What's the news: A report newly issued by the AMA shows that opioid prescribing nationwide has dropped 44.4% in the past decade and fell nearly 7% from 2019 to 2020. At the same time, the country is facing a worsening epidemic of drug-related overdoses and deaths.
Overdoses and deaths are spiking even as physicians and other clinicians have greatly increased the use of prescription drug-monitoring programs (PDMPs)—more than 910 million times in 2020, according to the AMA's "2021 Overdose Epidemic Report" (PDF). That's up 21% from the 750 million times that PDMPs were used in 2019 by doctors and others.
The report also highlights that more than 106,000 physicians and other health professionals have an "X-waiver" allowing them to prescribe buprenorphine for the treatment of opioid-use disorder. That's up by 70,000 since 2017, yet between 80% to 90% of people with a substance-use disorder (SUD) get no treatment.
Why it's important: The AMA report underscores the reality of the overdose epidemic, which is being driven by illicit fentanyl, fentanyl analogs, methamphetamine and cocaine, as illustrated by data from the Centers for Disease Control and Prevention.
"The nation's drug overdose and death epidemic has never just been about prescription opioids," said AMA President Gerald E. Harmon, MD. "Physicians have become more cautious about prescribing opioids, are trained to treat opioid-use disorder and support evidence-based harm-reduction strategies.
"We use PDMPs as a tool, but they are not a panacea," added Dr. Harmon, a South Carolina family physician. "Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidence-based care."
To help physicians end the overdose epidemic, policymakers should act now to:
- Stop prior authorization for medications to treat opioid-use disorder.
- Ensure access to affordable, evidence-based care for patients with pain, including opioid therapy when indicated.
- Better support harm-reduction services such as naloxone and needle and syringe-exchange services. These proven harm-reduction strategies save lives,but are often stigmatized.
- Collect adequate, standardized data to identify and treat at-risk populations, and better understand the issues facing communities.
"The focus of our national efforts must shift," Dr. Harmon said. "Until further action is taken, we are doing a great injustice to our patients with pain, those with a mental illness and those with a substance-use disorder."
Learn more: This frequently updated AMA issue brief (PDF) documents national, state and local reports illustrating how the nation's epidemic of drug-related overdoses and deaths continues to get worse.
The "2021 Overdose Epidemic Report" (PDF) outlines how the AMA has collaborated with policymakers, medical associations, patient organizations and other key stakeholders to:
- Influence over a dozen states in enacting laws directing that opioid-litigation funds be used mainly for public health uses.
- Provide tangible actions for policymakers and public health officials to increase access to evidence-based care.
- Promote evidence-based recommendations to help employers increase access to care for pain, SUDs and harm-reduction services.
- Advocate the enactment several dozen laws and regulations to increase access to medications to treat opioid-use disorder, meaningfully enforce mental health and SUD parity laws, decriminalize drug-checking supplies and remove barriers to evidence-based care for patients with pain.
- Identify the gaps in states' overdose-reporting systems.
- Support the National Association of Insurance Commissioners' work to meaningfully address health inequities in its work to advance mental health and SUD parity.
- Enact legislation in Oklahoma and Colorado to support individualized patient-care decisions for patients with pain, including opioid therapy and nonopioid pain care.
At the AMA's End the Epidemic website, you can dive deeper into the data, find state- and specialty-specific resources, and read about the inspiring physicians who are helping patients with substance-use disorders or chronic pain.
The End the Epidemic website was recognized by the Academy of Interactive and Visual Arts. As part of that organization's 27th Annual Communicator Awards, End the Epidemic was honored with an Award of Excellence in the Cause & Awareness website category.