Proven, evidence-based strategies to end the nation’s drug-overdose epidemic are available for use and need to be implemented now or the epidemic’s deadly toll will continue to rise.
“Policymakers and those who are around decision-making tables have a choice: Implement the policy, act on this policy or, unfortunately, more people die,” according to former AMA President Patrice A. Harris, MD, MA.
Dr. Harris, also former chair of the panel now called the AMA Substance Use and Pain Care Task Force, joined its current chair Bobby Mukkamala, MD, in an AMA webinar produced with Manatt Health to track the trajectory of the ever-changing epidemic, reiterated proven policies and strategies to end it, and highlighted the release of a report profiling 25 physicians and others who have successfully put those strategies into practice.
Drug-related overdose deaths exceeded the 100,000 mark for the first time in 2021, even as physicians have reduced opioid prescribing by nearly 50% in the last decade. Drug overdoses and deaths are being fueled mostly by illicitly manufactured fentanyl, methamphetamine and cocaine, and these deaths are amplified by barriers to evidence-based care, ongoing inequities, and underlying social needs.
The recommendations highlighted in the report are to:
- Increase access to evidence-based treatments to help patients with a substance-use disorder (SUD).
- Ensure access to addiction medicine, psychiatry and other trained physicians.
- Enforce mental health and SUD parity laws.
- Improve access to multidisciplinary, multimodal care for patients with pain.
- Expand harm-reduction efforts to reduce death and disease.
- Improve public health data surveillance, monitoring and evaluation.
These recommendations are driven by the evidence and represent policies that have been shown to reduce mortality related to opioids and other drugs, improve patient outcomes, and reduce harm. They represent a marked shift from the tenor of the national discussion when the AMA task force was first formed.
“We wanted to bring the force of the AMA, the platform of the AMA, to identify collective efforts that physicians could take,” said Dr. Harris, a child psychiatrist in Atlanta. “A focus of ours early on was: Let’s make sure we elevate this issue.”
The 25 profiles in the new AMA-Manatt report, “The Fight to End the Nation’s Overdose Epidemic and Restore Compassionate Care” (PDF), tell the stories of physicians, policymakers and patient advocates who implemented the strategies and have the data to show they’ve worked.
“What we need to see happen is continued physician prescribing of naloxone, but also removing the barriers physicians, emergency departments and harm-reduction organizations have to putting this lifesaving medicine into people's hands,” Dr. Mukkamala said.
He added, however, that naloxone is only one piece of a multifaceted solution, and that—while it saves lives in acute situations—preventing those acute situations is critical to moving the nation in the right direction.
Dr. Mukkamala cited the work of emergency and addiction medicine physician Don Stader, MD, who led the Colorado Naloxone Project, which has established naloxone education and distribution programs at more than 100 hospitals in the state.
Regarding removing the stigma that is unfairly placed on patients in pain, he cited the work of Rita Agarwal, MD, Edwin C. Chapman, MD, and Cara Sedney, MD, who were profiled in the report and featured in an AMA Advocacy Insights webinar last year.
The use of telehealth by Lewei Allison Lin, MD, an addiction psychiatrist at the University of Michigan Addiction Center and the VA Ann Arbor Healthcare System, to manage patients’ conditions was also cited in the webinar.
Dr. Harris noted the need for equitable access to treatment and mentioned the efforts of Gordon Smith, the former executive vice president at the Maine Medical Association who is now the director of the state’s opioid response efforts and helped ensure that treatment was available to patients in prisons and jails.
“I’m glad the focus on the epidemic has been elevated, but we have to realize the elevation occurred when middle-class and upper-middle-class white families began to be impacted by the epidemic,” she noted. “While we must urge policymakers to take action, we must ensure that the solutions are equitably provided.”
Barriers to implementing the strategies remain, and too often local government and health officials need convincing, for example, that policies for harm-reduction strategies such as naloxone distribution and syringe exchanges will work.
“A lot of people in decision-making roles on these issues, frankly, are less than comfortable with these harm-reduction solutions,” said Dr. Mukkamala. “We get rid of the fear by providing the data that shows that it is a useful tool and the AMA bases its advocacy on data.”
The AMA believes that science, evidence, and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic has become a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA End the Epidemic website.