Disturbing Trends on Overdose Deaths Requires Specific Actions, All-Hands Approach

With the recent release of a report detailing the horrific toll of the nation’s overdose and death epidemic, the American Medical Association (AMA) calls 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% 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. Black and Brown Americans and young people are dying at the fastest growing rates. The spiking mortality numbers add yet another urgent call to remove health inequities from the nation’s health care system. We know we have not exhausted all policy remedies. Until we have, we must keep advocating for humane, effective responses,” said Bobby Mukkamala, M.D., chair of the AMA Substance Use and Pain Care Task Force.

In Michigan, opioid prescriptions have decreased by 48.1 percent between 2012-2021; prescription drug monitoring programs were used nearly 19 million 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, continues to increase in Michigan.

“While physician training has had a clear impact on prescribing habits, from decreases in opioid prescribing to increases in medications for opioid use disorder (MOUD) and naloxone prescribing, Michigan’s overdose epidemic demands attention and collaboration by all stakeholders,” stated Cara Poland, MD, MEd, FACP, DFASAM, and Chair, Michigan State Medical Society (MSMS) Opioid Stewardship Task Force.  “MSMS supports the actions recommended in the AMA’s report and is committed to working with policy makers, medical schools, community leaders, and others to implement solutions to save lives.”

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 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.

As illicitly manufactured fentanyl, methamphetamine and cocaine continue to fuel increases in overdose events and deaths, it is clear that modifying physician prescribing habits alone will not stop this upward trend. Tabitha Moses, MS, MD/PhD Candidate, Wayne State University School of Medicine and MSMS Opioid Stewardship Task Force Vice Chair, notes, “Michigan’s medical students, residents, and physicians are dedicated to being part of the campaign to halt the overdose crisis and invite other professional, industry, and community leaders to join.”

Read the report, including state-by-state data for opioid prescriptions, MOUD, naloxone and PDMP use.