The number of opioid-related deaths in New Jersey is on pace to reach or exceed 3,000 by the end of the year, which would represent an increase of a third over 2016, despite efforts by health, treatment and law-enforcement officials to battle the epidemic.
A significant decline in opioid prescriptions has so far not stopped the accelerating number of deaths due to heroin, fentanyl and other opioids, the latest data from the state Attorney General’sshows. Through June 17, 1,394 New Jerseyans had died of opioid overdoses, compared with 2,221 for all of 2016. Data for 2017 are not yet available. Angelo Valente, executive director of the Partnership for a Drug-Free New Jersey, said that the rising abuse of fentanyl, a pain reliever that is also made synthetically, has contributed to the increase in deaths. Many experts agree fentanyl — which is many times stronger then heroin and is sometimes mixed in with other opioids without the users’ knowledge — is a major factor in the increase in overdose deaths.
“The fact is that in many of these cases, fentanyl plays a major role,” he said. “That’s something we did not have in previous years.”
“Overall, I would say I’m pretty concerned about the current state of the opioid problem in New Jersey,” said Health Commissioner Dr. Shereef Elnahal. So the state is retooling its efforts to tackle this public health problem, “focusing on a much more comprehensive approach” to meet the challenge at every opportunity — from a person’s initial contact with an opioid through treatment and the criminal justice system.
The prior administration focused more on outreach and awareness, Elnahal said, and “unfortunately most of the resources went to things like television ads and did not get to the front lines.” Former Gov. Chris Christie issued an executive order in January 2017 declaring opioid abuse and addiction “a public health crisis” and creating a task force to develop and execute a comprehensive strategy to combat the epidemic.
Elnahal said the $100 million Gov. Phil Murphy is seeking to spend would fund “a more holistic approach” that would involve multiple state departments working together on the problem and that they have put together a roadmap for tackling opioids.
One positive sign is that the number of prescriptions issued for opioids continues to decline. State data show that almost 2 million prescriptions had been written in New Jersey through June 12, which is on a pace to be about 9 percent fewer than last year and 21 percent below the 5.6 million written in 2015. Last year, Christie enacted a new limit on initial opioid prescriptions to a supply of five days and a requirement that doctors must tell parents about the addictive risks of opioids when prescribing to minors. Elnahal called the drop in prescriptions “really promising.”
He also praised new programs like ALTO, the Alternatives to Opiates Program, at St. Joseph’s University Medical Center that treat patients when possible with alternative pain-relief measures, including nonopioid medications, trigger-point injections, nitrous oxide and ultrasound guided nerve blocks.
Valente said that despite the continuing rise in opioid deaths, the state has made “real progress” over the last several years in a number of areas, including the decline in prescription rates and an increase in awareness of the problem. “We hear from doctors all the time that patients are coming in and asking if opioids are necessary,” he said.
A few places, most notably Ocean County, have started to get ahead of the problem. Considered an epicenter of the initial crisis, Ocean is on pace for the greatest decline in opioid-related deaths among New Jersey counties this year. There have been 86 opioid deaths in Ocean through June 17, while there were 253 in 2016.
“We have put in a ton of great programs, the biggest of which is Blue Heart,” said Al Della Fave, a spokesman for Ocean County Prosecutor Joseph Coronato. Blue Heart is a program that allows a person to go to any of seven police departments, turn in any drugs and get into treatment, even without insurance coverage. “It’s been fine-tuned so we can track every person. If they fall out, we find out and can get them back in.”
The county is also aggressively pursuing strict liability drug-induced death charges against those who sell drugs to someone who dies as a result.
“We are sending a message to dealers, ‘You can’t deal in Ocean County,’” Della Fave said.
Other counties are seeing huge increases in opioid deaths. Both Cumberland and Mercer counties have already had more people die of overdoses this year than in all of 2016. Cumberland has had 57 deaths through June 17, compared with 53 in 2016, while Mercer has had 83 deaths, already 24 more than the 59 it had in 2016.
Valente said the state needs to continue to make a “full court press” both in continuing to increase awareness of the problem, including a push for education in the elementary grades, as well as making greater efforts at treatment and providing more support for families, including the use of “recovery coaches” to serve as advocates for those who are in recovery and their families.
Roseanne Scotti, New Jersey state director of the Drug Policy Alliance, suggested the state take a number of additional steps to cut down on deaths.
“One of the most effective things we could do would be to ensure that many more people have access to the Medication Assisted Treatments buprenorphine and methadone,” Scotti said. “There should be treatment on request when people want to get on to these medications and anyone who overdoses should be offered methadone or buprenorphine.”
While naloxone, a medicine that can rapidly reverse an opioid overdose, has become commonplace among police and emergency responders, it should become even more commonplace among the public, Scotti said. NJCares shows that naloxone had been administered nearly 4,000 times through April 15.
“We also need to get more naloxone into the hands of ‘first responders’ and by first responders I mean people who use opioids,” she said. “People usually use opioids with others who also use. It is great that New Jersey has made such an effort to make sure police, EMTs and families have access to naloxone but most people aren’t with the police, EMTs or their family when they overdose. They are with other people who use opioids and we haven’t done enough to make sure that people who use opioids can easily get naloxone.”