International Overdose Awareness Day on Aug. 31 sparks both sadness and optimism within me. I grieve the loss of hundreds of thousands of lives to drug-related overdoses, because every death tears apart families and communities and leaves devastating economic and psychological damage in its wake.
But the fact that fatal drug overdoses plunged by 25% from last year offers hope that our nation is on the right track in battling substance misuse and substance-use disorder (SUD), particularly from high-potency, illicitly made fentanyl (IMF).
Physicians play a critical role in maintaining this momentum by supporting overdose prevention and education efforts while knocking down persistent barriers to evidence-based care. It’s important that we all spread awareness that recovery is possible, and help strip away the stigma that still surrounds drug use by emphasizing that addiction is a chronic disease and not a moral failing.
We need to employ every measure to increase access to care for individuals with a substance-use disorder or pain—and do everything we can from a primary and secondary prevention standpoint to keep people alive and reduce their risks.
Role of prevention to reduce harm
Because opioids (particularly IMF) are responsible for the majority of fatal drug overdoses in the U.S., the widespread availability of opioid reversal agents, particularly naloxone, in the community has helped reduce deaths.
Having helped secure over-the-counter status for naloxone, the AMA supports its expanded availability in all formulations and urges officials to provide access to it in all types of public places, including schools, airports, concerts and public institutions. Just like automated external defibrillators, we hope naloxone won’t be necessary, but we want people to be ready if it is. You can find a video on the proper method to administer naloxone here.
Naloxone is a key element of the AMA’s broad-based overdose education and prevention strategy that has helped our nation reduce overdose deaths. The use of fentanyl test strips can also mitigate overdose risk by allowing individuals to test street drugs for the presence of potent adulterants like IMF and xylazine.
The AMA strongly supports physicians in overdose-prevention efforts, including making naloxone education part of their regular discussions with patients. The AMA has also developed a new issue brief (PDF) to help build awareness about polysubstance use and an educational podcast series to support physicians’ conversations with patients.
Search for solutions
The AMA is more active than ever in advancing solutions and practical policies backed by evidence-based science to save lives and improve outcomes for those struggling with addiction. The AMA Substance Use and Pain Care Task Force that I chair is pursuing a five-point plan to:
- Knock down barriers to evidence-based treatment for substance-use disorders by ensuring access to medication for opioid use disorder and co-occurring mental illness.
- Support access to and coverage of comprehensive, multimodal and evidenced-based treatment on an individualized basis for patients dealing with pain, a SUD or mental illness, and protecting these patients from continued stigma.
- Expand primary and secondary education and prevention strategies to prevent fatal overdoses and limit the spread of infectious disease, with a particular emphasis on naloxone and availability of fentanyl test strips, among other strategies.
- Establish a collaborative effort among patients, health professionals, lawmakers, policymakers, employers, community leaders and others to enhance education and training in treating pain, SUD and mental illness.
- Build a sustainable and resilient health care workforce and infrastructure, eliminate widespread gaps in evidence-based treatment and prevention efforts, collect better data and address polysubstance use.
You can find much more information on the drug-overdose crisis and how the AMA is working to implement solutions in our 2024 Overdose Epidemic Report.
Role of mental health parity
Tragically, uneven monitoring and lax enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA) has allowed health insurers to circumvent the key directive of this 2008 law: to ensure that those seeking mental health care or treatment for a SUD do not encounter greater barriers or limits than they would in securing medical and surgical care.
The law specifies, among other things, that health plans cannot impose co-payments, deductibles, prior authorization rules or other requirements on mental health and substance use disorder benefits that are more restrictive than those applied to medical and surgical benefits.
But this is precisely what continues to happen. Health plans have violated MHPAEA since it became law nearly two decades ago, and they continue to do so—often flagrantly—to this day. This lack of compliance takes many forms, but the bottom line is that every violation winds up delaying or blocking treatment to an individual who needs mental health or SUD care. Delayed and denied care invariably harms patients.
As a cancer survivor, I know firsthand the individual and family trauma that results from medical uncertainty, as well as the relief and reality of receiving timely care. Why should patients with cancer be treated differently by health plans than patients with a mental illness or SUD?
Part of the reason is stigma. But obstacles imposed by health plans compound that stigma and discrimination that patients dealing with mental health issues and SUDs encounter daily. These barriers often dissuade patients from seeking any type of treatment. The AMA calls on all state departments of insurance to hold health plans accountable for complying with parity laws. It shouldn’t be this hard.
AMA resources
The AMA Ed Hub™ offers the latest research on overdose prevention, SUD treatment best practices, pain management, addiction recovery and a host of related topics. Changing our collective mindset about those dealing with addiction will speed the decline in overdose deaths and help our nation turn this crisis around. At the same time, the AMA is working every day at the state level to remove prior authorization requirements that remain in place for medications like buprenorphine that are used to treat opioid use disorder.
Working together, we can advance practical, evidence-based solutions to end the epidemic of drug overdoses and deaths. Doing so will accelerate the decline in fatal overdoses already underway and save countless more lives.
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