Why we must act quickly and decisively to end the overdose epidemic

Jesse M. Ehrenfeld, MD, MPH , Immediate Past President

With more than 100,000 lives lost annually and millions without access to affordable, available treatment for substance use disorder, our nation must heighten the fight against an epidemic that darkens our future: drug-related overdoses and deaths.

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For several years now, the AMA has presented annual data on the epidemic. The 2023 AMA Overdose Epidemic Report details how the epidemic continues to worsen, presenting policymakers with a clear choice: help increase access to evidence-based care for substance use disorders, as well as pain and harm reduction, or prolong and worsen the epidemic.

This crisis continues to evolve and pose new challenges for physicians, policymakers and other stakeholders working to find effective solutions. While our latest report shows the number of opioid prescriptions dropped for the 13th straight year, overdoses and fatalities linked to illicitly manufactured fentanyl, methamphetamine, and cocaine are on the rise—fueling the deaths of more than 110,000 people nationwide in 2022, or nearly 300 fatalities each day, according to figures from the Centers for Disease Control and Prevention (CDC).

To be certain, Black and Brown communities, pregnant individuals, and youth are hit hardest, dying at disproportionately higher rates than other population groups. At the same time, the emergence of toxic synthetic adulterants such as xylazine pose a new threat while complicating our search for solutions.

It's important to note that not all of the indicators we continue to monitor in this crisis are negative. For example, opioid prescriptions written by physicians and other health care professionals have plunged in every state, and by almost 50% nationally. Yet there is no indication that health insurers have increased access to non-opioid pain care options. And there is growing evidence that patients who benefit from opioid therapy continue to face the brunt of inappropriate dose and quantity restrictions based on the now-repudiated 2016 CDC opioid prescribing guideline.

State prescription drug-monitoring programs (PDMPs) were used more than 1.3 billion times in 2022, which is a testament to the fact that the databases have improved in functionality. Yet, a PDMP is not treatment, and it doesn’t connect individuals to care.

Perhaps the best news from the AMA report relates to naloxone, the lifesaving opioid overdose antidote. There are significant increases in physician prescribing, and massive increases in naloxone distributed in the community by harm-reduction organizations. The Food and Drug Administration’s approval of over-the-counter sales of naloxone earlier this year also is positive, but the AMA is deeply disappointed that the price of the life-saving medication is out of reach for too many—and that pharmacy chains are placing it behind the counter—which helps no one.

As a nation, we have to do better. As physicians, we must show the leadership necessary to make a difference.

Wider access to opioid-reversal medications such as naloxone has no doubt prevented untold numbers of overdose fatalities, and continues to do so—but we need to make it as easily available as first-aid kits and the defibrillators that are now routinely found in public spaces. The AMA supports updating naloxone access laws and policies that would make it more widely available not only in schools, but also in large public buildings and spaces that can be outfitted with rescue stations that provide the medication along with instructions on its use.

Increased access to naloxone is absolutely necessary, but that alone is insufficient. Harm reduction recognizes the fact that people with substance-use disorders may not be able to completely abstain from using drugs, so we need to support public health strategies that keep people alive and—as the name implies—reduces harm. This is why the AMA supports initiatives such as sterile needle and syringe-service programs to reduce the spread of blood-borne infectious disease. Syringe service programs can help reduce the spread of HIV, viral hepatitis and other infectious diseases transmitted by injection drug use.

The AMA supports decriminalizing test strips and other devices that check for the presence of illicit fentanyl and other adulterants such as xylazine. These drug-checking supplies can help people use differently—or not use at all. The AMA also urges state lawmakers to embrace updated Good Samaritan statutes that protect people who overdose as well as those who seek assistance for others during an overdose event.

The AMA also supports:

  • Ensuring that state insurance departments enforce mental health and substance-use disorder parity laws, with which health insurers consistently fail to comply.
  • Extending the reach of opioid treatment programs in underserved communities.
  • Removing the stigma that surrounds both substance-use disorder and harm-reduction strategies.
  • Stripping barriers such as step therapy and prior authorization for medications used to treat opioid-use disorder, including dosage caps on buprenorphine.
  • Identifying and removing the health inequities responsible for the disproportionate impact of drug-related overdoses and deaths in Black and Brown communities.
  • Prohibiting barriers to treating substance-use disorders in jails and prisons.

The nation’s drug-related overdose and death epidemic demands immediate and collective action.

Without such action, more Americans will suffer and die.