In the past 5 years, there has been a significant drop in the use of prescription opioids and in deaths associated with such use; but at the same time there’s been a dramatic increase in fatalities involving illicit opioids and stimulants, a new report from the American Medical Association (AMA) Opioid Task Force shows.
Although the medical community has made some important progress against the opioid epidemic, with a 37% reduction in opioid prescribing since 2013, illicit drugs are now the dominant reason why drug overdoses kill more than 70,000 people each year, the report says.
In an effort to improve the situation, the AMA Opioid Task Force is urging the removal of barriers to evidence-based care for patients who have pain and for those who have substance use disorders (SUDs). The report notes that “red tape and misguided policies are grave dangers” to these patients.
“It is critically important as we see drug overdoses increasing that we work towards reducing barriers of care for substance use abusers,” Task Force Chair Patrice A. Harris, MD, told Medscape Medical News.
“At present, the status quo is killing far too many of our loved ones and wreaking havoc in our communities,” she said.
Harris noted that “a more coordinated/integrated approach” is needed to help individuals with SUDs.
“It is vitally important that these individuals can get access to treatment. Everyone deserves the opportunity for care,” she added.
The report cites figures from the Centers of Disease Control and Prevention that indicate the following regarding the period from the beginning of 2015 to the end of 2019:
Deaths involving illicitly manufactured fentanyl and fentanyl analogues increased from 5766 to 36,509;
Deaths involving stimulants such as methamphetamine increased from 4402 to 16,279;
Deaths involving cocaine increased from 5496 to 15,974;
Deaths involving heroin increased from 10,788 to 14,079;
Deaths involving prescription opioids decreased from 12,269 to 11,904.
The report notes that deaths involving prescription opioids peaked in July 2017 at 15,003.
Some Good News
In addition to the 37% reduction in opioid prescribing in recent years, the AMA lists other points of progress, such as a large increase in prescription drug monitoring program registrations. More than 1.8 million physicians and other healthcare professionals now participate in these programs.
Also, more physicians are now certified to treat opioid use disorder. More than 85,000 physicians, as well as a growing number of nurse practitioners and physician assistants, are now certified to treat patients in the office with buprenorphine. This represents an increase of more than 50,000 from 2017.
Access to naloxone is also increasing. More than 1 million naloxone prescriptions were dispensed in 2019 ― nearly double the amount in 2018. This represents a 649% increase from 2017.
“We have made some good progress, but we can’t declare victory, and there are far too many barriers to getting treatment for substance use disorder,” Harris said.
“Policymakers, public health officials, and insurance companies need to come together to create a system where there are no barriers to care for people with substance use disorder and for those needing pain medications,” she added.
At present, prior authorization is often needed before these patients can receive medication. “This involves quite a bit of administration, filling in forms, making phone calls, and this is stopping people getting the care they need,” said Harris.
“This is a highly regulated environment. There are also regulations on the amount of methadone that can be prescribed and for the prescription of buprenorphine, which has to be initiated in person,” she said.
Will COVID-19 Bring Change?
Harris noted that some of these regulations have been relaxed during the COVID-19 crisis so that physicians could ensure that patients have continued access to medication, and she suggested that this may pave the way for the future.
“We need now to look at this carefully and have a conversation about whether these relaxations can be continued. But this would have to be evidence based. Perhaps we can use experience from the COVID-19 period to guide future policy on this,” she said.
The report highlights that despite medical society and patient advocacy, only 21 states and the District of Columbia have enacted laws that limit public and private insurers from imposing prior authorization requirements on SUD services or medications.
The Task Force urges removal of remaining prior authorizations, step therapy, and other inappropriate administrative burdens that delay or deny care for FDA-approved medications used as part of medication-assisted treatment for opioid use disorder.
The organization is also calling for better implementation of mental health and substance use disorder parity laws that require health insurers to provide the same level of benefits for mental health and SUD treatment and services that they do for medical/surgical care.
At present, only a few states have taken meaningful action to enact or enforce those laws, the report notes.
The Task Force also recommends the implementation of systems to track overdose and mortality trends to provide equitable public health interventions. These measures would include comprehensive, disaggregated racial and ethnic data collection related to testing, hospitalization, and mortality associated with opioids and other substances.
“We know that ending the drug overdose epidemic will not be easy, but if policymakers allow the status quo to continue, it will be impossible,” Harris said.
“This is particularly important given concerns that the COVID-19 pandemic is worsening the drug overdose epidemic. Physicians will continue to do our part. We urge policymakers to do theirs,” she added.
AMA. Opioid Task Force 2020 Progress Report. Full text