American Medical Association report: Worrying trends in overdose deaths require specific actions, comprehensive approach
A report published this month (September 2022) detailing the toll of drug overdoses and the nation’s death epidemic, the South Dakota State Medical Association and the American Medical Association call for a comprehensive approach – policymakers, health experts public, educators, religious leaders and employers – to help save lives.
While doctors and other medical professionals have reduced opioid prescribing in every state — by nearly 50% nationally — that alone cannot reverse the trend of drug-related overdose deaths. In fact, for the first time, in 2021, the number of drug-related overdose deaths exceeded 100,000, primarily due to illegally 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. Soaring mortality figures – with young people and black and brown Americans dying at the fastest growing rates – adds another urgent call to eliminate health inequities from the country’s health system. We know that policy makers have not exhausted all avenues. Until we have, we must continue to advocate for answers humane and evidence-based,” said Bobby Mukkamala, MD, chair of the AMA’s Substance Use and Pain Management Working Group.
In South Dakota, opioid prescriptions decreased by 37.8% between 2012 and 2021; prescription drug monitoring programs were used more than 445,457 times in 2021; and there has been a sharp increase in naloxone prescriptions and prescriptions for drugs to treat opioid use disorder. Drug-related mortality, however, remains a major concern.
“While we are pleased to see the positive steps taken by physicians, we still have work to do,” said SDSMA President Lucio N. Margallo II, MD. “Using this momentum, we will go even further to save the lives of those affected by opioid abuse.”
The report calls for a campaign to include:
- Policymakers, health insurance plans, national pharmacy chains and other stakeholders need to shift 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 treatment alternatives more accessible and affordable.
- Authorization boards for physicians and other healthcare professionals to help patients with pain by reviewing and reversing arbitrary restrictions on opioid treatment, as now recommended by the Centers for Disease Control and Prevention.
- State officials must remove punitive policies against pregnant women and parents who have substance use disorder. State corrections and private jails and jails must ensure that all people with opioid use disorder or mental illness receive evidence-based care while incarcerated. – and are linked to care upon release. This includes ensuring access to medication for opioid use disorder (MOUD).
- Employers should review their health insurance and benefit plans to ensure employees and their families have access to pain specialists and affordable access to comprehensive pain care, physicians who provide the MOUD and to psychiatrists who are part of the employer’s network.
- Public health officials to help control the spread of infectious diseases by supporting comprehensive needle service programs, reducing overdoses through widespread community-level distribution of naloxone and fentanyl test strips and pilot projects at support from overdose prevention centres.
- Faith leaders will help destigmatize substance use disorders and reduce harm by educating their members and hosting overdose awareness events.
“What is becoming painfully clear is that there are limits to what doctors 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 illegally manufactured fentanyl is fueling this epidemic. We need the help of leaders from all sectors to tackle this public health crisis,” said Dr Mukkamala.
Use of Prescription Drug Monitoring Programs (PDMPs) also continued its upward trajectory, with physicians and other healthcare professionals surpassing the billion mark for the first time. PDMPs are electronic databases that track prescriptions for controlled substances and help identify patients whose care is uncoordinated and who may be receiving multiple prescriptions from multiple prescribers.
State-by-state data for opioid prescriptions, MOUD, naloxone and PDMP use can be found in the report.
Read the report here.
|Year||Drug-related overdose deaths||Opioid prescriptions issued by retail pharmacies||Prescription Drug Monitoring Program Inquiries|
|2012||41,502||260 464 735|
|2013||43,982||251 770 763|
|2014||47,055||244 484 091||61,462,376|
|2015||52,404||227 807 356||86 096 259|
|2016||63,632||215 998 653||136,643,036|
|2017||70,237||192 696 190||295 347 288|
|2018||67,367||168 858 135||449 497 610|
|2019||70,630||153 966 961||744 943 531|
|2020||91,799||143 389 354||908 269 727|