Overdoses Still Climb Despite Big Drop in Prescription Opioids
By Sean Price

The number of opioid prescriptions has dropped 44% since 2011, yet there are still more drug-related overdose deaths than ever – a clear sign policymakers should work to remove barriers to care for patients, according to the American Medical Association’s 2021 Overdose Epidemic Report

The AMA report listed policy changes designed to reduce overdose deaths and opioid use. Those recommendations substantially reflect Texas Medical Association policies or reports from the Subcommittee on Behavioral Health, part of the Council on Science and Public Health, says Carlos Tirado, MD, an addiction psychiatrist who is founder and chief medical officer at CARMAhealth in Austin and a subcommittee member. 

In recent years, U.S. government agencies have enacted policies to rein in opioid prescribing, he says. That includes moving hydrocodone from Schedule III to Schedule II and increasing use of prescription monitoring programs

“The intention of this was to somehow address the prescription opioid epidemic,” he said. “What we saw, though, since those measures were enacted … [was] no impact on decreasing opioid deaths and – unintended – a reduction in access for pain management treatment in patients who were benefiting from it.” 

Instead, overdose deaths are now being driven by illicit fentanyl, fentanyl analogs, methamphetamine, and cocaine, according to data from the Centers for Disease Control and Prevention

AMA presented the following seven points to cut overdose deaths and opioid use, focusing mostly on improving access to care: 

  • Remove barriers to evidence-based care for patients with substance use disorder. This includes removing prior authorizations for medications to treat opioid-use disorder, as well as ongoing flexibility for medication for opioid treatment and continuing telehealth options for patients to begin those medications.
  • Lift roadblocks to medications that treat substance use disorder and co-occurring mental illness in jails and prisons.
  • Protect families by focusing on increasing access to evidence-based care rather than using punishment and the threat of family separation.
  • Ensure access to affordable, evidence-based care for patients with pain, including opioid therapy when indicated. Require health insurance companies and other payers to make nonopioid pain care alternatives more accessible and affordable.
  • 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.
  • Collect adequate, standardized data to identify and treat at-risk populations, and better understand the issues facing communities. 

TMA’s Subcommittee on Behavioral Health has called for similar measures, especially improved access to medications such as buprenorphine that help treat substance use disorder, Dr. Tirado says. The AMA priorities also reflect TMA-supported policies to improve aspects of medicine that touch directly on behavioral health, such as making telemedicine easier and more affordable for patients and physicians.  

“Gains that we made through TMA advocacy around greater access and expansion of telehealth, such as getting telehealth parity for reimbursement, fall into this very squarely,” Dr. Tirado said. “Telehealth prescription of buprenorphine is one of the priority items for physicians and other [health care professionals].” 

Physicians can find out more about the opioid epidemic on TMA’s Opioid Resources page.

Last Updated On

October 08, 2021

Originally Published On

October 08, 2021

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Sean Price

Reporter

(512) 370-1392

Sean Price is a reporter for Texas Medicine and Texas Medicine Today. He grew up in Fort Worth and graduated from the University of Texas at Austin. He's worked as an award-winning writer and editor for a variety of national magazine, book, and website publishers in New York and Washington. He's also helped produce Texas-based marketing campaigns designed to promote public health. Sean lives in Austin and enjoys hiking, photography, and spending time with his wife and two sons.

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