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State Lawmaker Calls for Nation's First Opioid Warning Labels

Warnings would highlight the significant potential for addiction and overdose associated with these drugs

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New Jersey could be the first state in the nation to require warning stickers on opioid prescriptions, according to legislation proposed by a new state lawmaker eager to reduce the impact of the state's epidemic of drug addiction.

Assemblyman John Armato (D-Atlantic), who was sworn in last month, introduced a bill last week that would require pharmacists to affix a label to all opioid medications to highlight the significant potential for addiction and overdose. The measure would build on existing Garden State regulations that are among the country's most restrictive when it comes to the distribution of so-called Schedule II prescriptions.

John Armato
John Armato

Armato, a township committeeman in Buena Vista, serves on the Atlantic County Opioid Task Force, recently become a certified recovery coach - a trained individual who can help guide an overdose victim toward treatment - and he runs a monthly meeting for co-dependents, or friends and family members who are essentially addicted to the chaos associated with a loved one's substance-use disorder.

"We have warning labels on just about all medications these days," Armato said. "In the middle of this epidemic, we need to utilize every tool in our arsenal to increase awareness and education about the effects of opioid abuse. Adding a warning sticker to all opioid medications is an easy, cost-effective way that can save lives."

Gateway drug

In addition to their own addictive risks, certain studies have shown opioid-based painkillers can lead some users to turn to illegal drugs, which are often less expensive; nearly eight out of 10 heroin users first got hooked on prescription drugs, according to the National Institute on Drug Abuse. In New Jersey, tens of thousands of residents have sought treatment annually in recent years and more than 2,000 lost their lives to addiction in 2017.

New Jersey already has some of the country's most aggressive restrictions on opioid medications, a trend that has raised concerns among some physicians and advocates for pain patients.

Under former Gov. Chris Christie, a Republican, the state instituted an initial five-day limit - the nation's strictest - on new, acute-pain prescriptions for these drugs. Christie also created and refined the state's prescription drug database, which allows prescribers and pharmacists to track patient attempts to get opiates, and now connects with systems in more than a dozen other states.

State-based efforts

Data from the federal Centers for Disease Control and Prevention suggest state-based efforts to better control the distribution of these drugs have had an impact, according to a report issued in July. But while fewer prescriptions are being written, physicians are now recommending higher doses for their patients. (Results for New Jersey showed a wide range of use patterns.)

While the federal Food and Drug Administration regulates drug labeling, Armato said states are permitted to require additional warning stickers, although this is yet to happen for opioids. Pharmacies frequently affix brightly colored pre-printed stickers - such as "For External Use Only" or "Take With Food" - to remind patients how and when to take their medications.

Armato's proposal (A-3292), which has not been posted publicly, will be co-sponsored by his district mate, Assemblyman Vincent Mazzeo (D-Atlantic). It would require the director of the Division of Consumer Affairs, which oversees the prescription database, to work with staff at the Department of Health to come up with the specific language for the warning.

At a minimum, the legislation calls for a red sticker with white text that clearly indicates the medication is an opioid and that such drugs carry a risk of addiction and overdose. It would be the pharmacists' responsibility to add the warning sticker to pill bottles or other containers.

"In 2018 in New Jersey, it's sadly an oddity to know someone who hasn't in some way been touched by the ongoing epidemic," Armato said. "I look forward to working with all doctors, nurses, pharmacists, recovery groups, and all stakeholders to pass this important piece of legislation."

The new lawmaker has also joined colleagues to sponsor legislation to require an individual to present identification when picking up an opioid prescription from a pharmacy and to fund the construction of sober-living facilities. He has also introduced a bill to establish an electronic monitoring system, linked to the state's prescription database, for the pain-management contracts signed by doctors and their patients.

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