The AMA House of Delegates in June adopted several policies intended to increase patient access to care and lifesaving tools for mental health and substance-use disorders—all part of the American Medical Association’s ongoing advocacy to improve the health of the nation.
A report from the AMA Board of Trustees finds school districts and universities across the country are rapidly adopting efforts to increase access to naloxone. The report, introduced at the 2024 AMA Annual Meeting in Chicago last month, highlights AMA policy encouraging states and communities to allow schools to have safe and effective overdose reversal medications readily accessible to staff, teachers and students.
CDC data show monthly overdose deaths among adolescents increased 109% between 2019 to 2021, with 84% of deaths involving illicitly manufactured fentanyl. Two-thirds of deadly overdoses had one or more potential bystanders present, but naloxone was administered only 30% of the time.
“Schools are recognizing the value of having naloxone on hand. It is a needed layer of protection to keep young people safe and alive,” said Bobby Mukkamala, MD, the AMA’s president-elect and also chair of the AMA Substance Use and Pain Care Task Force. “AMA advocacy and model legislation has led to approximately 30 states authorizing educational settings to administer naloxone. That’s great progress, but the remaining states need to get on board to save lives.”
The AMA continues to support widespread distribution and availability of naloxone and urges physicians to educate patients on naloxone and prescribe to patients at risk of overdose.
About 26,500 opioid overdoses in the U.S. were reversed by laypeople using naloxone from 1996 to 2014, according to CDC data. To bolster the use of naloxone and ensure it is more widely accessible, the AMA adopted new policy to support the expansion of naloxone availability by locating intranasal naloxone along with automated external defibrillators (AEDs) in public locations.
“We know that naloxone is not only safe and effective in reversing opioid overdoses, but easy for bystanders to use when an opioid overdose is suspected. By making naloxone more accessible, particularly where AEDs are located in public spaces, we can help prevent more opioid overdoses and save lives,” said Dr. Mukkamala.
To gain an overview of the breadth and depth of the nation’s drug overdose and death epidemic, explore two updated AMA issue briefs that provide a national snapshot (PDF) and state-by-state reports (PDF).
Enforcing parity laws
In response to the nation’s ongoing mental health crisis and overdose epidemic, delegates voted to adopt policy further strengthening the AMA’s commitment to addressing insurers’ continued failures to comply with the Mental Health Parity and Addiction Equity Act.
The policy calls for continued advocacy for meaningful financial and other penalties for insurers that do not comply with parity laws. A recent study found that when compared with other medical and surgical care, patients are nine times more likely to seek out-of-network care for behavioral health care from psychiatrists and other mental health professionals, highlighting the challenges in finding affordable care for mental health and substance-use disorders.
The AMA has long advocated for holding insurers accountable and increasing enforcement in parity laws, including urging federal regulators to finalize rules (PDF) that would strengthen the Mental Health Parity and Addiction Equity Act.
Supporting harm reduction
Delegates also adopted policy supporting efforts to decriminalize the possession of nonprescribed buprenorphine for personal use by people who lack access to a physician for the treatment of opioid-use disorder. A 2023 study found that buprenorphine treatment after nonfatal opioid-involved overdose was associated with a 62% reduction in the risk of opioid-involved overdose death.
Despite strong evidence for the effectiveness of buprenorphine to treat opioid-use disorder, there is a lack of access due to multiple factors including stigma, regulatory and legal barriers, and issues with health insurance coverage.
“Opioid-use disorder is a treatable medical disease and buprenorphine is proven to be an effective treatment,” Dr. Mukkamala said. “Given the innumerable barriers to care for opioid use disorder, combined with the clear benefits of increasing access to buprenorphine, decriminalizing nonprescribed buprenorphine for personal use is necessary to prevent more overdoses and deaths.”
Separately, the AMA joined the American Society of Addiction Medicine, American Pharmacists Association and American Society of Health-System Pharmacists in writing to the Biden administration (PDF) in May. The physician and pharmacist organizations said that buprenorphine for the treatment of opioid-use disorder should be removed from manufacturers’ and distributors’ suspicious order-report algorithms. Doing so would help avoid the risk of harmful delays and denials of care.
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.
