What’s at stake
Opioid prescriptions have decreased by nearly 50% nationwide, but the nation’s drug overdose and death epidemic continues to worsen, making it clear that an all-hands approach is needed to save lives.
Annual drug-related overdose deaths exceeded the 100,000 mark for the first time in 2021. Fueled mostly by illicitly manufactured fentanyl, methamphetamine and cocaine, these deaths are amplified by underlying social needs including a lack of affordable housing and transportation.
In the past decade, physicians and other health professionals have increased the use of state prescription drug-monitoring programs in every state, with more than 1.1 billion queries in 2021. Plus, buprenorphine dispensing for the treatment of opioid-use disorder more than doubled in the past 10 years, and dispensing of the opioid-reversal medication naloxone has risen nearly 800% since 2012.
Of the 40.3 million people nationwide with a substance use disorder, 93% get no treatment. Meanwhile, a 2022 Labor Department found that health insurers regularly violate state and federal laws designed to provide coverage for substance-use disorders (SUDs) and mental illness. They also put up barriers to medications for opioid-use disorder (MOUD) and deny care to patients with pain—or make it so expensive that patients cannot access care.
The AMA’s position
While physicians are leading in areas where they can have an influence, they cannot end the epidemic alone. The organization’s road map calls for:
- Removing barriers to evidence-based care for patients with an SUD, including prior authorization, step therapy and dosage caps for MOUD.
- Continuing federal flexibilities for take-home medication for opioid treatment programs and audiovisual and audio-only telehealth options for patients to begin treatment.
- Removing regulations that prevent most physicians from being able to prescribe MOUD for their patients.
- Increasing access to evidence-based care rather than using punishment and the threat of family separation for persons with an SUD who are pregnant, peripartum, postpartum and parenting.
- Enforcing laws that require mental health parity to broaden access to treatment for mental health and substance-use disorders.
- Pharmacy chains, health insurers and pharmacy benefit managers to remove arbitrary barriers to opioid therapy and ensure access to affordable, accessible nonopioid pain care.
- Patients and physicians to have conversations about safe storage and disposal of opioids and all medications.
- Increasing access to naloxone for patients at risk of overdose.
- Developing and implementing systems to collect timely, adequate and standardized data to identify at-risk populations, fully understand polysubstance drug use.
- Implement public health interventions that directly address removing structural and racial inequities.
AMA advocacy in action
The AMA has:
- Helped enact more than two dozen state laws increasing access to naloxone and broadening Good Samaritan protections for those who help people who overdose.
- Supported community-based harm reduction efforts, calling on all naloxone manufacturers to make their products more accessible, including over the counter, and further urged the Biden administration (PDF) and Congress to remove the prescription status of naloxone.
- Provided comments (PDF) to the Centers for Disease Control and Prevention, whose updated opioid-prescribing guideline includes nearly all previous AMA recommendations, including removing harmful thresholds on dose and quantity that have harmed tens of thousands of patients.
- Worked with multiple states, including Minnesota (PDF) and Oklahoma, to help physicians who treat patients with pain provide individualized care—even when that care may go outside arbitrary numeric thresholds.
- Supported the Biden administration’s National Drug Control Strategy’s focus on harm reduction and encouraged the administration to continue to help remove barriers to medications for opioid-use disorder as well as harm-reduction services.
- Supported state legislation in Maryland (PDF) to ensure opioid-litigation settlement funds from major distributors go to public health and treatment.
The AMA is:
- Urging congressional leaders (PDF), state departments of insurance and state attorneys general to address nearly 15 years of repeated failures by health insurance companies to comply with the landmark mental health and substance-use disorder parity law, and continuing to support greater state-level enforcement of parity laws.
- Continuing efforts to remove the federal “x-waiver” for prescribing buprenorphine in-office for opioid-use disorder.
- Urging state legislatures to adopt additional harm-reduction measures, including decriminalizing fentanyl test strips.
- Recently adopted AMA policy on opioids.
- AMA Substance Use and Pain Care Task Force recommendations (PDF).
- “2022 Overdose Epidemic Report” (PDF).
- “State Toolkit to End the Nation’s Drug Overdose Epidemic: Leading-Edge Actions and Strategies to Remove Barriers to Evidence-based Patient Care” (PDF).
- End the Epidemic, which includes state- and specialty-specific resources, data dashboard, and inspiring stories about physicians who are helping patients with SUDs or chronic pain.
Visit AMA Advocacy in Action to learn more about the advocacy priorities the AMA is actively working on.