Although opioid-related overdose deaths declined last year, the epidemic remains widespread and increasingly complex, driven by mixing opioids and other substances and an unpredictable illicit drug supply, according to a new report from the AMA.
The new AMA report (PDF) outlines five areas of concern and actionable steps to address the nation’s overdose epidemic and offer treatment to patients with pain and substance-use disorders.
“While the data points to meaningful progress, it also shows the overdose epidemic is evolving in dangerous ways,” said AMA President Bobby Mukkamala, MD. “Illicitly manufactured fentanyl and polysubstance use continue to put patients at risk, while barriers to pain care and addiction treatment persist. Every patient deserves timely, evidence-based care without stigma. State and national efforts must keep pace with the changing nature of this epidemic.”
Opioid-related deaths dropped from more than 110,000 in 2023 to 75,000 in 2025. Most of these deaths “are still driven by illicitly made fentanyl—and nearly 60% involve more than one dangerous substance. The drug supply is more toxic and unpredictable than ever,” AMA CEO and Executive Vice President John Whyte, MD, MPH, wrote in a letter accompanying the new report.
“The bottom line: this epidemic is evolving faster than our systems are,” he added. “Small steps aren’t enough. We need physicians, policymakers, payers, and communities working together to remove barriers, expand treatment, and respond quickly to new threats. Every patient deserves care without stigma and without delay.”
Five areas of concern
The AMA Substance Use and Pain Care Task Force has worked to support patients with pain and addiction. And there has been progress. Prescriptions dispensed for buprenorphine—a key treatment for opioid-use disorder—have risen from 1.4 million in 2012 to 15.4 million in 2024. But, the AMA’s report notes, large gaps remain in these critical areas.
Pain care: Access to nonopioid pain options is still inadequate, even with the drop in opioid prescriptions from 260.5 million in 2012 to 125.7 million in 2024. The AMA advocates for individualized patient care decisions, legislative and other reforms to preserve physician discretion and increased access to multimodal, multispecialty therapies.
Treatment for opioid-use disorder: Medications for opioid-use disorder, including buprenorphine and methadone, save lives but remain underused due to stigma, regulatory barriers and insurance restrictions. The AMA calls for eliminating prior authorization and expanding methadone access beyond opioid treatment program settings.
Naloxone: Wider access to naloxone prevents overdose deaths. The AMA supports over-the-counter access, emergency department distribution and community-based programs to ensure timely administration.
Emerging threats: Polysubstance use is on the rise. Users often take combinations of these drugs, which include stimulants, xylazine, kratom, tianeptine and inhalants. Additionally, cannabis-use disorder is growing, which increases mental health and pregnancy risks. The AMA calls for increased surveillance, research and public policies to mitigate further harm.
Policy priorities: The AMA is calling for action to enforce mental health and substance-use disorder parity laws, remove barriers to treatment for pain and substance-use disorders, and strengthen overdose-prevention efforts aimed at helping youth and populations at high risk.
The need for policymakers and regulators to help remove barriers to care for people with a substance-use disorder or a mental illness was the focus of an expert panel discussion held at last week’s AMA State Advocacy Summit. The conference, held in Southern California, drew more than 300 physician leaders and medical society staff. Key actions states can take, according to the AMA, include:
- Increasing enforcement of state mental health and substance use disorder parity laws—including imposing meaningful penalties on health insurance companies that fail to demonstrate parity compliance.
- Removing barriers to medications for opioid-use disorder, including prior authorization and restrictions on buprenorphine dosages greater than 24mg.
- Building upon efforts to increase access to naloxone—through physician prescribing, over-the-counter access in pharmacies, and community-specific distribution initiatives.
Dr. Mukkamala—who also chairs the AMA Substance Use and Pain Care Task Force—moderated the discussion.
He was joined by panelists Yngvild Olsen, MD, MPH—a national adviser at Manatt Health who formerly served as director off the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAHMSA)—and Lauren Finke, MPP, senior policy director at The Kennedy Forum. They provided specific state legislative solutions designed to help people with a mental illness or substance-use disorder and outlined achievable policy and clinical interventions to improve outcomes and save lives.
Finke also demonstrated the Mental Health Parity Index, a first-of-its-kind data visualization tool that analyzes commercial insurance plans based on coverage and access to mental health and substance use services compared to physical health services using health plans’ own data across three indicators: network composition, outpatient professional reimbursement, and inpatient acute reimbursement. The AMA collaborated with The Kennedy Forum and Third Horizon to launch a pilot of the Mental Health Parity Index.
Building lifesaving momentum
In 2025, the AMA worked to build collaborative efforts among physicians, policymakers, insurers and community organizations to increase access to care for opioid-use and other substance-use disorders, reduce stigma and save lives.
Highlights include:
- Partnering with key medical societies urging the Food and Drug Administration to clarify that higher doses of buprenorphine may be appropriate for patients with opioid-use disorder.
- Joining a physician-pharmacy coalition to urge the U.S. Drug Enforcement Administration to clarify policies to reduce pharmacy and distributor reluctance in dispensing buprenorphine.
- Supporting new state laws in Colorado, Illinois, Virginia and Washington on policy priorities, including pain care, mental health and substance-use disorder parity, and access to naloxone.
- Advancing state and national initiatives to improve naloxone access and protect patients with pain.
The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA’s End the Epidemic website.
