New psychoactive substances (NPS) are quickly emerging, transient and difficult to track. While some coordinated public health responses have been used to combat NPS outbreaks, most strategies and solutions remain disconnected, lacking necessary information and data sharing capability. With the eruption of both illicit and synthetic drugs, as well as a lack of regulation, physicians are also searching for further education to aid in treating patients.

Delegates at the 2017 AMA Annual Meeting voted to support multifaceted, multiagency approaches to combat NPS. Delegates also supported increased NPS surveillance and early warning systems for more actionable information that can quickly aid law enforcement, public health officials, emergency physicians and vulnerable populations in mitigating the growing NPS problem.

Overdose deaths skyrocket

Drug overdose deaths in the United States involving synthetic opioid drugs such as fentanyl and carfentanil more than doubled between 2010 and 2015. And it won’t stop there—drug overdose deaths are expected to continue to increase year over year. Physicians, public health officials, law enforcement, first responders and forensic laboratories all need to collaborate to decrease morbidity and mortality related to emerging drugs of abuse, says an AMA Council on Science and Public Health report whose recommendations the AMA House of Delegates (HOD) adopted.

Eliminating the threat of NPS in the United States will require a comprehensive, multidisciplinary effort. The frequent emergence of new drugs of abuse with unknown dangers and a potentially high death toll, especially NPS opioids, are a challenge that requires a coordinated effort and response to mitigate risks to the public health to improve outcomes, the report says.

“Although Congress passed AMA-supported legislation in 2012 that placed 26 synthetic drugs in Schedule 1 under the Controlled Substances Act (CSA), drug traffickers have devised ways to circumvent federal drug laws by slightly altering the chemical structure of their products and designing new synthetic drugs,” said Patrice A. Harris, MD, chair of the AMA Board of Trustees and the AMA Opioid Task Force.

“These new products are currently unregulated and are frequently marketed to young people as innocent products like 'bath salts,' plant food or incense," she added. "They also include variations of the extremely dangerous opioid fentanyl, which has been wreaking havoc across the country and resulting in a sharp increase in drug overdoses and deaths due to such overdoses.”

The HOD amended existing policy to state that the Association:

  • Recognizes that emerging drugs of abuse, especially NPS, are a public health threat.
  • Supports ongoing efforts of the Centers for Disease Control and Prevention (CDC), the Department of Justice, the Department of Homeland Security and state departments of health, in addition to the existing departments to develop and disseminate fact sheets, other educational materials and public awareness campaigns.
  • Supports a collaborative, multiagency approach to addressing emerging drugs of abuse, including information and data sharing, increased epidemiological surveillance, early warning systems informed by laboratories and epidemiologic surveillance tools, and population-driven, real-time social media resulting in actionable information to reach stakeholders.
  • Encourages adequate federal and state funding of agencies tasked with addressing the emerging drug of abuse threat.
  • Encourages the development of continuing medical education on emerging trends in illicit drug use.
  • Supports not only the federal government, but state and local government agencies to identify new drugs of abuse and to institute the necessary administrative or legislative actions to deem such drugs illegal in an expedited manner.

In addition to these modifications, delegates directed the AMA to participate as a stakeholder in the CDC -Drug Enforcement Administration (DEA) task force for the development of a national forum for discussion of NPS-related issues.

The AMA also supports the Synthetic Drug Control Act of 2017 (H.R. 1732). The bill would require the U.S. attorney general to classify as Schedule I about 250 new synthetic substances identified by the DEA since 2012

Read more news coverage from the 2017 AMA Annual Meeting.

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