Lawmakers Begin to Shape Battle Plan for Fight Against Opioids and Heroin

Andrew Kitchenman | October 18, 2013 | Health Care
Addiction experts recommend wide range of measures to try to reduce number of overdose deaths

Susan Foster, vice president and director of policy research and analysis of the National Center on Addiction and Substance Abuse (CASA) at Columbia University, testifies during hearings on how to deal with a rise in deaths from overdoses of heroin and prescription opioids.
New Jersey can take more steps to stem the toll on its residents caused by heroin and prescription opioid drugs, addiction experts told a Senate committee yesterday.

Their recommendations range from expanding what doctors are required to learn about addictions and conducting a public-awareness campaign to providing addiction treatment in jails and using technology to link primary care providers with addiction specialists.

The Senate Health, Human Services and Senior Citizens Committee held a hearing on the topic yesterday as the starting point for what committee Chairman Joseph Vitale (D-Middlesex) said would be a comprehensive effort to bolster prevention, treatment and recovery from opioid addiction.

The committee’s work is likely to lead to new legislation, since members of both parties – including Gov. Chris Christie – have expressed concern about the problem.

This concern has already led to a new lawintended to reduce the number of overdose deaths by protecting from prosecution those who report overdoses or administer a heroin overdose antidote.

The issue will also be the topic of a report scheduled to be published next month by a task force formed by the Governor’s Council on Alcoholism and Drug Abuse. This task force, which includes former Gov. James E. McGreevey, has been gathering testimony from experts and family members of people who died from overdoses.

Vitale laid out the stakes for committee yesterday, noting that more than 6,000 state residents have died from overdoses since 2005, including more than 700 in 2009 alone.

The senator also noted the connection between prescription opioid addiction and heroin use, since many who become addicted to the prescription drug turn to heroin due to its lower street value.

“A bag of heroin is cheaper than a box of cigarettes, cheaper than a six-pack of beer,” Vitale said.

Sen. Robert W. Singer (R-Monmouth and Ocean) said that while more Ocean County residents died from overdoses in the past year than dolphins died along the county’s shoreline, the dolphins’ deaths drew more concern from the public.

Singer called for more funding for addiction treatment, including more money from insurance companies. He also called for requiring doctors to participate in the state’s Prescription Monitoring Program (PMP), which tracks prescriptions of controlled dangerous substances to patients.

“We have to continue working – this is a nonstop type of issue,” Singer said.

Sen. Diane Allen (R-Burlington) added her concern. She said she has had two friends in their 60s who died from overdoses.

“We have people who have some issues and they start to self-medicate and they don’t know … and their doctors maybe aren’t maybe overseeing it appropriately,” Allen said.

This policy debate is occurring at a time when medical science has found a variety of ways to prevent and treat addiction, but a gap has grown between that knowledge and public policy, according to Susan Foster, vice president and director of policy research and analysis of the National Center on Addiction and Substance Abuse (CASA) at Columbia University.

“We are struggling to quickly integrate a large and growing body of science into practice,” Foster said.

Foster called for treating addiction much like other medical conditions, with a focus on treating addiction rather than reducing the use of any specific addictive substance. The longstanding approach of looking at different substances as separate problems amounts to a game of “whack a mole,” in which reducing addictions of one substance leads to patients becoming addicted to other substances.

CASA estimates that only 3 percent of state spending related to the addiction problem goes to prevention and treatment, while 97 percent “goes to shovel-up after the fact, in our prisons, our jails, our healthcare, programs, schools, assistance programs, even the workforce,” she said.

Researchers have identified risk factors for addiction, including the first use of a potentially addictive substance at an early age, Foster said.

“The earlier teens use any substance – opioids, nicotine, alcohol, other drugs – the greater the likelihood that they will develop addiction to that initial substance or to any substance,” she said.

Of those in need of addiction treatment, only 11 percent receive it, while less than 6 percent of referrals to treatment come from healthcare providers, Foster said, adding that these numbers show a failure to identify risky behavior.

Foster said addiction treatment providers should be required to meet professional standards and that treatment should be connected with mainstream medical practices.

“There’s simply no other disease where appropriate care is not provided by the medical profession,” she said.

CASA officials recommend that states increase screening to prevent and treat addiction early and make treatment funding conditional on providers following appropriate treatment practices.

“What we all need now is the will to act,” she said.

Dr. Louis Baxter of the West Windsor-based Professional Assistance Program of New Jersey said it is important to provide more education about addictions to doctors, parents and children.

Baxter said addiction still isn’t treated the same as other chronic illnesses. He contrasted the administration of methadone to an overdose victim with the administration of insulin to a diabetic patient.

While a person who has overdosed will simply be released from the hospital, a diabetic patient will receive a full range of education and treatment to help them manage their condition. A person with an addiction should be treated the same way, he said, with detoxification seen as only the first step in treatment.

Treatment should also include rehabilitation counseling, ongoing medical and mental-health follow-up and therapy using medication, Baxter said. He also called on the state to drop the requirement that patients with addictions receive prior authorization in order to receive insurance payments for treatment. He said many children have died while awaiting authorization over a weekend.

Baxter decried the lack of long-term treatment facilities in the state, as well as the tendency to allow patients with addictions to return to the same environment that contributed to their addiction.

New Jersey primary care providers can improve their treatment of addiction by using technology to connect with specialists, according to Dr. Daren Anderson, vice president and chief quality officer for the Middletown, Connecticut,-based Community Health Center Inc.

Anderson’s organization, which is a federally qualified health center, has made use of “eConsults” – email communication between primary-care providers and specialists that has dramatically reduced the number of patient visits to specialists. It has also used Project ECHO (Extension for Community Healthcare Outcomes), a New Mexico-based program that uses video links between addiction specialists and primary-care providers to improve treatment practices through weekly sessions.

Steven Rosenberg, president of Community Oriented Correctional Health Services, called for addiction treatment for people who incarcerated. He said this is a weak link in treatment.

Vitale said the wealth of ideas raised during the meeting demonstrated that the committee should take a comprehensive approach to the issue of addiction.