Opioid Policies

The American Medical Association (AMA) issued a report today showing a 44.4 percent decrease in opioid prescribing nationwide in the past decade. At the same time, the country is facing a worsening drug-related overdose and death epidemic.

To address this continuing epidemic, the Medical Society of the District of Columbia (MSDC) and the AMA are urging policymakers to join physicians to reduce mortality and improve patient outcomes by removing barriers to evidence-based care. The report shows that overdose and deaths are spiking even as physicians have greatly increased the use of prescription drug monitoring programs (PDMPs), which are electronic databases that track controlled substance prescriptions and help identify patients who may be receiving multiple prescriptions from multiple prescribers. The report shows that physicians and others used state PDMPs more than 910 million times in 2020.

Yet, the District of Columbia– like nearly every other state in the nation – continues to see increases in overdose mainly due to illicit fentanyl, fentanyl analogs, methamphetamine and cocaine, according to the U.S. Centers for Disease Control and Prevention.  In addition, state public health, media and other reports compiled by the AMA show that the drug-related overdose and death have worsened in the District of Columbia and nationally. Research and data from the National Institutes of Health, U.S. Substance Abuse and Mental Health Services Administration, and Indian Health Service underscore the continued challenges and inequities for Black, Latinx and American Indian/Native Alaskan populations.

In Washington, D.C., opioid prescriptions have decreased by 57.8% between 2011-2020, including a 17% decrease from 2019-2020, according to an AMA survey. Along with the sharp decreases in opioid prescriptions, new AMA data also show that nationally physicians and other health care professionals used the state PDMP more than 910 million times in 2020. That is more than double the number of queries in 2018.

Locally, DC Health is not releasing its data on program usage.

The report also highlights that more than 104,000 physicians and other health care professionals have an “X -waiver” to allow them to prescribe buprenorphine for the treatment of opioid use disorder. This is an increase of 70,000 providers since 2017, yet 80-90 percent of people with a substance use disorder receive no treatment.

“The District’s drug overdose and death epidemic has never just been about prescription opioids,” said MSDC President E.W. Emanuel, MD. “Physicians have become more cautious about prescribing opioids, are trained to treat opioid use disorder and support evidence-based harm reduction strategies. We use PDMPs as a tool, but they are not a panacea. Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidence-based care.”

Actions that states and the District of Columbia can take

MSDC and the AMA urge policymakers to act now:

• Stop prior authorization for medications to treat opioid use disorder. Prior authorization is a cost-control process that health insurance companies and other payers use that requires providers to obtain prior approval from the insurer or payer before performing a service or obtaining a prescription. It is used to deny and delay services – including life-saving ones – as physicians are required to fill out burdensome forms and patients are forced to wait for approval. 
• Ensure access to affordable, evidence-based care for patients with pain, including opioid therapy when indicated. While opioid prescriptions have decreased, the AMA and MSDC are greatly concerned by widespread reports of patients with pain being denied care because of arbitrary restrictions on opioid therapy or a lack of access to affordable non-opioid pain care. 
• Take action to better support harm reduction services such as naloxone and needle and syringe exchange services. These proven harm reduction strategies save lives but are often stigmatized.  
• Improve the data by collecting adequate, standardized data to identify and treat at-risk populations and better understand the issues facing communities. Effective public health interventions require robust data, and there are too many gaps to implement widespread interventions that work.

“With record-breaking numbers of overdose deaths across the country, these are actions policymakers and other stakeholders must take,” said AMA President Gerald E. Harmon, MD. “The medical community will continue to play its part, and overall, the focus of our national efforts must shift. Until further action is taken, we are doing a great injustice to our patients with pain, those with a mental illness and those with a substance use disorder.”

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