CHICAGO – The American Medical Association (AMA) gathered physician and medical student leaders from all corners of medicine at its Annual Meeting to shape guiding policies on emerging health care topics.

The AMA’s House of Delegates is the policy-making body at the center of American medicine, bringing together an inclusive group of physicians, residents, and medical students representing every state and medical specialty. Working in a democratic process, delegates create a national physician consensus on emerging issues.

The policies adopted by the House of Delegates that address substance use include:

Increasing Access to Overdose Reversing Medications for Teachers and Students 

The AMA will encourage states and communities to adopt legislative and regulatory policies that allow safe and effective overdose reversal medications be readily accessible to staff, teachers, and students in educational settings to prevent opioid overdose deaths, according to new policy adopted by the nation’s physicians. The AMA recognizes the opioid epidemic as one of the many factors within the National Child Mental Health Crisis. Drug overdose deaths in young people ages 10 to 19 increased 109% from 2019-2021, largely driven by an increased amount of illicitly manufactured fentanyl.  

“We are facing a national overdose crisis and it’s affecting our young people at an alarming rate. Just as students carry prescription inhalers to treat an asthma attack, we must destigmatize substance use disorders and treat naloxone as a lifesaving tool,” said Bobby Mukkamala, M.D., chair of the AMA Substance Use and Pain Care Task Force. “Fortunately, an overdose tragedy can be reversed if quick action is taken with these safe and effective medications like naloxone. Allowing teachers and students to carry these medications is a commonsense decision and will no doubt result in young lives saved.”

In addition, physicians voted to support the development of adjuncts and alternatives to naloxone to combat synthetic opioid-induced respiratory depression and overdose. Lastly, AMA policy on increasing availability of naloxone and other safe and effective overdose reversal medications was strengthened when physicians voted to add support for the availability, delivery and procession and use of mail-order overdose reversal medications.

Expanding Non-punitive Access to Prenatal Care and Treatment for Substance Use Disorder

Threats of incarceration, immediate loss of child custody, and other potential punishments drive pregnant, postpartum, and parenting individuals away from vital prenatal care and treatment for substance use disorder. To address the chilling effect of blunt legal sanctions or interventions against pregnant individuals with substance use disorder, the AMA strengthened policy in strong support of maternal and child health in the context of the opioid crisis.

The nation’s physicians voted to advocate for amended state and federal child protection laws so that pregnant people with substance use and substance use disorder are only reported to child welfare agencies when protective concerns are identified by the clinical team, rather than through automatic or mandated reporting of all pregnant people with a positive toxicology test, positive verbal substance use screen, or diagnosis of a substance use disorder.

“Pregnant people in pain or struggling with substance use need comprehensive support and treatment, not judgment,” said Chair of the AMA Substance Use and Pain Care Task Force Bobby Mukkamala, M.D. “But judgment is often what they unfairly receive from some laws and statutes that imply any indication of substance use by a pregnant individual is automatically representative of child abuse. Research has found that non-punitive public health approaches to treatment result in better outcomes for both pregnant individuals and babies.”

Supporting FDA’s Role in Ensuring the Safety of Medicinal Psychedelics

As lawmakers in some U.S. states have embraced the use of psychedelics, the nation’s physicians expressed concern about legislative efforts that circumvent the role of the U.S. Food and Drug Administration (FDA) to ensure the safety of medication options.

In response, the nation’s physicians adopted policy instructing the AMA to advocate against the use of any psychedelics or entactogenic agents, such as psilocybin and methylenedioxymethamphetamine (MDMA, ‘ecstasy’) to treat any psychiatric disorder except those which have received FDA approval or those prescribed in approved investigational studies.

“The AMA believes that scientifically valid and well-controlled clinical trials are necessary to assess the safety and effectiveness of all new drugs, including the potential use of psychedelics for the treatment of psychiatric disorders,” said AMA Immediate Past President Jack Resneck Jr., M.D. “The AMA appreciates that lawmakers want to help address the mental health crisis in the U.S., but there are other straightforward approaches that don’t thwart drug safety assessment and regulation, such as increasing coverage and removing barriers to care for evidence-based treatments.”

Physicians also voted to have the AMA support continued research and encourage therapeutic discovery into psychedelic and entactogenic agents with the same scientific integrity and regulatory standards applied to other promising drug therapies.