AMA: Opioid prescriptions down, illicit drug use up
Although opioid prescriptions decreased in the last year, the use and overdose rates of illicit drugs — including fentanyl and stimulants — have increased, according to a progress report released by the AMA Opioid Task Force.
“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,” Patrice A. Harris, MD, MA, past AMA president and chair of the AMA Opioid Task Force, said in a press release.
The report showed that the use of illicit drugs such as fentanyl, fentanyl analogues and stimulants like methamphetamine and cocaine has increased by 10.1%, while overdoses with these drugs have increased by 10.8%.
The report details data from the CDC on other drug use, which show that the number of deaths involving illicitly manufactured fentanyl and fentanyl analogs increased from 5,766 in 2015 to 36,509 in 2019.
The number of deaths from stimulants like methamphetamine also rose substantially during this time, from 4,402 in 2015 to 16,279 in 2019. The number of deaths that involved cocaine increased, from 5,496 in 2015 to 15,974 in 2019; deaths from heroin overdose went from 10,788 in 2015 to 14,079 in 2019.
During the same time, the number of deaths that involved prescription opioids decreased from 12,269 in 2015 to 11,904 in 2019, according to the CDC data cited in the report.
From 2014 to 2019, there was a 37.1% decrease in opioid prescriptions in the United States, according to the report. In addition, there was a 64.4% increase in prescription drug monitoring program use in 2019.
Physicians also made efforts to combat the opioid epidemic, with more than 85,000 physicians and health care personnel certified to prescribe buprenorphine in 2019, an increase of nearly 50,000 certified personnel compared with 2017.
The AMA report also stated that there were more than 1 million prescriptions of naloxone dispensed in 2019, a massive increase from the 6,588 prescriptions dispensed in 2015.
“If it weren’t for naloxone, there likely would be tens of thousands additional deaths,” Harris said in the release.
Despite medical society and patient advocacy efforts, just 21 states and the District of Columbia have laws in place to prevent public and private insurers from enforcing prior authorization requirements on services or medication for substance use disorders, according to the report. Ninety-two percent of pain medicine specialists who were surveyed reported that they had been required to submit prior authorization for non-opioid pain care requests, and 72% reported that they or their patients had been required to reduce the dose or quantity of prescribed medication.
“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,” Harris said in the press release.
The AMA Opioid Task Force urged policymakers to take action to remove administrative barriers that delay or deny care with FDA-approved medications for opioid use disorder and barriers to comprehensive, multimodal, multidisciplinary pain care and rehabilitation programs.
Their recommendations to policymakers also include supporting efforts on sterile needle and syringe service programs in addition to civil and criminal justice system reforms that would ensure access to high-quality, evidence-based opioid use disorder care.
The task force members also called for policymakers to enact meaningful oversight and enforce mental health and substance use parity laws.
“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 in the press release. “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.”
AMA. AMA report shows evolving, deadlier overdose epidemic. https://www.ama-assn.org/press-center/press-releases/ama-report-shows-evolving-deadlier-overdose-epidemic. Accessed July 22, 2020.
AMA. Opioid Task Force Progress Report. https://www.ama-assn.org/system/files/2020-07/opioid-task-force-progress-report.pdf. Accessed July 22, 2020.