American Medical Association Report: Disturbing trends on overdose deaths requires specific actions, all-hands approach

A report issued this month (Sept. 2022) detailing the toll of the nation’s drug overdose and death epidemic has the South Dakota State Medical Association and American Medical Association call for an all-hands approach– policymakers, public health experts, educators, faith leaders, and employers – to help save lives.

While physicians and other health care professionals have reduced opioid prescribing in every state—by nearly 50 percent nationally – that by itself cannot reverse the trend of drug-related overdose deaths. In fact, for the first time, in 2021 drug-related overdose deaths exceeded 100,000—primarily due to illicitly manufactured fentanyl, methamphetamine and cocaine. Overdose deaths are amplified by underlying social needs including housing and transportation.

“No community has been – or will be – spared the pain of this epidemic. The spiking mortality numbers – with young people and Black and Brown Americans dying at the fastest growing rates – add yet another urgent call to remove health inequities from the nation’s health care system. We know policymakers have not exhausted all remedies. Until we have, we must keep advocating for humane, evidence-based responses,” said Bobby Mukkamala, MD, chair of the AMA Substance Use and Pain Care Task Force.

In South Dakota, opioid prescriptions have decreased by 37.8 percent between 2012-2021; prescription drug monitoring programs were used more than 445,457 times in 2021; and there have been strong increases in naloxone prescriptions and prescriptions for medications to treat opioid use disorder. Drug-related mortality, however, remains a major concern.

“While we’re glad to see the positive actions physicians have taken, we still have work to do,” said SDSMA President Lucio N. Margallo II, MD. “Using this momentum, we’ll go even further to save the lives of those affected by the misuse of opioids.”

The report calls for a campaign to include:

• Policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and remove barriers – such as prior authorization — to evidence-based care. States should require health insurance companies and other payers to make non-opioid pain care alternatives more accessible and affordable.
• Medical and other health care professional licensing boards to help patients with pain by reviewing and rescinding arbitrary restrictions on opioid therapy—as now recommended by the Centers for Disease Control and Prevention.
• State officials to remove punitive policies against pregnant individuals and parents who have a substance use disorder. State departments of corrections and private jails and prisons need to ensure that all individuals with an opioid use disorder or mental illness receive evidence-based care while incarcerated — and are linked to care upon release. This includes ensuring access to medications for opioid use disorder (MOUD).
• Employers to review their health insurance and benefits plans to ensure employees and their families have access to pain specialists and affordable access to comprehensive pain care, physicians who provide MOUD, and psychiatrists who are in the employer’s network.
• Public health officials to help control infectious disease spread through supporting comprehensive syringe services programs, reduce overdose through widespread, community-level distribution of naloxone and fentanyl test strips and pilot projects in support of overdose prevention centers.
• Faith leaders to help destigmatize substance used disorders and harm reduction by educating their members and holding overdose awareness events.

“What is becoming painfully evident is that there are limits to what physicians can do. We have dramatically increased training and changed our prescribing habits, reducing the number of opioids prescribed while increasing access to naloxone, buprenorphine and methadone. But illicitly manufactured fentanyl is supercharging this epidemic. We need help from leaders across sectors to combat this public health crisis,” said Dr. Mukkamala.

The use of prescription drug monitoring programs (PDMPs) also continued its upward trajectory with physicians and other health care professions surpassing the 1 billion mark for the first time. PDMPs are electronic databases that track controlled substance prescriptions and help identify patients with uncoordinated care who might be receiving multiple prescriptions from multiple prescribers.

State-by-state data for opioid prescriptions, MOUD, naloxone and PDMP use can be found within the report.

Read the report here.