So much work still needs to be done and the numbers are still way too high, but the deadly toll from the nation’s drug-overdose epidemic is starting to trend downward slightly as jurisdictions across the country adopt evidence-based policies that save lives.
According to the rolling counts kept by the Centers for Disease Control and Prevention (CDC), the count peaked at 110,317 drug overdose deaths predicted for the 12-month period ending in March 2022. The latest CDC numbers predict 106,840 deaths for the 12-month period ending in September 2022—a drop of 3.15% from last year’s high point.
The AMA remains deeply concerned, however, by rising trends in mortality for young people and Black and Brown Americans.
One American dies of drug overdose “nearly every five minutes around the clock—that's unacceptable,” said Rahul Gupta, MD, MPH, the leader of the White House Office of National Drug Control Policy (ONDCP). “Let's stop it.”
Dr. Gupta, the first physician to serve as director of national drug control policy, spoke to hundreds of physicians and medical society staffers gathered for the 2023 AMA National Advocacy Conference.
A long-time AMA member, Dr. Gupta coordinates development and implementation of the nation's drug-control strategy across 19 federal agencies with an emphasis on prevention, harm reduction, treatment and recovery, and supply distribution. A practicing internist, he still sees patients in charity-care settings, including patients with substance-use disorders (SUDs).
“Just like you, as a physician, I've had a front-row seat to this problem,” Dr. Gupta said.
Dr. Gupta added that a major focus has to be expanding access to evidence-based treatment so that “everyone that needs substance-use disorder treatment gets it.” He noted that 46.3 million people 12 or older meet the criteria for an SUD diagnosis, yet only 6% get treatment for it, according to the most recent National Survey on Drug Use and Health,
This includes the incarcerated population, and Dr. Gupta said that, by this summer, the Federal Bureau of Prisons is going to be offer medication-based treatment for opioid-use disorder—including buprenorphine, methadone, extended-release naltrexone therapies—at all of its corrections facilities. The goal is to extend this beyond the federal prison system.
“When we make that treatment available in every prison—federal or state, and every jail, county or local municipality—it's going to get people treatment and it's going to be able to make them connected back to services when they're released,” Dr. Gupta said. “It gets people back to work and integrated into their community. That's one of the best things that we have—as opposed to incarcerating without treatment.”
Make treatment more accessible
The AMA supports the recommendation by two Food and Drug Administration advisory panels to make the overdose-reversing drug naloxone available over the counter without a prescription.
“Individuals should be able to pick up a package of naloxone without having to face the potential stigma or shame of having to ask for this lifesaving medication,” AMA Trustee Bobby Mukkamala, MD, chair of the AMA Substance Use and Pain Care Task Force, wrote in a MedPage Today column. “There is no moral or medical reason for naloxone to be hidden behind the pharmacy counter.”
Another positive recent development is that the omnibus spending package enacted late last year incorporated central provisions of two bills the AMA supported:
- The “MAT Act” to permanently repeal X-waiver requirements for the prescribing of buprenorphine for opioid-use disorder.
- The “NOPAIN Act,” which directs the Centers for Medicare & Medicaid Services to provide separate payment for nonopioid treatments used to manage pain in the hospital outpatient departments and ambulatory surgery center settings.
Dr. Gupta made note of the AMA’s efforts to get these two pieces of legislation passed.
“The president called for it and he was so excited and happy to sign that bill into law on Dec. 29,” he said. “It wouldn't have been done without your contribution, without the AMA stepping up and advocating.”
Substance-use disorder is treatable
In recognition of his focus on emphasizing evidence-based treatment for SUDs and embracing harm-reduction approaches, Dr. Gupta was presented with the AMA Award for Outstanding Government Service.
“As the first physician to lead ONDCP, the AMA appreciates Dr. Gupta’s deep understanding of the causes and tragic outcomes of the overdose epidemic, and greatly supports his patient-centered approach to ending it, emphasizing treatment and harm reduction in alignment with AMA advocacy,” AMA Board Chair Sandra Adamson Fryhofer, MD, said in a news release.
“In a challenging job at an extremely difficult moment, Dr. Gupta is doing the right things on policy because he’s personally seen them work on a clinical level,” Dr. Fryhofer added.
In presenting the award, the AMA noted that, under Dr. Gupta’s leadership, President Biden’s drug-control strategy “rightly emphasizes substance-use disorders as a treatable illness and focuses on both treatment and harm reduction, using evidence-based approaches.”
In his address at the National Advocacy Conference, Dr. Gupta compared substance-use disorders to other chronic conditions that require medical treatment.
“We really need more folks across our profession to help figure out how to treat people with an SUD,” he said. “I don't see it as any different than diabetes, hypertension or heart disease. It's another thing that we can do for our patients, and we can't do that without your help.”
The AMA believes that science, evidence, and compassion must continue to guide patient care and policy change as the nation’s opioid epidemic has become a more dangerous and complicated illicit drug overdose epidemic. Find state- and specialty-specific resources at the AMA's End the Epidemic website, and explore overdose-related data metrics on the AMA’s overdose data dashboard, and read about the inspiring physicians who are helping patients with SUDs or chronic pain.
