The AMA joined the Rhode Island Medical Society (RIMS) in urging the state to develop and implement a pilot overdose prevention site (OPS) to help save lives from drug-related overdose.

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“We support this effort as the OPS would be designed, monitored, and evaluated to generate data to inform policymakers on the feasibility, effectiveness, and legal aspects of an OPS in reducing harms and health care costs related to, among other things, injection drug use,” wrote AMA Executive Vice President and CEO James L. Madara, MD, to Senator Joshua Miller, chair of the Rhode Island Senate Committee on Health and Human Services.

“These facilities save lives, reduce infectious disease transmission and put people who inject drugs in contact with the recovery community,” said Sarah Fessler, MD, a RIMS past president and member of the Rhode Island Governor’s Overdose Task Force.

The AMA joined a coalition of 31 medical, academic, public health and advocacy organizations in support of a set of principles aimed at guiding state and local spending of potential opioid litigation settlement funds. The coalition, coordinated by the Johns Hopkins Bloomberg School of Public Health, is urging state and local officials to avoid the mistakes of the 1998 tobacco settlement and use the expected funds from the litigation to support efforts based in evidence that save lives. This is especially important given deaths due to drug overdoses have significantly increased since the COVID-19 pandemic began, with some states reporting increases of 30%.

“We are still deep in the midst of an overdose crisis,” said Joshua Sharfstein, MD, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health. “We don’t want to see a repeat of what happened with the tobacco litigation settlements where the vast majority of the funds weren’t used to address the actual public health issue at hand.” Sharfstein also directs the Bloomberg American Health Initiative at the Bloomberg School.

The report, Principles for the Use of Funds From the Opioid Litigation (PDF), provides five principles to help guide spending and policies supported by the settlement funds:

  1. Spend money to save lives Given the economic downturn, many states and localities will be tempted to use the dollars to fill holes in their budgets rather than expand needed programs. Jurisdictions should use the funds to add to, rather than replace, existing spending.
  2. Use evidence to guide spending  At this point in the overdose epidemic, researchers and clinicians have built a substantial body of evidence demonstrating what works and what does not. States and localities should use this information to make funding decisions. 
  3. Invest in youth prevention States and localities should support children, youth, and families by making long-term investments in effective programs and strategies for community change. 
  4. Focus on racial equity States and localities should direct significant funds to communities affected by years of discriminatory policies that now experience substantial increases in overdoses.
  5. Develop a fair and transparent process for deciding where to spend the funding This process should be guided by public health leaders with the active engagement of people and families with lived experience, clinicians, as well as other key groups.
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