The nation’s overdose epidemic is growing in complexity

The AMA’s “Overdose Epidemic Report 2023” yielded two major takeaways. While physician prescribing dropped for the 13th consecutive year, down nearly 50% nationally, overdoses and deaths related to illicitly manufactured fentanyl, xylazine and other synthetic substances continue to trend upward.

More than 107,000 Americans died from a drug-related overdose in the U.S. last year. Looking at statistics on individual drugs, deaths related to illicitly manufactured fentanyl rose to more than 75,000 in 2022. In 2021, the age-adjusted rate of drug overdose deaths involving xylazine was 35 times higher than in 2018, according to the report.

The epidemic disproportionately affects youth, people from historically marginalized racial and ethnic groups, and pregnant women. Among those 10–19 years old, median monthly overdose deaths rose 109% from 2019 to 2021. Deaths related to illicitly manufactured fentanyl jumped 182%.

These deaths are happening despite a decadelong, 49.4% drop in opioid prescriptions, demonstrating once again that policies to restrict opioid prescribing have not slowed the epidemic or increased access to treatment for substance-use disorders.

Learn more in this Dec. 12 episode of the “AMA Advocacy Insights Webinar Series” about policy actions that need to be taken, harm-reduction strategies that should be implemented more broadly, and efforts by physicians and the AMA Substance Use and Pain Care Task Force to end the epidemic. 

One policy that has not had a meaningful effect on reducing overdose or increasing access to treatment has been mandates to use state prescription-drug monitoring programs. While the AMA supports such programs as helpful tools, they are not designed to increase access to care, identify physicians to treat substance-use disorders or remove barriers to care for patients with pain. From 2018 to 2022, there was a 197.3% rise in use of prescription drug-monitoring programs.

“The AMA remains focused on advocating for meaningful policy implementation and enforcement to support affordable, accessible, evidence-based care for patients with a substance use disorder as well as for patients with pain,” said Bobby Mukkamala, MD, chair of the AMA Substance Use and Pain Care Task Force.

In its report, the AMA called for collaborative partnerships and evidence-based approaches such as overdose-prevention sites to prevent overdose deaths and connect patients with substance-use disorder treatment.

The AMA also urged lawmakers and government officials to:

• Ramp up harm-reduction resources such as syringe-services programs and fentanyl test strips, and stocking naloxone in schools, universities and other public venues.
• Remove barriers such as prior authorization, step therapy and dosage caps for medications to treat opioid-use disorder, including dosage caps on buprenorphine.
• Enforce mental health and substance-use disorder parity laws and step up financial and other penalties against health insurers who violate the law and require corrective actions.
• Remove punitive policies against pregnant people and parents who have a substance-use disorder, and ensure that all people with opioid-use disorders or mental illnesses get evidence-based care while incarcerated and have access to care upon release.

“Health insurers must stop dragging their feet when it comes to eliminating barriers to accessing these treatments and do their part to end the epidemic,” Dr. Mukkamala added. “Without action on the policy recommendations in this report, the epidemic will continue to harm and kill Americans.”

The AMA believes that science, evidence and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic evolves into a more dangerous and complicated illicit drug overdose epidemic. Learn more at the AMA’s End the Epidemic website. 

The Food and Drug Administration’s approval this year of over-the-counter (OTC) naloxone, which AMA advocacy efforts have long supported, has the potential to be a gamechanger in this fight.

“Naloxone is one success story we’ve seen this year because access to opioid-overdose reversal medications continues to save tens of thousands of lives,” Dr. Mukkamala said. Naloxone should be as accessible as a first-aid kit or defibrillator in public spaces, he added.

“While we continue to study and address the underlying factors that contribute to substance-use disorders, policymakers must look at additional, evidence-based harm-reduction strategies to combat the skyrocketing number of overdoses,” he said.

The AMA remains concerned, however, by the high cost of OTC naloxone and reports that pharmacy chains are keeping the lifesaving product behind the counter.

The AMA has urged manufacturers of overdose-reversal agents to submit applications for over-the-counter status and to price their products responsibly. Payers, meanwhile, should cover naloxone with little or no cost-sharing for patients.