AMA report finds U.S. opioid prescribing down by 37% since 2014 – and 27% in Georgia – but overdose numbers troubling
The American Medical Association’s (AMA) Opioid Task Force has released a report that shows both a dramatic drop in the use of prescription opioids and a troubling increase in fatalities involving illicit opioids, stimulants (e.g., methamphetamine), heroin, and cocaine.
AMA emphasizes that, “The changing landscape of the opioid epidemic poses challenges for the health care system, which must pivot to treat people in danger of overdose from all drugs.”
AMA and the Medical Association of Georgia (MAG) are subsequently calling for health insurers and policymakers to “remove barriers to evidence-based care. Red tape and misguided policies are grave dangers to pain patients and those with an opioid-use disorder.”
The AMA report also found that physicians have reduced opioid prescribing, increased the use of state prescription drug monitoring programs (PDMP), and are prescribing more naloxone – which can offset the effects of a drug overdose.
In Georgia, physicians and allied health care professionals reduced opioid prescribing by 27 percent between 2014 (8.6 million) and 2019 (6.3 million), while the number of PDMP queries in the state rose from 1.14 million in 2016 to 9.4 million in 2019. It is also worth noting that Georgia has the third lowest per-capita prescribing rate in the U.S.
AMA notes that, “Physicians also have continued to educate themselves on safe prescribing, pain management and recognizing signs of addiction. More than 50,000 physicians and other health care professionals nationwide have become certified to provide treatment for opioid use disorder in the past three years. Yet, illicit drugs are now the dominant reason why drug overdoses kill more than 70,000 people in the United States each year.”
According to the U.S. Centers of Disease Control and Prevention (CDC), from the beginning of 2015 until the end of 2019…
– Deaths involving illicitly manufactured fentanyl and fentanyl analogs increased from 5,766 to 36,509
– Deaths involving stimulants (e.g., methamphetamine) increased from 4,402 to 16,279
– Deaths involving cocaine increased from 5,496 to 15,974
– Deaths involving heroin increased from 10,788 to 14,079
In a positive, the CDC determined that deaths involving prescription opioids decreased from 12,269 to 11,904 in the 2015-2019 timeframe – keeping in mind that number reached a high of 15,003 in July 2017.
“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,” says AMA Opioid Task Force Chair and former AMA President Patrice A. Harris, M.D., M.A. “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.”
MAG President Andrew Reisman, M.D., adds that, “Physicians and allied health care professionals in Georgia should be applauded for the contributions that they have made in the fight against opioid misuse, but we can all agree that the number of deaths that are caused by overdoses is unacceptable – which means that we can’t afford to take our foot of the pedal.”
In terms of other key findings, AMA’s report found that…
Opioid prescribing in the U.S. decreased for a sixth year in a row. Between 2013 and 2019, the number of opioid prescriptions in the U.S. dropped by more than 90 million or 37.1 percent.
PDMP registration and use continues to increase. In 2019, U.S. health care professionals accessed state PDMPs more than 739 million times – a 64.4 percent increase from 2018 and more than an 1,100 percent increase from 2014. More than 1.8 million physicians and other health care professionals have now registered with state PDMPs.
More physicians are certified to treat opioid use disorder. More than 85,000 physicians (as well as a growing number of nurse practitioners and physician assistants) across the U.S. are now certified to treat patients in-office with buprenorphine – an increase of more than 50,000 from 2017.
Access to naloxone increasing. More than 1 million naloxone prescriptions were dispensed in the U.S. in 2019, nearly double the amount in 2018, and a 649 percent increase versus 2017.
Despite patients’ and physicians’ advocacy efforts, just 21 states and the District of Columbia have enacted laws limiting public and private insurers from imposing prior authorization requirements on substance use disorders’ services or medications, according to the Legal Action Center.
AMA explains that, “Even fewer states have taken meaningful action to enforce mental health and substance use disorder parity laws. While access to legitimate opioid analgesics has decreased in every state, no state has taken meaningful action to require health insurers to increase access to non-opioid pain care or to remove arbitrary restrictions on access to opioid therapy. A recent survey from The American Board of Pain Medicine found 92 percent of pain medicine physicians said they have been required to submit a prior authorization for non-opioid pain care.”
AMA and MAG are encouraging policymakers to…
– Remove prior authorization, step therapy and other inappropriate administrative burdens or barriers that delay or deny care for FDA-approved medications used as part of medication-assisted treatment (MAT) for opioid use disorder.
– Support assessment, referral and treatment for co-occurring mental health disorders as well as enforce meaningful oversight and enforcement of state and federal mental health and substance use disorder parity laws, including requiring health insurance companies to demonstrate parity compliance at the time of their rate and form filing.
– Remove administrative and other barriers to comprehensive, multimodal, multidisciplinary pain care and rehabilitation programs.
– Support maternal and child health by increasing access to evidence-based treatment, preserving families, and ensuring that policies are non-punitive.
– Support increased efforts to expand sterile needle and syringe services programs as well as reforms in the civil and criminal justice system that ensure access to high quality, evidence-based care for opioid use disorder, including MAT.
– Implement systems to track overdose and mortality trends to provide equitable public health interventions that include comprehensive, disaggregated, racial and ethnic data collection related to testing, hospitalization, and mortality associated with opioids and other substances.
“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,” concludes Dr. Harris. “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.”
And Dr. Reisman says that, “The COVID-19 outbreak has placed incredible and unprecedented stress on our patients and the health care community, so it is essential for every individual and organizational stakeholder that touches the health care health system to be both united and relentless in the fight against drug abuse and misuse.”
AMA’s Opioid Task Force Report
‘Total opioid prescriptions have decreased by more than 37 percent since 2014’ summary
‘Physicians’ and health care professionals’ use of state prescription drug monitoring programs surpass 739 million queries – more than 10 times the queries in 2014’ fact sheet
AMA Media Relations
MAG Media Relations
Created in 2014, the AMA Opioid Task Force is comprised of more than 25 national, state, specialty and other medical associations to coordinate efforts within organized medicine to help end the nation’s overdose epidemic. Go to www.end-overdose-epidemic.org for details.
With more than 8,400 members, MAG is the leading voice for physicians in Georgia. MAG is an advocate for physicians in every practice setting and specialty. Visit www.mag.org for information, and go to www.mag.org/tai for details on the MAG Foundation’s ‘Think About It’ initiative to reduce prescription drug misuse in Georgia.