AMA introduces policies supporting naloxone access, mental health treatment

Key takeaways:

• New policies call for better access to naloxone in schools and for the public.
• The policies also address insurers’ failure to comply with mental health and addiction parity requirements.

The AMA House of Delegates adopted several policies that aim to expand the availability of life-saving medications and care for substance use disorders, overdoses and mental health.

The policies come as the United States continues to face a drug overdose crisis. Although there has been a recent decline in drug-related deaths in the U.S., CDC data show that more than 107,500 people died from an overdose in 2023.

Supporting harm reduction

Despite the proven benefits of buprenorphine in treating opioid use disorder (OUD), the AMA said that access is limited because of regulatory and legal barriers, stigma and issues with health insurance coverage.

The organization called for efforts to decriminalize the possession of non-prescribed buprenorphine for personal use by individuals who lack access to a physician for the treatment of OUD.

“Given the innumerable barriers to care for OUD, combined with the clear benefits of increasing access to buprenorphine, decriminalizing nonprescribed buprenorphine for personal use is necessary to prevent more overdoses and deaths,” Bobby Mukkamala, MD, AMA president-elect and chair of the AMA Substance Use and Pain Care Task Force, said in the release.

Overdose reversal medications in schools

Research from the University of California, Los Angeles, showed that about 22 adolescents aged 14 to 18 years in the U.S. died each week from drug overdoses in 2022, increasing the death rate in this age group to 5.2 per 100,000. Researchers said the trend was largely driven by fentanyl in counterfeit pills.

The AMA addressed these harms by advocating for states and communities to allow schools to have access to effective and safe overdose reversal medications.

“Schools are recognizing the value of having naloxone on hand,” Mukkamala said. “It is a needed layer of protection to keep young people safe and alive. 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.”

Expanded access to naloxone in public locations

Another AMA policy advocates for better access to overdose reversal medications in other areas outside of schools. Specifically, the organization supports efforts to place intranasal naloxone along with automated external defibrillators (AED) in public locations.

The AMA cited CDC data that showed around 26,500 opioid overdoses in the U.S. were reversed with naloxone from 1996 to 2014.

“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,” Mukkamala said. “By making naloxone more accessible, particularly where AEDs are located in public spaces, we can help prevent more opioid overdoses and save lives.”

Enforcement of parity laws

The AMA additionally adopted a policy to address insurers’ failures to comply with the Mental Health Parity and Addiction Equity Act, or MHPAEA.

According to HHS, the MHPAEA requires insurers and group plans that cover mental health and substance use disorder services to provide the same level of benefits for these services as they do for medical and surgical care.

However, patients are nine times likelier to seek out-of-network care for behavioral health clinicians, psychiatrists and psychologists vs. other medical and surgical care, the AMA noted, “highlighting the challenges in finding affordable care for mental health and substance use disorders.”

The new policy advocates for “meaningful financial and other penalties for insurers that do not comply with parity laws,” the release said.

References:

• About 22 high school age adolescents died each week from overdoses in 2022, driven by fentanyl-laced prescription pills. https://www.uclahealth.org/news/release/about-22-high-school-age-adolescents-died-each-week. Published Jan. 8, 2024. Accessed June 12, 2024.
• AMA adopts policies on substance use disorder and mental health treatment. https://www.ama-assn.org/press-center/press-releases/ama-adopts-policies-substance-use-disorder-and-mental-health-treatment. Published June 12, 2024. Accessed June 12, 2024.
• Mental health and substance use insurance help. https://www.hhs.gov/programs/health-insurance/mental-health-substance-use-insurance-help/index.html. Accessed June 12, 2024.