Drug-related mortality has fallen in recent years, but there are still more than 75,000 people dying annually, according to the AMA's latest report (PDF) on substance use and treatment. Substance use has become increasingly complex, with rising polysubstance use involving illegally made fentanyl, methamphetamine, cocaine and other drugs such as xylazine.
This calls for integrated approaches that link addiction treatment, mental health care, and overdose prevention, AMA President Bobby Mukkamala, MD, said during the AMA State Advocacy Summit, held in January in Rancho Palos Verdes, California.
Dr. Mukkamala, who chairs the AMA Substance Use and Pain Care Task Force, moderated a panel discussion at the conference on state legislative solutions to help people with mental health or substance-use disorders. He was joined by AMA member Yngvild Olsen, MD, MPH, a national adviser at Manatt Health and former director for the Center for Substance Abuse Treatment at the federal Substance Abuse and Mental Health Services Administration, and Lauren Finke, MPP, senior policy director at The Kennedy Forum.
More than 15 years ago, as reports of rapid increases in opioid-related overdoses began to increase, the AMA and many state and national physician and patient advocacy groups began working together to identify solutions to reduce overdose while ensuring access to evidence-based care for patients with pain and those with a substance-use disorder. To ensure that physicians’ voices were front and center, the AMA formed its task force, which is comprised of nearly 30 national, state and specialty societies so that organized medicine could speak with one, powerful voice, said Dr. Mukkamala.
Since that time, the AMA’s evidence-based recommendations—regularly updated over the years—“are now embedded in countless state governance and state laws and organizational policies,” noted Dr. Mukkamala. The AMA has worked to convene experts, build consensus and advance education “that's going to truly change practices as early as the medical student-level of education,” he said.
The next generation of physicians will be better equipped to address substance-use disorder challenges when the responsibility is passed on to them, he added.
Substance use, however, has become increasingly complex, with rising polysubstance use involving fentanyl, methamphetamine, cocaine, and other drugs, Dr. Mukkamala said. He noted that this reality underscores the need for integrated approaches that link addiction treatment, mental health care, and overdose prevention.
According to the AMA’s report, illicitly made fentanyl is driving most opioid-related deaths and nearly 60% involve more than one dangerous substance.
“We have very effective ways of being able to treat, identify, prevent and help people recover and help continue that recovery from a health lens—and not just a public safety criminal lens,” said Dr. Olsen.
Evidence has shown that medications for opioid-use disorder such as methadone and buprenorphine cut mortality by more than 50%, she said.
Challenges at the state level
States have noticeably shifted away from some of the federal approaches that previously emphasized public health strategies, Dr. Olsen said. Support for harm-reduction efforts has declined, reducing the accessibility of programs designed to lower risks associated with drug use.
This pullback from the states is concerning because it is already contributing to rising rates of infectious diseases such as hepatitis C and HIV in communities where prevention services have been defunded or shut down, she noted.
Lauren Finke, of The Kennedy Forum, detailed 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.
The AMA collaborated with The Kennedy Forum and Third Horizon to launch a pilot of the Mental Health Parity Index.
“We really took that transparency and coverage data and created this so that you can look and see things for yourself in your own jurisdiction that you're either operating under or that your patients are living in,” said Finke. A Feb. 17 AMA webinar, available to view on demand with registration, included further details on this new tool.
Data from the index will be an incredibly valuable tool—not only for mental health, but also for substance-use disorder care, said Finke. Now, insurance commissioners and states often don’t have enough documented complaints to hold insurers accountable or make a strong case for policy changes. This kind of data can fill that gap, she said.
Finke also emphasized the need for state-level advocacy, including to remove insurance policies that create barriers to lifesaving treatment. Prior authorization is a prime example.
In early February, Dr. Mukkamala and the AMA welcomed federal actions to expand access to treatment for substance-use disorder.
The Department of Health and Human Services’ “announcement includes new funding and initiatives to strengthen access to mental health programs and medications for opioid use disorder, which are critical components of a comprehensive approach to addressing the overdose and death epidemic,” Dr. Mukkamala said in an AMA statement.
Imagine a patient who has just seen their doctor, received a prescription for buprenorphine, and then is turned away at the pharmacy because approval hasn’t come through, said Finke.
That delay can push someone back to using dangerous, unpredictable street drugs—sometimes leading to overdoses that can be fatal. From an insurance standpoint, those outcomes are far costlier than simply removing prior authorization and allowing immediate access to proven treatments, added Dr. Olsen.
Insurers, legislators and states need to understand this reality so they can be part of the solution by eliminating barriers such as prior authorization and other policies that delay care, Finke emphasized.
Find out how the AMA is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
How the AMA is shaping state law
The panelists emphasized the importance of physician organizations and patient advocates to work together to enact or strengthen state laws and oppose payers’ that seek to deny or delay evidence-based care for mental health or substance-use disorders.
The AMA in 2025 collaborated with physicians, policymakers, insurers and community organizations to increase access to care for substance use disorders, reduce stigma and save lives. In one example, the AMA partnered with key medical societies asking the Food and Drug Administration to clarify that higher doses of buprenorphine may be appropriate for patients with opioid-use disorder.
Additionally, the AMA advanced state and national initiatives to improve naloxone access and protect patients with pain, and also fought to secure approval for the opioid-overdose antidote to be sold over the counter.
Without a strong medical voice pushing back against payers, people with substance-use disorders run the risk of being abandoned, Dr. Olsen said. Instead, policies should focus on prevention and early engagement. That means moving away from criminalization and toward approaches that help people before they reach a crisis point, she added.
Finke emphasized Dr. Olsen’s point by stressing how physicians are excellent advocates while patient stories often can be the difference in whether a bill passes or fails.
“At the end of the day,” said Finke, “These laws are meant to protect patients, so it’s up to us to ensure that legislators and regulators hear their voice.”
