The number of people dying from illicit opioids, stimulants such as methamphetamine, heroin and cocaine has risen sharply over the last few years, a recent report issued by the American Medical Association (AMA) declared, even as the prescription opioid epidemic abates.
The good news is that physicians have slowed prescribing of opioids in response to that crisis and turned increasingly to state prescription drug monitoring programs (PDMP) to monitor their efforts. Education efforts surrounding prescription, pain management and addiction are on the rise and medication designed to reverse opioid overdoses, such as naloxone, is more readily available.
This helped drop deaths involving prescription opioids from a high of 15,003 in July 2017 to 11,904 in 2019, the report said.
However, the AMA Opioid Task Force found that this has done nothing to halt drug overdoses caused by illicit drugs. In this, it cited the Centers for Disease Control and Prevention (CDC), which found that between 2015 and 2019 deaths involving fentanyl and its analogs increased more than six times its previous figure, to 36,509 cases. Stimulants rose from 4,402 deaths to 16,279. Cocaine deaths likewise tripled, to 15,974. Heroin’s gains were more moderate by comparison, but still represent a worsening case load, increasing from 10,788 in 2015 to 14,079 by 2019.
“The nation needs to confront the fact that the nation’s drug overdose epidemic is now being driven predominantly by highly potent illicit fentanyl, heroin, methamphetamine and cocaine, although mortality involving prescription opioids remains a top concern,” Dr. Patrice Harris, AMA Opioid Task Force Chair and AMA’s past president, said. “If it weren’t for naloxone, there likely would be tens of thousands additional deaths. It is past time for policymakers, health insurers, pharmacy chains and pharmacy benefit managers to remove barriers to evidence-based care for patients with pain and those with a substance use disorder.”
In fact, by the task force’s estimation, naloxone prescriptions reached more than 1 million as of 2019 – a massive uptick in four years, given that in 2015 only 6,588 prescriptions were recorded.
At this time, the task force determined, the U.S. needs to shift to treating people in danger of all drug-induced overdoses, not merely prescription opioids. To do this, barriers to evidence-based care would need to be removed and certain established policies revamped. For example, only 21 states and the District of Columbia currently have laws limiting public and private insurers from requiring prior authorization for treating substance use disorders. Fewer have actively worked to enforce mental health and substance use disorder parity laws.
The American Board of Pain Medicine found that 92 percent of surveyed pain medicine physicians were required to submit prior authorization before providing non-opioid pain care. The AMA Opioid Task Force would like to see prior authorization requirements that delay care removed outright when involving Food and Drug Administration-approved medications.
Given the lax mental health care, the task force also supported assessment, referral and treatment options for mental health disorders and greater enforcement of state and federal parity laws, including demanding compliance from insurance companies. Non-punitive policies going forward could make a world of difference, in its view, particularly when paired with tracking systems for overdose and mortality trends, which will better inform public health workers.
So far, no state has actively worked to require that health insurers increase access to non-opioid pain care or remove restrictions on opioid therapy.
“We know that ending the drug overdose epidemic will not be easy, but if policymakers allow the status quo to continue, it will be impossible,” Harris said. “This is particularly important given concerns that the COVID-19 pandemic is worsening the drug overdose epidemic. Physicians will continue to do our part. We urge policymakers to do theirs.”
However, some positives include the fact that as of 2019, more than 1.8 million physicians and other healthcare professionals were registered to use state PDMPs across the country. They accessed those programs more than 739 million times over the course of the year. Further, more than 85,000 physicians, nurse practitioners and physician assistants are now certified to treat patients with buprenorphine, another medication used to treat opioid addiction. That’s a more than 50,000 person increase over 2017.