The nation’s drug overdose epidemic continues to evolve and more Americans than ever are dying from overdose related to illicitly manufactured fentanyl and fentanyl analogs as well as methamphetamine, cocaine and heroin.
The key is to not fixate on any one particular substance, but to focus on preventing substance-use disorder (SUD), removing barriers to treatment, and delivering equitable, sustainable and easily accessible care, said AMA Opioid Task Force Chair Patrice A. Harris, MD, MA, who also is the AMA’s immediate past president.
Dr. Harris made these remarks while participating in “Trauma and Resiliency: The Opioid Crisis in Communities of Color,” an online panel discussion hosted by the Commonwealth Club of California that explored the impact that historical and ongoing trauma has had in marginalized and minoritized communities.
“This trauma is often perpetuated by the lack of community-based prevention, intervention and access to treatment—especially culturally competent care—as well as the lack of addressing cultural stigma related to seeking treatment in communities of color,” the program’s description stated.
Dr. Harris noted that the Centers for Disease Control and Prevention (CDC) has data showing that exposure to trauma not only can lead to SUDs, but also cardiovascular disease, diabetes and other health concerns.
Nearly 71,000 Americans died from an unintentional drug overdose last year. Now, layered on top of this ongoing epidemic is the COVID-19 pandemic and there are reports of overdose surges across the U.S.
Learn how COVID-19 may be worsening the overdose crisis, but states can take action.
“We have lost some hard-won ground and our hearts are broken,” said panel moderator Grace “Katie” Bell, a nurse consultant with the TeleWell Indian Health Medication-Assisted Treatment (MAT) Project in Grass Valley, California.
Barriers to treatment must be removed
“Certainly, we know COVID has amplified many things,” Dr. Harris said, noting that the physical distancing necessary to slow the spread of COVID-19 can potentially create more anxiety and feelings of isolation that may trigger substance use.
Dr. Harris also pointed to some encouraging signs such as growing treatment capacity, growing access to naloxone, and fewer opioid prescriptions being written, although patients with pain report ongoing challenges in obtaining nonopioid pain care. Also, the federal government has authorized physicians to provide patients with increased amounts of take-home doses of methadone as well as authorizing physicians to t start a buprenorphine regimen without an in-person visit.
It’s hoped that the health system can learn from and “continue to build upon these few glimmers of hope,” she said.
This would include removing any and all barriers—such as prior authorization and step therapy—to medications to help treat opioid-use disorder and to evidence-based pain care, Dr. Harris explained. She added that, what also needs to be done, is make the health system much easier for patients to navigate—something that people in her home city of Atlanta refer to as “inverting the burden.”
Learn more about Dr. Harris’ strategy to reignite the nation’s fight against the overdose epidemic.
Panelist Marlies Perez, chief of the California Behavioral Health Community Services Division, also referenced federal government flexibilities during COVID-19 and said: “Let’s keep them coming.” Perez also questioned why some restrictions on treatment were ever instituted in the first place, and she noted how they “reinforce stigma.”
Bell agreed and noted that she uses the term “stigma injury,” which she defined as “when somebody has endured so much wounding because the system hurts them.”
Health and where people live
Dr. Harris explained that patients may be on medication for diabetes but live in food deserts and maintaining a proper diet requires arduous journeys via public transportation.
“We need to account for the reason someone’s life expectancy is determined by their ZIP code,” Dr. Harris said, adding that one productive approach would be to collect data for ZIP codes where residents have lower life expectancy and use that information to develop targeted public health interventions.
Systemwide bias and institutionalized racism contribute to inequities across the U.S. health care system.
The AMA is fighting for greater health equity by identifying and eliminating inequities through advocacy, community leadership and education.
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