AMA adopts new public health policies to improve health of nation

The American Medical Association (AMA) gathered physician and medical student leaders from all corners of medicine at its Interim Meeting of the House of Delegates to shape guiding policies on emerging health care topics.

The new policies adopted on the final day of voting at the AMA Interim Meeting include advocating for funding to support school-based mental health, removing barriers to improve access to opioid use disorder medications, improving health care for veterans, and protecting health care professionals from ionizing radiation. 

With school-based mental health grants being discontinued, the AMA House of Delegates called for sustained and stable funding to prevent disruptions in student care. 

Earlier this year, the U.S. Education Department announced it would not continue funding many of the mental health grants beyond the current budget period, effectively rescinding the future funding for about $1 billion worth of awards. The grants were intended for training and placing school-based mental health professionals in K–12 settings. 

The AMA will support federal legislation incorporating automatic continuity protection and retention of school-based mental health professionals, with priority given to rural and underserved communities. 

“The decision to end these grants will disproportionately impact rural and underserved districts, disrupting continuity of care, decreasing access to mental health care for our children, and destabilizing the workforce pipeline for counselors, psychologists, social workers, and physicians engaged in school-based health services in the middle of a mental health crisis,” said Dr. Melissa Garretson, a member of the AMA Board of Trustees. 

The American Medical Association will advocate at the state and federal level to remove “red flag” or suspicious order designations for ordering FDA-approved products in treating opioid use disorder (OUD).

The AMA has heard reports that patients with OUD have struggled to have prescriptions for buprenorphine products dispensed at pharmacies. Some pharmacies are not increasing their orders for fear of triggering suspicious order reports and subjecting them to DEA scrutiny. 

Buprenorphine is a clinically effective treatment for OUD, and patient access to this treatment is vital to fight the ongoing illicitly manufactured fentanyl-driven overdose and death epidemic. Buprenorphine diversion is not commonplace and mainly occurs because individuals with an OUD cannot readily access treatment. With the help of buprenorphine, drug overdose deaths have dropped from over 100,000 a year to 75,000 now, though still too high and reflect the need for continued use of many approaches to this epidemic.

“Access to these buprenorphine products will remain a struggle across the country as long as FDA approved products are included in suspicious order designations,” said AMA President Bobby Mukkamala, M.D. “It is beyond comprehension that at a time when we all have worked so hard to remove barriers to treatments that yet another barrier would rear up and put patients’ lives in jeopardy.”

The House-passed resolution also called for the AMA to advocate to remove all barriers to medications for opioid use disorder, including prior authorization, fail-first and step-therapy policies. 

Research consistently shows that veterans experience mental health disorders, substance use disorders, post-traumatic stress, traumatic brain injury, and other health conditions at disproportionately higher rates than their civilian counterparts. Additionally, veterans receiving care from the Department of Veterans Affairs (VA) are more likely to be diagnosed with post-traumatic stress disorder (PTSD) than those who seek community health services, in part because the VA screens all veteran patients for PTSD.

To help ensure veterans receive the comprehensive, informed care they deserve, the AMA adopted new policy aimed at enhancing clinical care related to military service.

Under the new policy, the AMA will advocate for legislation, as well as regulatory action, encouraging health care systems to develop and implement standardized protocols for identifying patients with a history of military service. The standardized protocols will help document military service history – including deployment locations and occupational exposures – to help improve care for veterans.  

“We know that when military service is included as part of a patient’s health history, it can lead to improved diagnosis and treatment, as well as better opportunities for accessing earned benefits. We have a responsibility to make sure the health care workforce has the information and tools needed to better understand and address the unique health needs of our veterans, and to provide them with the highest standard of care,” said AMA Board Member Sandra Adamson Fryhofer, MD.   

In addition, the AMA will advocate for developing evidence-based clinical guidelines for health conditions prevalent among veterans. The policy also calls for collaboration with medical education accrediting bodies to encourage medical schools, residency programs, and continuing medical education providers to incorporate training on veteran-specific conditions, occupational exposure assessment, and screening protocols into their curricula.

As the use of imaging and interventional procedures that rely on ionizing radiation continues to grow, the AMA adopted new policy to strengthen protections for health care professionals and trainees who may face occupational exposure.

Data suggests that health care professionals exposed to ionizing radiation can experience an increased risk of cancer, cardiovascular disease, reproductive health effects, and cataracts. The use of protective measures, however, significantly reduces these risks. The new policy supports the use of well-fitting PPE that covers all body types, genders, and pregnancy statuses, as well as the use of dosimetry badges for health care personnel and trainees who work in settings where radiation exposure is possible. 

Additionally, the new policy urges continued research into the health effects of low-level and very-low- level exposure to ionizing radiation; the effectiveness of PPE and administrative and engineering controls designed to reduce exposure; and barriers that prevent PPE use and ways to improve it. The policy also calls for educating all health care personnel and trainees—tailored to specific exposure risk – on how to limit radiation exposure for themselves and their patients. The policy also encourages medical specialty societies to establish education and training standards in this area.

“Taking steps to help more health care professionals better limit their exposure to ionizing radiation will go a long way toward reducing or avoiding potentially harmful, long-lasting health effects,” said AMA Board Member Sandra Adamson Fryhofer, MD.

The Council on Science and Public Health report underpinning the new policy provides a review of the health risks associated with low-dose radiation exposure, effectiveness of PPE use, and the current regulations and guidance related to ionizing radiation exposure.