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Trying to Get Doctors to Think Twice Before Prescribing Opioids to Minors

New Jersey has been particularly hard-hit by opioid addiction. Now there’s a move to make doctors discuss risks with parents before prescribing controlled substance to kids

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Support appears to be building for a measure designed to reduce the flow of prescription painkillers to young patients, while also decreasing the potential for illicit diversion of these addictive substances.

The proposal is backed by a growing number of lawmakers and drug policy advocates, but has raised questions for some medical providers — including a key Assembly leader who is also a doctor.

The Assembly health committee is now scheduled to vote Monday on the bill, (A-3424), to require doctors to discuss the addiction risks with the parents or guardians of patients under age 18, before writing any prescription for a controlled substance to a minor. The measure would also require healthcare providers to get ongoing education in opiate use and addiction.

The proposal — championed by Senate Majority Leader Loretta Weinberg, (D-Bergen) and Sen. Joseph Vitale, (D-Middlesex), who chairs that chamber’s health committee — passed the full Senate in October with strong, bipartisan support, but has yet to receive a hearing in the Assembly.

That’s because Assemblyman Herb Conaway, (D-Gloucester), a physician who chairs the health committee and an outspoken critic of the bill, had declined to post it for a vote. Conaway has said the bill amounts to yet another government mandate that interferes with the sanctity of the doctor-patient relationship. But the measure, led by Assemblyman Joseph Lagana (D-Passaic), has attracted growing support with some 20 Assembly sponsors signing on in the past two months.

If approved, it would be the latest addition to a growing toolbox New Jersey is assembling to curb the flow of opioid medications, which are often diverted for illegal use or sale; assist those with drug addictions to get help; and reduce the harm to users who cannot escape the disease.

Under Gov. Chris Christie, officials have strengthened a multi-state database to help prescribers screen out patients who are “doctor shopping”; expanded treatment options for those arrested for non-violent drug offenses; and built a coordinated hotline to better connect those in need with services, among other efforts. (The hotline number is 1-844-276-2777 and professional help is available 24 hours a day, seven days a week.)

According to the first-ever U.S. Surgeon General’s report on addiction, issued recently, substance abuse disorders will impact one in seven Americans in their lifetime — nearly 15 percent of our population — and only one in ten will likely get the treatment they need. More than 30,000 died of heroin or prescription pill overdoses in 2014 alone, the report found. New Jersey has been particularly hard hit, data suggests: some 28,000 people sought treatment in 2015 and more than 1,200 were lost to overdoses, according to federal officials.

Surgeon General Dr. Vivek H. Murthy’s report outlined a broad spectrum of strategies to address this challenge and outlined the science behind the disease of addiction, underscoring that it is not the result of any personal failings. But he has also stressed the role healthcare professionals must play in any drug policy reform, launching a national campaign in August that included an unprecedented personal appeal to America’s 2.3 million physicians to rethink how they dispense opiates. The outreach included a pocket guide on smart prescribing and other tools designed to help doctors make the safest, most effective choices for their patients.

Sponsors of the New Jersey proposal have sought a similar approach to protecting patients. The measure is designed to help doctors understand the risks associated with these addictive medicines, by ensuring opiate-prescription training is part of the continuing education requirements for providers. (Earlier this year, the federal Centers for Disease Control and Prevention also updated its prescribing guide to reduce the potential for addictions.)

"As we continue to face the challenging opioid crisis, equipping our health care professionals with the right knowledge and tools through ongoing training is critical to success," Vitale said after the Senate vote.

The legislation requires doctors who are considering prescribing a controlled substance to a minor to talk with their parents or guardians about the addiction risks associated with that drug and, if appropriate, discuss less addictive options. Prescribers must then have the family sign a form acknowledging the conversation, which is to be kept in the patient’s file.

A previous version of the bill, approved last year by the Senate but not considered in the Assembly, would have required doctors to discuss less addictive options with all patient regardless of age. Supporters agreed to the compromise legislation that covers only minors because the potential for addiction is greatest in children. Some research has suggested that youngsters prescribed opiates are one-third more likely to become addicted in the future, due to the impact the powerful drugs have on their developing brains.

Given the danger of misuse and abuse, Weinberg agreed: "Health care providers must be a part of minimizing the potential for misuse through their own ongoing education, and this bill addresses that need."

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