Recent American Medical Association report highlights drug overdose epidemic challenges and solutions.
By Jenna Hughes
Since the 1990s, overdose deaths in the U.S. have risen significantly, driven by the use of opioid medications and illegal drugs. For decades, the nation has continued to face a severe drug abuse and overdose crisis, calling attention to the urgent need for broader healthcare and public intervention strategies.
Despite ongoing efforts to combat drug abuse, the overdose epidemic has persisted, remaining a complex public health challenge.
Most U.S. overdose deaths involve opioids, according to the National Institutes of Health (NIH), a group of drugs that includes illegal substances like heroin and prescription pain medicines. In 2017, the U.S. Department of Health and Human Services declared the opioid crisis a national public health emergency. Overdose deaths related to illicitly manufactured fentanyl, fentanyl analogs, methamphetamine and cocaine have also reached historic heights.
NIH data on drug use and overdose death rates reveal that the overdose epidemic has become extensive and national, affecting people of all racial and ethnic groups – in cities, suburbs, small towns, and rural areas, and that rates of drug overdose are rising among almost all groups.
To highlight the increasing need for solutions that address drug abuse, the American Medical Association’s (AMA) Substance Use and Pain Care Task Force released “The 2024 Overdose Epidemic Report”. The report emphasizes the need for better policies to address inequities and improve access to medications for opioid use disorders. Although there has been some progress, overdose deaths remain high, and outdated prescribing rules continue to harm patients in pain.
The impact of drug overdose
Drug overdose remains one of the leading causes of injury and death in adults in the U.S. Overdose rates have significantly increased over the past several decades, according to the Centers for Disease Control and Prevention (CDC), with the age-adjusted rate of drug overdose deaths nearly quadrupling from 8.2 in 2002 to 32.6 in 2022.
Since 2010, illegally made fentanyl and other synthetic opioids have also infiltrated the U.S. drug supply, according to the National Institute on Drug Abuse (NIDA). Fentanyl and related substances have been a significant contributing factor to the rise in overall drug overdose deaths across the nation.
Nearly 107,600 Americans died from a drug-related overdose in 2023, only a slight drop from 107,941 in 2022, according to the CDC. Death figures did, however, continue to drop during 2024, with figures showing a 17% decline.
The collateral impact of the ongoing drug-related overdose and death epidemic, however, includes widespread economic damage, psychological trauma, moral injury, and more; with data from the AMA showing that more than 320,000 children across the nation have lost a parent due to overdose.
Reducing stigma and facilitating change
For more than a decade, policymakers have searched for the right combination of policies to reduce drug-related mortality and improve outcomes for individuals with substance use disorder, patients with pain and people who use drugs.
Despite advancing some of these efforts, at least 39 states across the U.S. still have opioid prescribing restriction policies in place that interfere with patients being able to receive individualized pain care treatment options, according to the AMA. While opioid prescribing has decreased by more than 51.7% since 2012, many patients who utilize opioid therapy have been negatively impacted by laws from health insurers, pharmacy chains and pharmacy benefit managers.
These types of pharmacy companies have continued to maintain that restrictions in opioid prescribing will result in improved care and reduced mortality, according to the AMA. Many states and national pharmacy chains continue to hold on to dose and quantity restrictions that have resulted in harm for certain patients.
“Half-measures and outdated policies [in regard to the overdose epidemic] are costing lives, and the American Medical Association urges policymakers to act,” said Dr. Bobby Mukkamala, AMA president-elect and chair of the AMA Substance Use and Pain Care Task Force.
Despite a recent decline in opioid prescribing by physicians, restrictive laws stigmatize and reduce access to medication for certain patients with pain who require opioid therapy for surgery, sickle cell disease, chronic pain, hospice and palliative care, cancer and other medical conditions, according to the AMA.
“With thousands of families and communities devastated by overdose deaths, the time for incremental change has passed,” said Dr. Mukkamala. “We need unwavering commitment to expand access to lifesaving medications, enforce parity laws, and address the glaring gaps in harm reduction. We cannot stand by as outdated policies and insurance barriers prevent patients from accessing evidence-based care.”
State policy and payers have also taken few actions that meaningfully increase access to non-opioid alternatives for patients, including important steps forward such as adopting the April 2024 Federation of State Medical Boards “Strategies for Prescribing Opioids for the Management of Pain.”
In the 2024 Overdose Epidemic Report, the AMA urges state legislatures, Medicaid agencies, health insurance companies, and pharmacy chains to adopt new protocols and to rescind outdated laws, policies, and protocols (based on the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain).
Organizations such as the CDC and the Federation of State Medical Boards (FSMB) have begun to address outdated practices by spreading messaging campaigns to make it clear that an oversimplified approach to prescribing guidelines can be detrimental to patients’ health.
Progress and policy change
In terms of progress toward a drug-free nation, evidence-based policy change must continue to guide patient care as the nation’s opioid crisis evolves into a more dangerous and complicated illicit drug overdose epidemic.
“This epidemic has caused harm across multiple generations,” said Dr. Bruce A. Scott, AMA president. “We need to employ every measure to increase access to care for individuals with a substance use disorder or pain – and do everything we can from a harm reduction standpoint to keep people alive and reduce their risks.”
Policy recommendations highlighted in the AMA report include the meaningful enforcement of state and federal mental health and substance use disorder parity laws, increased access to medications for opioid use disorder (MOUD), requiring payers to increase access to non-opioid pain care options, increasing access to naloxone in pharmacies, schools, and public settings, and supporting efforts to fund and make other evidence-based harm reduction initiatives more widely available – including syringe services programs and overdose prevention centers.
FDA-approved medications for opioid use disorders (MOUD) include buprenorphine, methadone and naltrexone. Alternatively, the drug naloxone’s main purpose is to save lives from opioid-related overdose. Physicians are encouraged to prescribe naloxone or other opioid-overdose reversal agents to anyone at risk of an opioid-related overdose, including to youth and adolescents.
The amount of naloxone dispensed from retail pharmacies has continued to grow, per the AMA report. From 2018 to 2023, naloxone prescriptions increased from about 555,000 to nearly 2.2 million prescriptions.
The amount of buprenorphine dispensed from retail pharmacies, on the other hand, appears to have plateaued, likely due to a variety of factors including longer prescriptions, pharmacy reluctance to stock the medication, and confusion and fear over DEA suspicious order requirements.
“The AMA strongly agrees that when pharmacists have questions about a prescription for buprenorphine for the treatment of OUD, it is essential for the pharmacist and physician to discuss the situation – and not automatically deny the patient access to the life-saving medication,” according to the AMA.
The AMA asserts that efforts such as removing outdated prior authorization dosage requirements for buprenorphine, authorizing methadone to be prescribed outside of Opioid Treatment Program settings, and removing buprenorphine from the DEA’s suspicious order reporting requirements can help reduce barriers to life-saving treatment.
Addressing substance use disorders
In recent years, the U.S. has witnessed positive actions from physicians in relation to the overdose epidemic, growth in harm reduction services and much-needed policy advancements. State-level decreases in opioid prescriptions from 2012-2023 ranged between 36% to 68%, according to the AMA report, and total opioid prescriptions dispensed decreased from 260.5 million in 2012 to 125.9 million in 2023.
Total dosage strength of certain medications, measured in morphine milligram equivalents, also decreased 63.1% from 2012 to 2023, with every U.S. state having seen a significant decrease, according to the AMA report. State prescription drug monitoring programs were also used more than 1.4 billion times in 2023, a significant increase since 2014 when they were used only 61 million times.
The AMA has urged the healthcare industry to combat the overdose epidemic by providing evidence-based care for patients with pain as part of a larger effort to address substance use disorder, including non-opioid interventions when appropriate and opioid therapy only when clinically necessary. The AMA also emphasizes that pain management should always be guided by evidence and best practices for each patient, rather than relying on a one-size-fits-all approach.
“Two key actions every state can take to help patients with pain include supporting coverage for, access to, and payment of comprehensive, multidisciplinary, multi-modal evidence-based treatment for patients with pain, a substance use disorder or mental illness,” according to the AMA Substance Use and Pain Care Task Force. “Additionally, coverage, access and payment should directly address inequities as well as social determinants of health. Emphasis must be placed on individualized patient care decisions, protecting patients with pain, a substance use disorder or mental illness from continued stigma and addressing a lack of access to evidence-based care or accepted best practices.”
According to the AMA, tools such as drug checking equipment (DCE) helps detect fentanyl and other toxic materials in substances. Preliminary research shows that drug checking services have a positive impact on individuals’ intended drug use behaviors, including making changes to their drug use practices such as keeping naloxone nearby to prevent fatal overdose, according to the AMA. Empowering individuals who use drugs with knowledge about the presence of harmful substances in the drug supply can reduce potential harm associated with drug use.
Almost half of states in the U.S. have decriminalized the use of fentanyl test strips, however, the AMA states that additional state-wide advocacy is needed to decriminalize these types of test strips and other drug checking supplies for emerging adulterants.
“The AMA strongly supports increasing access to fentanyl test strips and naloxone from pharmacies and other retailers,” according to the 2024 Overdose Epidemic Report. “These are common sense strategies to help prevent more people from dying.”
The AMA asserts that an end to the nation’s drug abuse epidemic requires improving care for patients with pain or substance use disorder, and that increasing access to harm reduction services requires commitment, collaboration, and partnership between stakeholders.
“The AMA, our Substance Use and Pain Care Task Force, and the nation’s physicians continue to urge policymakers, health insurance companies and other payers to once and for all remove barriers to evidence-based treatment for substance use disorders, pain care and harm reduction initiatives,” said Dr. Mukkamala. “Delays or denials of this care only results in increased suffering and death. Ending the epidemic is possible, but much more work must be done.”
Key data cited in the Overdose Epidemic Report
- Opioid prescriptions have decreased by 51.7% since 2012. State-level decreases from 2012-2023 ranged between 36% to 68%.
- State prescription drug monitoring programs were used more than 1.4 billion times in 2023, a staggering increase since 2014 when they were used only 61 million times.
- Buprenorphine dispensed from retail pharmacies appears to have plateaued, likely due to a variety of factors including longer prescriptions, pharmacy reluctance to stock the medication, and confusion/fear over DEA suspicious order requirements.
- Naloxone dispensed from retail pharmacies continues to grow. From 2018 to 2023, naloxone prescriptions increased from about 555,000 to nearly 2.2 million prescriptions.
Emerging Trends in Drug Abuse and Product Development
As the landscape of drug abuse continues to evolve rapidly, healthcare and workplace testing solutions must keep pace with emerging substances and shifting usage patterns. In particular, the rise in synthetic opioid misuse and other prescription drugs is driving innovation in drug testing technology. Companies like Abbott are responding with advanced, easy-to-use testing solutions that meet the growing demand for speed, accuracy, and flexibility across a range of settings, from clinical practices to workplace and law enforcement environments.
In the following Q&A, Abbott shares insights into current drug abuse trends, evolving customer needs, technological advancements, and the future direction of substance misuse testing.
Repertoire: What emerging trends are you seeing in drug abuse, and how is that influencing the development of your products?
Abbott: There is a significant increase in the abuse of synthetic opioids, particularly Fentanyl, as well as prescription medications like Tramadol, which has driven the demand for CLIA waived testing solutions that can quickly and accurately detect these substances. In response, we have launched our CLIA waived 14 panel iScreen Dx Tox Cup, which includes Fentanyl, to meet market needs. Additionally, oral fluid drug testing is gaining traction for employment screening due to the ease of collection and ability to detect recent drug use. The Department of Transportation (DOT) approved oral fluid drug screening in 2023, and this method is currently being validated in several laboratories.
Commonly tested drugs and shifts over time
Repertoire: Which drugs of abuse are most commonly tested for, and how have those patterns shifted over time?
Abbott: The most commonly tested drugs of abuse include Amphetamine, Benzodiazepine, Buprenorphine, Cocaine, MDMA, Methamphetamine, Opiates, Oxycodone, and THC/marijuana. Over time, there has been a noticeable shift towards testing for synthetic opioids like Fentanyl, reflecting the growing prevalence of these substances. Conversely, drugs such as Propoxyphene and Tricyclic antidepressants are less frequently requested by customers, indicating a shift in the patterns of drug abuse and testing priorities.
Evolution of technology in drug testing
Repertoire: How has the technology evolved over the last few years?
Abbott: Urine testing remains the gold standard in drug testing due to its reliability and the extensive range of FDA cleared and CLIA waived options available. However, oral fluid testing is emerging as a valuable alternative, particularly for its ease of use and recent advancements in detecting substances like THC. The adoption of oral fluid testing by the DOT further underscores its growing importance in the industry.
Primary customers and market segments
Repertoire: Who are your primary customers? Are your solutions used more in workplaces, healthcare settings, or law enforcement?
Abbott: Our primary customers in Clinical Toxicology include Physician Office Laboratories (POLs) such as Family Practice/General Practice, OB/Gyn, Pediatrics, Internal Medicine, Pain Management, Community Health Centers (CHCs), and Hospitals. Our solutions are utilized across various markets, including workplaces, healthcare settings, and law enforcement. We offer CLIA-waived products for clinical use, oral fluid tests for workplace screening, and Forensic Use Only (FUO) tests for law enforcement. We have seen increased adoption in all these markets as customers recognize the benefits of rapid results, which facilitate timely treatment and efficient workflow management by sending only preliminary positives or unexpected results for lab confirmation.
Challenges in the drug testing industry
Repertoire: What are the biggest challenges in the drug testing industry today?
Abbott: One of the biggest challenges in the drug testing industry is the rapid change in drug abuse trends, which necessitates continuous updates to testing panels. Additionally, obtaining FDA clearance and CLIA waivers for new testing solutions can be a lengthy and complex process, and often delay the availability of products needed to address emerging trends.
Future of substance misuse testing
Repertoire: What do you see as the future of substance misuse testing in terms of both technology and societal impact?
Abbott: The future of substance misuse testing will likely be shaped by advancements in technology and evolving societal needs. Legislation for medication monitoring aims to ensure patients adhere to their prescriptions and prevent diversion while employment testing will continue to play a crucial role in creating safe work environments by mitigating substance and alcohol abuse.
Questions for distributor reps
Repertoire: What questions can distributor reps ask their customers in order to better serve their needs in this area?
Abbott: Distributor reps can ask the following questions to better understand and serve their customers’ needs:
- Current Screening Practices: Are you currently conducting any drug screening? Are you collecting samples and sending them to a lab?
- Clinical Efficiency: Would you be interested in a solution that provides results in 5 minutes to improve patient treatment and workflow efficiency?
- Employment Efficiency: Would you like a solution that delivers results in 5 minutes, allowing you to rule out negatives for employee testing and send only preliminary positives to the lab for confirmation? This approach can significantly improve workflow efficiency by reducing the time spent tracking lab results.