Ex-Governor: Doctors, Pharmacists Must Commit to Prescription Monitoring

Andrew Kitchenman | September 13, 2013 | Health Care
McGreevey says life-saving information is online, but medical professionals turn to it far too infrequently

Former Gov. James E. McGreevey (right) with Thomas Calcagni, state’s first Assistant Attorney General
Former Gov. James E. McGreevey is taking on doctors in his new role as advocate for incarcerated and recently released women, arguing vehemently that not enough physicians check a statewide database before prescribing opiates, facilitating drug abuse and addiction.

“It is critical that every physician participate” in the state Prescription Monitoring Program, or PMP, McGreevey said as part of his work on a task force examining heroin and other opiate use by young people in New Jersey. The PMP records every time a participating doctor or pharmacy prescribes or dispenses a controlled dangerous substance. Participation is voluntary and only 15 percent of prescribing doctors and advanced practice nurses check the database to see if a patient has been overprescribed medication.

“These drugs are healing only insofar as they’re used appropriately, but they’re also deadening,” McGreevey said of opioids.

McGreevey said that while many doctors prescribe appropriately, participation should be mandatory “to stem this crisis” of prescription abuse.

McGreevey’s position was immediately supported by Thomas Calcagni, the state’s first assistant attorney general and a member of the task force, which was formed by the Governor’s Council on Alcoholism and Drug Abuse.

Task force members spoke at the council’s annual summit in New Brunswick. The group is scheduled to release a set of recommendations to the governor’s council in November.

“Think of what kind of tool that can be for healthcare practitioners and law enforcement,” Calcagni said of the PMP. He noted that law enforcement could check to see which doctors are prescribing more dangerous drugs than the state average, and whether those prescription patterns are in line with their medical specialty.

“The system is only as good as the number of people using it,” he said. “I support mandating access and registration for the PMP.”

While state officials are exploring whether doctors and APNs can be required to register for the PMP, it may take a new state law to make them search the database before issuing prescriptions.

Calcagni said the administration’s approach to drug abuse should be “enlightened,” moving away from focusing on arrests toward saving lives.

McGreevey said he was “lobbying” for mandatory PMP registration and access, noting that there was a debate about the issue within the task force. He acknowledged that requiring prescribers to use the PMP would be an additional burden for doctors and APNs.

“There is a growing consensus that we need to move from voluntary to mandatory compliance,” he said.

The Medical Society of New Jersey, the state’s largest doctors’ organization, is working with the attorney general’s office to make it easier for prescribers to use the PMP, according to Mishael Azam, the organization’s senior manager of legislative affairs. She did not say whether the organization opposes mandatory PMP participation and searches.

The former governor’s emphasis on the PMP echoed a report released by the State Commission on Investigation that focused on several doctors in the state who wrongly prescribed dangerous drugs.

McGreevey also called for increasing the addiction treatment provided in county jails. He works as a spiritual counselor to female inmates at Hudson County Correctional Center as an associate of Integrity House, an addiction and recovery service provider.

“For many of the young men and young women, whether it’s by virtue of prescription drug abuse or heroin, opiates, jail may be the first time they are out their bad normative behavior and we have an opportunity for treatment,” McGreevey said.

He would like to see a drug abuse treatment program similar to the one offered by Integrity House in Hudson County in every county in the state. Integrity House provides individual counseling to inmates both before and after they are released, as well as a variety of group therapy sessions, including groups that focus on anger management; domestic violence and trauma; grief and loss; and preventing substance abuse relapses. McGreevey said the program has contributed to a low rate of recidivism among participants.

McGreevey credited Gov. Chris Christie with confronting opioid use “in a very transparent and open way.”

Calcagni said the state is making progress on addiction-related issues, including the recent passage of the Opioid Antidote and Overdose Prevention Act, which grants immunity to those who call for help for those who have overdosed, as well as for those who provide an antidote for opioid overdoses.

Frank Greenagel, chairman of the task force, said the recommendations would be far ranging, affecting organizations that provide medical care, addiction treatment and prevention efforts, and education. He noted that the number of New Jersey residents who die from drug overdoses has surpassed the number of fatalities from car crashes and gunshots.

In 2009, there were 752 deaths from overdoses in New Jersey, according to the Drug Policy Alliance. That compares with 583 deaths from car crashes and 220 deaths from gun violence. More recent statistics weren’t available.

“If you’re wondering and skeptical when we say this is a public crisis, that this is a national epidemic, that we have a horrific problem here in the state of New Jersey, that statistic bears that out,” Greenagel said.

Task force member Debra L. Wentz, chief executive officer of the New Jersey Association of Mental Health and Addiction Agencies, added that a false distinction has been made about the safety of prescription drugs and street drugs.

“The reality is there is no safe drug, whenever it’s not taken under the supervision of a doctor.” she said.

In response to a question about why members joined the task force, McGreevey said it was a matter of his faith, adding that he was inspired by the Hudson County inmates who are in recovery.

“In my own life, when I’ve had to make decisions and confront the chaos of my own life, I find great strength with the women I work with every day,” McGreevey said.

He added that the inmates need help from treatment and medical professionals, as well as spiritual support. “It’s understanding that addiction is a disease, and that if we’re going to move through and pass this disease, we need to have an open and honest conversation and people ought not be stigmatized, but they need to be welcomed and loved into the fullness of our community.”