Consensus Statement of the Physician Leadership on National Drug Policy as a rational approach to informing national drug policy on illegal drugs.   
2. The AMA will promote medical approaches to substance use disorders by continuing to encourage physician involvement in case identification, diagnostic assessment, clinical therapeutic interventions, medical evaluation and management, and ongoing chronic disease management, as appropriate, for cases of alcohol and other drug addiction.   
3. The AMA continues to believe that the legalization of illegal drugs would be contrary to the best interests of the public health and support for the positions of the Physician Leadership on National Drug Policy ought not be construed as support for such legalization. 

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APPENDIX

Consensus Statement: Physician Leadership on National Drug Policy

Addiction to illegal drugs is a major national problem that creates impaired health, harmful behaviors, and major economic and social burdens. Addiction to illegal drugs is a chronic illness. Addiction treatment requires continuity of care, including acute and follow-up care strategies, management of any relapses, and satisfactory outcome measurements.

We are impressed by the growing body of evidence that enhanced medical and public health approaches are the most effective method of reducing harmful use of illegal drugs. These approaches offer great opportunities to decrease the burden on individuals and communities, particularly when they are integrated into multidisciplinary and collaborative approaches. The current emphasis -- on use of the criminal justice system and interdiction to reduce illegal drug use and the harmful effects of illegal drugs -- is not adequate to address these problems.

The abuse of tobacco and alcohol is also a critically important national problem. We strongly support efforts to reduce tobacco use, including changes in the regulatory environment and tax policy. Abuse of alcohol causes a substantial burden of disease and antisocial behavior which requires vigorous, widely accessible treatment and prevention programs. Despite the gravity of problems caused by tobacco and alcohol, we are focusing our attention on illicit drugs because of the need for fundamental shift in policy.

As physicians, we believe that:

• It is time for a new emphasis in our national drug policy by substantially refocusing our investment in the prevention and treatment of harmful drug use. This requires reallocating resources toward drug treatment and prevention, utilizing criminal justice procedures which are shown to be effective in reducing supply and demand, and reducing the disabling regulation of addiction treatment programs.
  
• Concerted efforts to eliminate the stigma associated with the diagnosis and treatment of drug problems are essential. Substance abuse should be accorded parity with other chronic, relapsing conditions insofar as access to care, treatment benefits, and clinical outcomes are concerned. 
  
• Physicians and all other health professionals have a major responsibility to train themselves and their students to be clinically competent in this area.
     
• Community-based health partnerships are essential to solve these problems.
  
• New research opportunities produced by advances in the understanding of the biological and behavioral aspects of drugs and addiction, as well as research on the outcomes of prevention and treatment programs, should be exploited by expanding investments in research and training. 
  
• Over the next year, Physician Leadership on National Drug Policy will review the evidence to identify and recommend medical and public health approaches that are likely to be more cost-effective, in both human and economic terms. We shall also encourage our respective professional organizations to endorse and implement these policies. Back to Text