Recently, the American Medical Association (AMA) published the Overdose Epidemic Report 2023, outlining actions that have been taken by physicians to help end the opioid overdose and death epidemic, as well as what still needs to be done.
The report starts out by noting that “the drug-related overdose epidemic is deadlier than ever,” even as opioid prescriptions decreased for the 13th consecutive year. This is because overdose and death related to illicitly manufactured fentanyl, methamphetamine, and cocaine increased while xylazine and other toxic synthetic adulterants pose new challenges.
The AMA also notes that while the AMA Substance Use and Pain Care Task Force continues to “advance evidence-based recommendations for policymakers and physicians” to help end the opioid epidemic, “positive strides are hindered by a lack of meaningful implementation and enforcement of policies that support affordable, accessible and evidence-backed care for patients with substance use disorders, pain or those needing harm reduction services like naloxone, syringes and fentanyl test strips.” AMA further states that it is “Black and Brown communities, pregnant individuals, and youth” that are disproportionately impacted and dying at increased rates compared to other population groups.
The report acknowledges that physicians and other health care professionals have greatly reduced opioid prescribing in nearly every state – by almost 50% on a national level and that state prescription drug monitoring programs (PDMPs) are used in every state. However, reductions in opioid prescribing have not led to fewer drug-related mortality cases, “primarily due to illicitly manufactured fentanyl, fentanyl analogs, stimulants and other substances.”
What Else Can Be Done?
The AMA encourages all states to decriminalize drug checking supplies that test for illicit fentanyl and other adulterants, such as fentanyl test strips, as well as reform Good Samaritan statutes to protect those who overdose or those who seek help during an overdose event. Additionally, the AMA continues to urge physicians to educate patients on naloxone and prescribe it to patients who are at risk of overdose. The AMA believes that through increased access to evidence-based treatment, outcomes will be improved and mortality reduced.
The AMA also notes that there are still data gaps that limit the ability to pursue evidence-based public health outcomes and that despite state, national, and federal stakeholders working together to improve surveillance efforts, the efforts tend to lag “several months behind current data trends.”
The AMA makes several recommendations at the conclusion of the report, including the need to remove barriers to evidence-based care for patients with a substance use disorder and as well as remove barriers to medications for opioid use disorders and treatment for substance use disorders and co-occurring mental illness in the jails and prisons throughout the country. The AMA also recommends that systems be developed and implemented to collect timely, adequate, and standardized data to help identify at-risk populations, better understand polysubstance drug use, and implement public health interventions that address removing structural and racial inequities.