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American Medical Association calls on Maryland and other states to act on increase in opioid overdoses

The American Medical Association is calling on Maryland and Gov. Larry Hogan to take further steps to address opioid overdoses after statistics released earlier this year show they’re on the rise again compared with last year.

The association called on Maryland and 40 other states to address rising opioid overdose numbers during the COVID-19 pandemic, writing in a news release that the majority of the country is reporting “increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder.”

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The AMA is greatly concerned by an increasing number of reports from national, state and local media suggesting increases in opioid-related mortality — particularly from illicitly manufactured fentanyl and fentanyl analogs,” the association wrote in a release.

The AMA called on governors and states to address barriers to telehealth, remove quantity restrictions on opioid prescriptions and implement so-called further harm reduction tactics, such as clean needle exchange programs, among other recommendations published last week.

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In June, the state reported that 561 people had died due to opioids in January, February and March, a 2.6% increase over the same period last year.

While there is an increase in fatal overdoses, the most commonly used drug in those deaths was still fentanyl, a powerful synthetic opioid that has been increasingly sold as part of heroin drug trade in Baltimore and across the country in recent years.

The Hogan administration already has implemented some of the association’s call to action since the beginning of the pandemic, for example, removing barriers for private health providers to deliver more health care services over the phone or via videoconference — known as telehealth.

The state’s Behavioral Health Administration has been looking to address issues providers are having with telehealth and retaining clients. For example, an online survey administered May 26 through June 5 by the state found that 75% of opioid treatment providers who responded said that clients’ lack of access to telehealth was a key reason some patients have been keeping their appointments less often.

Steve Schuh, the executive director of the State’s Opioid Operational Command Center, wrote in a statement that the state is looking into one of the AMA’s recommendations, which calls for increasing access to overdose-reversing drugs such as naloxone as well as dependency treatment drugs like methadone and buprenorphine.

“Maryland is examining the benefits and challenges of increased flexibility for buprenorphine induction and dosing and extended take-home doses of methadone provided through licensed opioid treatment providers,” Schuh wrote.

“The state sees value in increasing the availability of these important medication assisted treatments for stable patients, and the Opioid Operational Command Center and our partners are reviewing the feasibility of continuing to provided expanded access in Maryland on a long-term basis,” he continued.

Gene Ransom, the CEO of MedChi, The Maryland State Medical Society, said Maryland has taken some actions. However, he added, there are still some issues the state could address in its harm-reduction strategy and that state insurance providers are not providing uniform coverage for certain procedures performed over telehealth.

For example, CareFirst BlueCross BlueShield, the state’s largest health insurer, is not reimbursing some medical and mental health providers for appointments heard over the phone or on audio-only platforms.

Ransom said the insurer, which serves more than 3 million members, is not paying for telehealth for certain specialties, such as cardiology. He added that MedChi has been in contact with them over the issue.

The state doctors organization is still reviewing the AMA’s list of recommendations and plans to produce its own memo, he said.

Unlike some neighboring states, Maryland also does not have a statewide clean needle exchange program, leaving municipalities and counties to work with the state Health Department if that jurisdiction’s leadership decides to implement one.

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The AMA is concerned such programs will be defunded as states attempt to make their economic recoveries in the years to come. In its recommendations, the AMA wrote that federal agencies “are [providing] new funding for emergency grants, grant funding to support sterile needle and syringe exchange can help protect public health, reduce the spread of blood-borne infectious disease and encourage those with an opioid use disorder to enter treatment.”

Baltimore City’s clean-needle exchange program has reduced its hours during the pandemic, but officials have yet to say whether permanent cuts will be considered when the city works on its budget.

“I think one of the concerns that we do have .... because the biggest one is in Baltimore City ... is will the funding crisis that’s occurring cause cuts to programs like that,” Ransom said.

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