The AMA’s 7 Recommendations for Reducing the Opioid Crisis

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According to a report from the American Medical Association (AMA), opioid prescriptions have gone down 44.4% nationwide in the past decade, and 6.9% from 2019 to 2020. Yet the country is experiencing a worsening overdose epidemic.¹

In order to address the epidemic, the AMA is urging policymakers to remove barriers to evidence-based care, and thus reduce mortality and improve patient outcomes.

“The nation’s drug overdose and death epidemic has never just been about prescription opioids,” said AMA President Gerald E. Harmon, MD. “Physicians, have become more cautious about prescribing opioids, are trained to treat opioid use disorder and support evidence-based harm reduction strategies. We use PDMPs [prescription drug monitoring programs] as a tool, but they are not a panacea. Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidence-based care.”²

The report shows that, despite increased use of PDMPs, overdose and deaths are spiking. According to the report, physicians and other mental health professionals used state PDMPs more than 910 million times in 2020, and about 750 million times in 2019.

“With record-breaking numbers of overdose deaths across the country, these are actions policymakers and other stakeholders must take,” Harmon said. “The medical community will continue to play its part, and overall, the focus of our national efforts must shift. Until further action is taken, we are doing a great injustice to our patients with pain, those with a mental illness and those with a substance use disorder.”²

Here are the AMA’s 7 recommendations for policymakers:

1. Remove barriers to evidence-based care for patients with a substance use disorder (SUD), including removing prior authorization and step therapy for medications to treat opioid use disorder, continuing federal flexibilities for take-home medication for opioid treatment programs, and continuing telehealth options for patients.

2. Remove barriers to opioid medications and treatment for SUDs in jails and prisons. There is no legal, medical, or policy reason to deny access to mental health care for incarcerated individuals.

3. Protect families by increasing access to evidence-based care rather than using the threat of family separation for persons who are pregnant, peripartum, postpartum, and parenting.

4. Support patients with pain by rescinding arbitrary laws and policies focused on restricting access to multidisciplinary, multimodal pain care. This might mean requiring health insurance companies and other payers to make nonopioid pain care alternatives more accessible and affordable.

5. State insurance commissioners, attorneys general, and the US Department of Labor must increase efforts to review health insurers’ policies on a regular basis to ensure they comply with the Mental Health Parity and Addiction Equity Act—and hold them accountable if not.

6. Support increased efforts to expand sterile needle and syringe exchange services programs, decriminalize drug checking supplies, and urge manufacturers to make naloxone available over the counter.

7. Develop and implement systems to collect timely, adequate, and standardized data to identify at-risk populations, fully understand polysubstance drug use, and implement public health interventions that directly address removing structural and racial inequities.

“Policymakers and other stakeholders have a choice of whether to pursue evidence-based strategies to support patients’ access to lifesaving and life- affirming care. Every effort must be made to remove health inequities and other barriers for patients with substance use disorders, mental illness and patients with pain. More of our loved ones will suffer and die if these barriers remain,” said Bobby Mukkamala, MD, Chair of the AMA Substance Use and Pain Care Task Force.¹

To read more on states’ efforts to combat the opioid crisis, see Reducing Opioid-Involved Overdose Deaths: States’ Prevention and Response Efforts.

References

1. American Medical Association. 2021 Overdose Epidemic Report. September 21, 2021. https://end-overdose-epidemic.org/wp-content/uploads/2021/09/AMA-2021-Overdose-Epidemic-Report_92021.pdf

2. American Medical Association. Report shows decreases in opioid prescribing, increase in overdoses. News release. September 21, 2021. https://www.ama-assn.org/press-center/press-releases/report-shows-decreases-opioid-prescribing-increase-overdoses