New psychoactive substances – or NPS - mimic the effects of a wide range of substances, including prescription opioids, cannabinoids, stimulants, hallucinogens, and central nervous system depressants. NPS are sold as “legal highs” and alternatives to established drugs of abuse. NPS have been increasingly associated with hospital emergencies, acute adverse health consequences, and drug-induced death.
“Although Congress passed AMA-supported legislation in 2012 that placed 26 synthetic drugs in Schedule 1 under the Controlled Substances Act (CSA), drug traffickers have devised ways to circumvent federal drug laws by slightly altering the chemical structure of their products and designing new synthetic drugs,” said Patrice A. Harris, M.D., chair of the AMA Board of Trustees and the AMA Task Force on Opioid Abuse. “These new products are currently unregulated and are frequently marketed to young people as innocent products like “bath salts,” plant food, or incense. They also include variations of the extremely dangerous opioid fentanyl, which has been wreaking havoc across the country and resulting in a sharp increase in drug overdoses and deaths due to such overdoses.”
Delegates at the AMA Annual Meeting voted to support multifaceted, collaborative multiagency approach to combat NPS. Delegates also supported increased NPS surveillance and early warning systems for more actionable information that can quickly aid law enforcement, public health officials, emergency physicians, and vulnerable populations in mitigating the growing NPS problem.
Public health approaches have been used to successfully address outbreaks of NPS overdoses. When such approaches have been successful, pre-existing coordinated relationships among multiple stakeholders have allowed for a rapid and comprehensive response to a given outbreak.
In addition to the newly adopted policies for eliminating the NPS threat, the AMA is also supporting the “Synthetic Drug Control Act of 2017” (H.R. 1732) that would require the Attorney General of the United States to assign Schedule I classification to approximately 250 dangerous new synthetic substances identified by the Drug Enforcement Administration since 2012.
In an effort to consider promising strategies that could reduce the health and societal problems associated with injection drug use, the AMA today voted to support the development of pilot facilities where people who use intravenous drugs can inject self-provided drugs under medical supervision.
Studies from other countries have shown that supervised injection facilities reduce the number of overdose deaths, reduce transmission rates of infectious disease, and increase the number of individuals initiating treatment for substance use disorders without increasing drug trafficking or crime in the areas where the facilities are located.
“State and local governments around the nation are currently involved in exploratory efforts to create supervised injection facilities to help reduce public health and societal impacts of illegal drug use,” said Dr. Harris.“Pilot facilities will help inform U.S . policymakers on the feasibility, effectiveness and legal aspects of supervised injection facilities in reducing harms and health care costs associated with injection drug use.”
The examination of this issue by physicians at the AMA Annual Meeting was greatly assisted by the Massachusetts Medical Society and its recently completed comprehensive study of the literature associated with supervised injection facilities.