Despite progress fighting the overdose epidemic, outdated policies are ‘costing lives’

Key takeaways:

• Opioid prescriptions decreased by 51.7% from 2012 to 2023.
• The AMA underlined the importance of removing barriers to accessing MOUD and enforcing parity laws to address the epidemic.

Drug overdose deaths decreased slightly in 2023 compared with the previous year but still remain at a near-historic high, according to an AMA report.

The slim reduction in drug-related mortality comes despite a more than 50% decrease in the number of opioid prescriptions over the last 12 years. The AMA’s 2024 Opioid Overdose Epidemic report highlights the significant progress achieved in reducing opioid prescriptions, in addition to increasing naloxone availability.

However, the report also captures challenges that remain obstructive of efforts to effectively address the ongoing crisis, such as barriers to accessing buprenorphine and other medications for opioid use disorder.

“Half-measures and outdated policies are costing lives, and we urge policymakers to act. With thousands of families and communities devastated by overdose deaths, the time for incremental change has passed,” Bobby Mukkamala, MD, AMA president-elect, said in a press release. “We need unwavering commitment to expand access to lifesaving medications, enforce parity laws, and address the glaring gaps in harm reduction. We cannot stand by as outdated policies and insurance barriers prevent patients from accessing evidence-based care.”

According to the report, opioid prescriptions decreased from 260.5 million in 2012 to 125.9 million in 2023 for a reduction of 51.7%, while decreases at the state-level during that time ranged between 36% and 68%.

These reductions in prescriptions did not result in substantial decreases in drug-related mortality, however, with 107,543 overdose deaths occurring in 2023.

Meanwhile, state prescription drug monitoring programs were used more than 1.4 billion times in 2023, up from 61 million in 2014.

The AMA noted that buprenorphine prescriptions dispensed from retail pharmacies plateaued at over 15.6 million in 2023, likely due to factors such as pharmacy reluctance to stock the medication, concerns over suspicious order reporting requirements from the U.S. Drug Enforcement Agency (DEA) and delays in care because of the restrictions.

In contrast, naloxone prescriptions from retail pharmacies have continued to grow, rising from around 555,000 in 2018 to almost 2.2 million in 2023 for an increase of 291.5%.

The AMA highlighted several policy recommendations for state and federal policymakers, urging for:

• state insurance departments to “meaningfully” enforce mental health and substance use disorder parity laws;
• increased access to naloxone in pharmacies, schools, universities and public settings, and for those settings to adopt best practices;
• the elimination of punitive policies against pregnant and parenting individuals who rely on medications for opioid use disorder ;
• medical and other health care professional licensing boards to review and rescind arbitrary restrictions on opioid therapy;
• all individuals with opioid use disorder or a mental illness entering jail or prison to be screened upon entry and have access to medications for opioid use disorder;
• increased access to medications for opioid use disorder through actions like removing prior authorization dosage requirements and step therapy for buprenorphine, having the DEA remove buprenorphine from its suspicious order reporting requirements until further notice or authorizing methadone to be prescribed outside of Opioid Treatment Program settings; and
• support of efforts aimed at funding and making additional evidence-based harm reduction initiatives more available.

Mukkamala underlined that denials or delays of harm reduction services, pain care and evidence-based treatment for substance use disorder “only [result] in increased suffering and death.”

“Ending the epidemic is possible, but much more work must be done,” he said.

References:

• 2024 Overdose Epidemic Report. Available at: https://end-overdose-epidemic.org/highlights/ama-reports/2024-report/. Accessed Nov. 21, 2024.
• New report calls for urgent action to combat overdose epidemic. Available at: https://www.ama-assn.org/press-center/press-releases/new-report-calls-urgent-action-combat-overdose-epidemic. Published Nov. 21, 2024. Accessed Nov. 21, 2024.
• Physicians’ progress toward ending the nation’s drug overdose epidemic. Available at: https://www.ama-assn.org/delivering-care/overdose-epidemic/physicians-progress-toward-ending-nation-s-drug-overdose-epidemic. Published Nov. 21, 2024. Accessed Nov. 21, 2024.