There has been a nearly 40% decline in opioid prescriptions in the last five years, but overdose deaths have continued to increase thanks to spiraling use of illicit drugs such as synthetic fentanyl, a new report finds.
The report, released Tuesday by the American Medical Association (AMA), calls for greater access to the opioid antagonist naloxone and to remove barriers such as prior authorization that stymie access to addiction treatments.
“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,” said Patrice Harris, the immediate past president of the AMA and the chairwoman of the association’s Opioid Task Force.
The report highlighted some of the metrics moving in the right direction.
From 2013 to 2019, the number of opioid prescriptions declined by more than 90 million, which represented a 37.3% decline, the report said citing data from the research firm IQVIA.
At the same time, registrations and use of Prescription Drug Monitoring Programs run by states increased. Last year, healthcare professionals accessed their state’s program 739 million times, a nearly 65% increase from 2018.
Access to the overdose antidote naloxone is also increasing. More than 1 million prescriptions for naloxone were dispensed in 2019, a whopping 649% increase from 2017, the AMA said.
Deaths involving a prescription opioid has decreased from 12,269 in 2015 to 11,904 in 2019, the report found.
But any progress on reducing prescription opioid deaths has been washed out by a massive increase in overdoses from illegally manufactured fentanyl and similar drugs.
From 2015 to 2019, deaths from synthetic fentanyl increased from 5,766 to 36,509. Deaths from other types of illicit drugs also increased, including cocaine (5,496 to 15,974) and methamphetamines and other stimulants (4,402 to 16.279).
Deaths involving the drug heroin also increased from 10,788 in 2015 to 14,079 last year, according to figures from the Centers for Disease Control and Prevention.
In the report, the AMA pressed for changes to remove barriers, such as prior authoritzation, to addicts gaining access to medical treatments.
“Health insurance companies continue to delay and deny access to non-opioid pain care and evidence-based treatment for opioid use disorder, while pharmacy chains, pharmacy benefit managers and state laws continue to inappropriately use arbitrary guidelines to restrict access to legitimate medication that some patients need to help manage their pain,” the report said.
AMA lamented that only 21 states and the District of Columbia have enacted laws which limit insurers from employing prior authorization for substance use disorder services or treatments.
Prior authorization has also been a problem for physicians who want to use methods other than opioids to combat pain.
The report pointed to a 2019 survey from the American Board of Pain Medicine that found 92% of pain medicine specialists have to submit a prior authorization request for non-opioid pain management.
AMA also wants more states to enforce mental health and substance use disorder parity laws that require insurers to provide the same level of benefits for substance abuse treatments as they do for medical and surgical care. It found only eight states have moved to meaningfully enforce the laws.