The AMA Opioid Task Force 2020 Report Should Come as No Surprise to Those Who Follow the Data

Jeffrey A. Singer

The American Medical Association recently released it Opioid Task Force 2020 Report. The Task Force found there was a 37.1 percent decrease in opioid prescriptions between 2014 and 2019; a 64.4 percent increase in the use of state prescription drug monitoring programs (PDMPs) in the last year (739 million queries in 2019); and hundreds of thousands of physicians accessing continuing medical education courses on opioid prescribing (now mandatory in some states). However, the report states:

Despite these efforts, illicitly manufactured fentanyl, fentanyl analogues and stimulants (e.g. methamphetamine, cocaine) are now killing more Americans than ever. The use of these illicit drugs has surged and their overdose rate increased by 10.1% and 10.8%, respectively.

This should come as no surprise. The government’s own data show no correlation between opioid prescription volume and past month nonmedical use of prescription opioids by persons age 12 an up. Nor does it find a correlation between prescription volume and past year diagnosis with prescription opioid use disorder in person age 12 and up.

The Task Force walks up to but doesn’t cross over the line to abandon the false narrative that the overdose crisis was caused by doctors “overprescribing” pain medication to their patients. Yet researchers at the University of Pittsburgh reported in 2018 that overdoses from the nonmedical use of licit and illicit drugs have been increasing steadily and exponentially since at least the late 1970s (well before the invention of OxyContin in 1996), with different drugs dominating the fatality statistics during different periods.

In the end, the fact remains that drug prohibition caused the overdose crisis. A growing population of nonmedical users of licit and illicit drugs are accessing increasingly dangerous drugs provided by the black market fueled by prohibition. The emphasis on prescription opioids only makes patients needlessly suffer and drives nonmedical users away from “diverted” prescription opioids and towards heroin and fentanyl.

The Task Force continues to support efforts to reduce opioid prescribing as well as developing alternative forms of pain management. But it also tacitly recognizes the role of drug prohibition. Its recommendations place a heavy emphasis on harm reduction. The task force urges stakeholders to

Support increased efforts to expand sterile needle and syringe services programs as well as reforms in the civil and criminal justice system that help ensure access to high quality, evidence‐​based care for opioid use disorder, including medication‐ assisted treatment.

Hopefully, as respected organizations such as the AMA and the National Academy of Science, Engineering, and Medicine place more emphasis on harm reduction and less on drug supply and interdiction, policymakers will finally get the message. It is time to end the assault on pain patients and the doctors trying to treat them—not to mention the assault on everyone’s civil liberties—by ending the war on drugs.