AMA Update

Bobby Mukkamala, MD, on tangible actions to reverse the overdose epidemic

Aug 30, 2022

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.

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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 housing and transportation.

A new AMA report on the overdose epidemic (PDF) details the grim numbers behind the epidemic and outlines how physicians, policymakers, public health experts, educators, faith leaders and employers can work together to reduce the epidemic’s deadly toll.

“No community has been—or will be—spared the pain of this epidemic,” said Bobby Mukkamala, MD, chair of the AMA Substance Use and Pain Care Task Force.

“We know policymakers have not exhausted all remedies,” said Dr. Mukkamala, an otolaryngologist in Flint, Michigan. “Until we have, we must keep advocating for humane, evidence-based responses.”

U.S. drug-related overdoses deaths rose to 107,622, up 17.2% from 2020. The deaths contributed to the decline in life expectancy (PDF) in the U.S., which was 77 in 2020 but fell to 76.1 last year.

Everyone has a role in removing barriers for people with substance-use disorders (SUDs) or patients living with pain, as well as increasing access to comprehensive harm-reduction efforts while reducing inequities due to racial, gender, ethnic and other biases, says the AMA report.

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Physicians have responded to the epidemic by increasing their training, changing their prescribing habits, and expanding patient access to naloxone, buprenorphine and methadone.

Physicians and other health care professionals also have used state prescription drug-monitoring programs (PDMPs) more than 1 billion times in 2021, yet there remains no clear evidence that PDMPs increase access to care for patients with pain or SUDs.

“What is becoming painfully evident is that there are limits to what physicians can do,” Dr. Mukkamala said. “We need help from leaders across sectors to combat this public health crisis.” 

Physicians’ positive actions have been offset by “an insufficient focus on meaningful policy implementation and enforcement to support affordable, accessible, evidence-based care for patients with a substance-use disorder, pain, or access to harm-reduction services,” the report says.

The report identifies how many different stakeholders can help:

Policymakers, health insurers and national pharmacy chains must remove barriers—such as prior authorization—to evidence-based care.

Medical and other health care professional licensing boards should help patients with pain by reviewing and rescinding arbitrary restrictions on opioid therapy—as now recommended by the Centers for Disease Control and Prevention and supported by the AMA (PDF).

States should require health insurers and other payers to make nonopioid pain care alternatives more accessible and affordable.

State officials must also remove punitive policies against pregnant people and parents with a substance-use disorder.

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Jail and prison officials must ensure that all people with an opioid-use disorder or mental illness get evidence-based care while incarcerated—and get connected to care upon release. This includes ensuring access to medications for opioid-use disorder.

Employers should review their health insurance and benefits plans to ensure that employees and their families have access to pain specialists and affordable access to comprehensive pain care, physicians who provide medications for opioid-use disorder, and psychiatrists who are in the employer’s network.

Public health officials need to help control the spread of infectious disease by supporting comprehensive syringe services programs, reducing overdose through widespread, community-level distribution of naloxone and fentanyl test strips, and conducting pilot projects in support of overdose-prevention and harm-reduction centers.

Faith leaders must help destigmatize SUDs and harm reduction by educating their members and holding overdose-awareness events.

Find state- and specialty-specific resources at the AMA's End the Epidemic website, and read about inspiring physicians who are helping patients with SUDs or chronic pain.

The AMA and Manatt Health 2022 state toolkit (PDF) identifies more than 400 state laws, regulations, policy guidance and other select national actions being implemented to help end the nation's drug overdose epidemic. All states can use this resource as a go-to guide to increase access to evidence-based treatment and save lives from overdose.

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