What’s the news: The AMA is amplifying concerns that the nation’s drug overdose epidemic appears to be worsening during the COVID-19 pandemic.

In an op-ed published in Morning Consult, AMA Immediate Past President Patrice A. Harris, MD, MA, wrote that there remains an urgent need to remove health insurers’ barriers to evidence-based treatment for patients with pain and substance-use disorders, enforcing mental health and substance-use disorder parity, and other actions necessary if the epidemic is going to end.

Why it’s important: The drug-overdose-and-death epidemic already was hurting communities big and small before COVID-19, but during the pandemic there have been reports from every region of the country on spikes in opioid-related calls to first responders, visits to the emergency department, fentanyl-related overdoses and tainted-drug-related overdoses. There also have been challenges to accessing sterile needle and syringe and exchange services.

“Social distancing, a dramatic increase in unemployment and widespread economic woes lend themselves to common substance misuse triggers: isolation and anxiety. The medical community often refers to addiction as ‘a disease of isolation,’ and Americans are at high risk now, even those who did not misuse opioids previously,” wrote Dr. Harris, chair of the AMA Opioid Task Force since its inception. “At the end of April, 28% of American reported worsening mental health and 34% reported worsening emotional well-being.”

To address the situation, the AMA is working with federal agencies. For example, the Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Enforcement Administration (DEA) increased flexibility for physicians to provide patients with buprenorphine and methadone for opioid use disorder. The DEA also made changes that help patients with pain get the medications they need.

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Taking action on opioid use disorder, pain & harm reduction during COVID-19

Dr. Harris called for further steps to be taken to prevent the opioid epidemic from worsening. These state-level measures include:

  • Adopting the new SAMHSA and DEA rules and guidance for the duration of the COVID-19 pandemic, which includes being able to use telemedicine to evaluate and prescribe.
  • Removing prior authorization, step therapy and other administrative barriers for medicines used to treat opioid use disorder.
  • Removing arbitrary dose, quantity and refill restrictions and other barriers to controlled substances so pain patients can get needed medications.
  • Enacting, implementing and supporting harm-reduction strategies, including removing barriers to sterile needle and syringe services programs and increasing access to naloxone.

“Recognizing the intersection of COVID-19 and the opioid epidemic, policymakers, physicians, community leaders, first responders and others must ensure enhanced collaboration now more than ever,” the op-ed concludes.

Learn more: The AMA also is urging the Centers for Disease Control and Prevention (CDC) to revise its 2016 opioid prescribing guideline to remove arbitrary limits or other restrictions on opioid prescribing given the lack of evidence that these limits have improved outcomes for patients with pain. Rather, they have increased stigma for patients with pain and have resulted in legitimate pain care being denied to patients.

“Hard thresholds should never be used. Where such thresholds have been implemented based on the previous CDC Guideline, they should be eliminated,” AMA Executive Vice President and CEO James L. Madara wrote in a letter to the CDC last week.

Find out more about what the AMA’s COVID-19 policy recommendations for opioid-use disorder, pain care and harm reduction. To discover what the AMA is doing to combat the opioid epidemic, access additional resources and hear what other physicians are doing to improve and increase access to care at the AMA Opioid Task Force’s End the Epidemic website.

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