The AMA’s “Overdose Epidemic Report 2024” notes significant policy achievements as part of physicians’ efforts to end the nation’s drug-related overdose and death epidemic. The AMA also welcomes the drop in drug-related mortality in some states over the past year—a trend the AMA hopes will continue, though overdose deaths associated with illicit drugs remain at historic highs, signaling that the epidemic is far from over.
Outdated policies and health insurance barriers are preventing patients from accessing evidence-based care, said Bobby Mukkamala, MD, the AMA’s president-elect and chair of the AMA Substance Use and Pain Care Task Force.
“With thousands of families and communities devastated by overdose deaths, the time for incremental change has passed. We need unwavering commitment to expand access to lifesaving medications, enforce parity laws, and address the glaring gaps in harm reduction,” he said.
What the data shows
Opioid prescriptions have fallen by 51.7% over 11 years, from 260.5 million in 2012 to 125.9 million in 2023. Yet reductions in prescribing have not led to huge drops in drug-related deaths. While 107,543 Americans died from overdose last year, according to provisional 12-month data from the Centers for Disease Control and Prevention (CDC), that was only a slight drop from 107,941 in 2022. The death figures continued to drop in 2024, with 12-month provisional figures showing a 17% decline.
Efforts have been made to increase access to medications for opioid-use disorder for people who are pregnant or incarcerated. Nevertheless, “stigma and health insurance companies continue to impede access,” the AMA’s report says.
Many payers do not comply with state and federal laws that require parity in coverage for mental health and substance-use disorders—and state efforts to hold payers accountable need to be much stronger. Prior authorization for medications for opioid-use disorder remains a problem. And on the federal side, the AMA supports legislation authorizing methadone prescriptions outside of opioid-treatment program settings. The U.S. Drug Enforcement Administration also should remove buprenorphine from its suspicious order reporting requirements until further notice.
Learn more from Dr. Mukkamala’s recent appearance on “AMA Update” regarding the next steps that must be taken to end the overdose epidemic.
Patients with pain face challenges
Despite policies from the CDC and Federation of State Medical Boards calling for individualized pain care decision-making, state policies are largely focused on arbitrary, numeric thresholds for restricting access to opioid therapy. In addition to policies supporting the reductions in opioid prescribing, state policymakers also believed that mandates to use state prescription drug-monitoring programs (PDMPs) would end opioid-related mortality.
State PDMPs were used more than 1.4 billion times in 2023, “a staggering increase since 2014, when they were used only 61 million times,” the AMA report says. While PDMPs contain helpful information, they are not treatment tools. At the same time, 39 states have opioid prescribing policies that restrict a patient’s ability to get tailored pain-care treatment options, and pharmacy chains and payers typically have highly restrictive prescribing and dispensing policies.
“Many patients who rely on, or benefit from, opioid therapy have been harmed by these state laws and related policies from health insurers, pharmacy chains and pharmacy benefit managers,” the AMA report says.
Lifesaving recommendations
Naloxone is one area “where policy and practice have come together … to prevent opioid-related overdose,” the report says. More physicians and other health professionals are prescribing it, and it’s also become increasingly available in public and educational settings.
From 2018 to 2023, naloxone prescriptions rose from about 555,000 to nearly 2.2 million in retail pharmacies. The AMA strongly urges physicians to prescribe naloxone to patients at risk of overdose and for educational settings to make naloxone widely available.
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The AMA is calling on lawmakers and other government officials to:
- Eliminate punitive policies against pregnant individuals and parents who rely on medications for opioid-use disorder.
- Remove harmful, one-size-fits-all restrictions on opioid therapy that contradict policies from the CDC and the Federation of State Medical Boards.
- Require payers to increase access to nonopioid, multimodal pain-care options.
- Increase access to naloxone in pharmacies, schools, universities and public settings.
- Support efforts to fund and make available other evidence-based harm-reduction initiatives such as syringe-services programs and overdose-prevention centers.
“The AMA, our Substance Use and Pain Care Task Force, and the nation's physicians continue to urge policymakers, health insurance companies and other payers to once and for all remove barriers to evidence-based treatment for substance-use disorders, pain care and harm-reduction initiatives,” said Dr. Mukkamala. “Delays or denials of this care only results in increased suffering and death. Ending the epidemic is possible, but much more work must be done.”
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.
