AMA Calls for Wider Access to Naloxone, Other Types of Harm Reduction

The American Medical Association (AMA) is calling for wider access to the overdose reversal agent naloxone (Narcan), even as it notes that distribution of the medication has increased 203% since 2018.

In a new report looking at the overdose epidemic, the organization is also seeking better access to buprenorphine for opioid use disorder, as well as fentanyl test strips, sterile needle and syringe services programs, and other harm-reduction methods to prevent deaths.

"Naloxone is one success story we've seen this year because access to opioid-overdose reversal medications continues to save tens of thousands of lives," said Bobby Mukkamala, MD, chair of the AMA Substance Use and Pain Care Task Force, in a statement.

In 2022, community pharmacies dispensed more than 1.6 million doses of naloxone, up from just under 600,000 in 2018. But the availability is still less-than-desirable, said the AMA.

"Unfortunately, we are at a place where naloxone needs to be available as easily as a first aid kit or a defibrillator in public spaces," said Mukkamala, adding that "policymakers must look at additional, evidence-based harm-reduction strategies to combat the skyrocketing number of overdoses."

Provisional data from the US Centers for Disease Control and Prevention (CDC) shows that 106,539 Americans died from an overdose from May 2022 to May 2023.

Low- or No-Cost Naloxone

The AMA is urging schools, universities, and other public venues to keep naloxone supplies on hand and is encouraging manufacturers of overdose reversal agents to seek US Food and Drug Administration (FDA) approval to market their products directly to consumers and, once approved, to "price their products responsibly."  Payers said the AMA should cover naloxone at a low cost or no cost.

The organization noted that opioid prescribing has declined by 50% in the US over the last decade, and that use of state prescription drug monitoring programs (PDMPs) has risen from 450 million queries in 2018 to more than 1.3 billion queries in 2022. Community pharmacies have doubled the doses of buprenorphine dispensed in the past 10 years, with 16 million doses dispensed in 2022, AMA's report notes.

However, in 2021, only 3 million of the estimated 43 million people with a drug or alcohol use disorder received treatment in the past year, and less than half of the 58 million adults with any mental health condition received treatment, according to the AMA report.

The report documented a small rise in the number of opioid treatment programs — from 1519 in 2018 to 2050 in 2023, citing data from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The AMA is calling on legislators and regulators to remove barriers such as prior authorization, step therapy and dosage caps for medications to treat opioid use disorder, including dosage caps on buprenorphine.

Lawmakers should also be more supportive of harm reduction, said the AMA. More than half of states have decriminalized fentanyl test strips, according to the report. The AMA wants all states to decriminalize drug checking supplies that allow users to check for illicit fentanyl and other adulterants.

And the AMA is also calling for more support of syringe services programs, which can help reduce infectious diseases — such as hepatitis A, B and C and HIV — that result from shared or dirty needles. The syringe programs can also "help serve as a bridge to other health services, including HIV and HCV testing, counseling and MOUD (medications to treat opioid use disorder)," said the AMA report.   

Alicia Ault is a Saint Petersburg, Florida-based freelance journalist whose work has appeared in publications including JAMA and Smithsonian.com. You can find her on Twitter @aliciaault.

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Cite this: AMA Calls for Wider Access to Naloxone, Other Types of Harm Reduction - Medscape - Nov 10, 2023.