AMA adopts substance use policies on prenatal care, medicinal psychedelics, more

Key takeaways:

• The AMA adopted new policies on overdose-reversing medications, sentencing disparities, medicinal psychedelics and access to prenatal care.
• The organization also strengthened existing policy.

Members of the AMA adopted new policies on substance use during its annual meeting of the House of Delegates, according to a press release.

The policies include decisions on overdose-reversing medications, sentencing disparities for some drugs, medicinal use of psychedelics and care for pregnant people with substance use disorder.

Access to overdose-reversing medications

The AMA encouraged communities and states to adopt regulatory and legislative policies allowing safe, effective overdose reversal medications to be readily available to staff, teachers and students in educational settings.

Bobby Mukkamala, MD, chair of theAMA Substance Use and Pain Care Task Force, said in the release that allowing teachers and students to carry safe, effective medications like naloxone “is a commonsense decision and will no doubt result in young lives saved.”

“We are facing a national opioid 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,” Mukkamala said.

Physicians additionally strengthened AMA policy on increasing access to naloxone and other overdose-reversal medications by voting to add support for the availability, procession, delivery and use of mail-order overdose-reversal medications. They also voted to support the development of alternatives and adjuncts to naloxone to combat overdose and synthetic opioid-induced respiratory depression.

Sentencing disparities for crack versus powder cocaine

The AMA supported efforts to eliminate disparities in sentencing for powder cocaine and crack and retroactively apply changes to those who have already been sentenced or convicted.

According to the association, the average prison sentencing is 18 days for using crack but only 1 day for powder cocaine. This discrepancy has led to a disproportionate share of Black and Brown people receiving longer prison sentences.

AMA Board of Trustees Member Ilse Levin, DO, MPHTM, said the disparity “has no basis in science.”

“There are no significant pharmacological differences between the drugs. Not only do we need to stop the disparity, but we also need to go back and ensure justice for those who were convicted under these unjust laws,” Levin said in the release.

U.S. Attorney General Merrick Garland has also instructed federal prosecutors to end the disparities.

Ensuring medicinal psychedelics safety

The AMA additionally supported the FDA’s role in ensuring the safety of medicinal psychedelics.

The organization adopted a policy that instructed the AMA to advocate against using any psychedelics or entactogenic agents — including psilocybin and methylenedioxymethamphetamine (MDMA) — to treat psychiatric disorders other than those prescribed in approved investigational studies or those which have received FDA approval.

AMA Immediate Past President Jack Resneck Jr., MD, said in the release that the organization “appreciates that lawmakers want to help address the mental health crisis” but notes that other approaches are more straightforward and do not “thwart drug safety assessment and regulation, such as increasing coverage and removing barriers to care for evidence-based treatments.”

“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,” Resneck said in the release.

Notably, the physicians also opted to have the AMA encourage and support continued research and therapeutic discovery into psychedelic and entactogenic agents “with the same scientific integrity and regulatory standards applied to other promising drug therapies.”

Access to prenatal care for substance use disorder

The AMA strengthened policy to further support maternal and child health in the context of the opioid crisis, instructing the AMA to advocate for amended child protection laws so that people who are pregnant with substance use and substance use disorder are reported to child welfare agencies only when the clinical team identifies protective concerns rather than mandated or automated reporting.

“Pregnant people in pain or struggling with substance use need comprehensive support and treatment, not judgment,” Mukkamala said in the release. “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.”

References:

• AMA adopts new policies on substance use during second day of annual meeting. https://www.ama-assn.org/press-center/press-releases/ama-adopts-new-policies-substance-use-during-second-day-annual-meeting. Published June 13, 2023. Accessed June 14, 2023.
• AMA adopts policies on first day of annual meeting. https://www.ama-assn.org/press-center/press-releases/ama-adopts-policies-first-day-annual-meeting. Published June 12, 2023. Accessed June 14, 2023.