As the COVID-19 pandemic continues to devastate families and communities across the U.S., we cannot ignore that illicit fentanyl is fueling the nation’s drug overdose epidemic and primarily responsible for the deaths of more than 100,000 people last year alone.
Unless policymakers take action in 2022 to update rules and laws that are enabling our worsening overdose epidemic, more Americans will die, and more families will suffer preventable tragedies.
The stakes are high. Drug-overdose deaths are an epidemic in the U.S., touching virtually every state. About 60% of those deaths in the past year are linked to illicitly manufactured or adulterated fentanyl. With the U.S. Drug Enforcement Administration seizing nearly 10 million fake pills last year—many laced with counterfeit fentanyl—we must act with evidence-based public health interventions to limit the risks and harms of overdose.
Knock down barriers
First, it’s far past time for policymakers and other key stakeholders to remove barriers to evidence-based treatment for substance-use disorders. Multiple states cut addiction treatment programs from their yearly budget in 2020. Ongoing state budgetary challenges do not help.
All 50 states and the District of Columbia reported a spike or increase in overdose numbers during the COVID-19 pandemic. Action is required to address this unprecedented situation, including prohibiting health insurance companies from using administrative tactics such as prior authorization to delay and deny care to those with a substance use disorder.
More than 90% of doctors reported delays in treatment while waiting for health insurers to authorize necessary care, according to the AMA’s latest research in 2020. And nearly 80% of physicians said authorization delays have forced some patient to abandon treatment altogether.
Furthermore, courts, jails and prisons must ensure access to medications to treat opioid-use disorder. And we urge all state insurance departments and attorneys general to show the leadership necessary to enforce mental health and substance-use disorder parity. Removing barriers to evidence-based care also will help address long-standing racial and gender inequities, including the fact that overdose deaths are rising most rapidly among Black people. Improving access to evidence-based treatment is an effective strategy for improving equity.
Second, harm reduction must be more than just increasing access to naloxone, the opioid-related overdose-reversing drug. More physicians than ever are prescribing naloxone, but that’s just a first step. The AMA urges changes to state laws that allow for emergency departments, for example, to distribute naloxone to anyone who has experienced an overdose.
We further urge all states to broaden their Good Samaritan statutes to provide comprehensive civil and criminal immunities for anyone who calls for help during an overdose or experience an overdose. And we repeat our call for all naloxone manufacturers to submit applications to the Food and Drug Administration (FDA) to make their products available and affordable over the counter.
This includes having FDA remove the “prescription” status for generic forms of injectable naloxone that harm-reduction organizations rely upon to help save tens of thousands of people each year. There is no justifiable reason for keeping naloxone behind the counter other than pharmaceutical industry profit.
Make drug-checking supplies legal
Third, while naloxone has saved the lives of tens of thousands, a cost-effective, safe and commonsense solution to help people who use substances nonmedically is to decriminalize fentanyl test strips and other drug-checking supplies.
Unfortunately, 32 states view these potentially life-saving tests as illegal drug paraphernalia, according to the Legislative Analysis and Public Policy Association (PDF). The AMA has model state legislation to decriminalize fentanyl strips and other drug-checking supplies. A single fentanyl test strip costs $1, is easy to use, and only takes a couple of minutes to show the results. These test strips provide crucial answers to a person from one testing sample that could potentially save a life.
Finally, we urge states to also decriminalize and make sterile needle and exchange services more widely available. After all, substance-use disorders are medical conditions that require treatment, not punishment and judgement. The American Rescue Act included $30 million “to support community-based overdose prevention programs, syringe services programs, and other harm reduction services.”
We agree with public health experts that the Centers for Disease Control and Prevention and the Substance Abuse Mental Health Services Administration “should act expeditiously to award these grants directly to community-based harm reduction organizations who will use them to provide syringes and other supplies to the hundreds of thousands of already vulnerable individuals made even more vulnerable by the twin epidemics of overdose and COVID-19.”
These steps will not solve all of the challenges in the nation’s drug overdose epidemic, but they are evidence-based strategies that will save lives. We must further address social determinants of health such as housing, employment and transportation that help people with substance use disorders access care. There is much to do. The AMA urges all stakeholders to join us to make it happen.
Bobby Mukkamala, MD, an otolaryngologist from Flint, Michigan, is the chair of the AMA Board of Trustees. He also chairs the AMA Substance Use and Pain Care Task Force.
