Bills Targeting Overdoses from Heroin and Opioids Go Far Beyond ‘Just Say No’

Andrew Kitchenman | September 18, 2014 | Health Care
Legislative package would require behavioral-health insurance coverage, mandate participation in prescription-tracking program

Joseph Vitale, Loretta Weinberg and other legislators and advocates announce bills intended to reduce overdose deaths.
A rising tide of deaths from heroin and prescription-drug overdoses has prompted legislators to introduce a wide-ranging package of bills designed to revamp the way the state treats and tries to prevent drug addiction and abuse.

The widespread sense that heroin and prescription opioid addiction is spiraling out of control in all corners of New Jersey has attracted the attention of legislative leaders from both parties.

In addition, Gov, Chris Christie has already worked with the Legislature on related bills, including legislation expanding access to drug courts for nonviolent offenders and the Overdose Protection Act, which provides legal immunity to people who report overdoses and allows the administration of the heroin antidote naloxone.

The 21-bill package includes proposals to require health-insurance plans to cover behavioral healthcare services when a healthcare provider deems it medically necessary; to increase Medicaid reimbursements for some behavioral healthcare; and to require doctors and other prescribers to participate in the state program monitoring opioid prescriptions.

Several of the bills have drawn sponsors from both parties. Senate Health, Human Services and Senior Citizens Committee Chairman Joseph F. Vitale (D-Middlesex), who has focused on the opioids issue over the past 18 months, said the Christie administration has expressed interest in the proposals.

But some healthcare providers have said the legislation’s goals can be achieved without adding more mandates.

In addition, at a time of persistent state budget shortfalls, the cost is expected to be “tens of millions” of dollars, Vitale said. That means fiscal realities would make it difficult to implement some of the legislation before the next budget year begins in July 2015.

Vitale said there is still a stigma attached to addiction and mental illness. Addiction “is a chronic, lifelong disease like any other disease,” Vitale said, and should be treated the same way.

“When someone suffers from heart disease or cancer or diabetes, they aren’t told that there isn’t a hospital bed or an outpatient facility,” Vitale said. “We talk freely and openly about our surgeries, our hip replacements, our knee replacements and we even show off our scars. But rarely if we ever openly discuss an addiction or mental illness.”

Vitale noted that the bills emphasize prevention and treatment strategies that have been proven to work, rather than the old approach relying on platitudes like “Just say no.”

Vitale said the current Medicaid reimbursement rate is “embarrassing” and prevents providers from helping people with addictions.

He also noted that the requirement of addiction treatment to residents admitted into the drug court program contrasts with the lack of access to many programs.

“They have to wait for months for treatment options to become available, or simply commit a petty crime so they can get the help, but that’s not acceptable,” Vitale said.

Patty DiRenzo, a Blackwood resident whose 26-year-old son Salvatore died of an overdose in 2010, said expanded insurance coverage is a necessary step. She said her son was repeatedly turned away from treatment because his insurance wouldn’t cover it.

“New Jersey is facing an epidemic and we are losing a generation of children to this disease,” DiRenzo said.

One of the more contentious issues is how to get more doctors and other prescribers to participate in the state’s Prescription Monitoring Program (PMP), which tracks all prescriptions for dangerous drugs.

Assembly Health and Senior Services Committee Chairman Assemblyman Herb Conaway Jr. (D-Burlington) said the PMP is useful, but it’s wrong to mandate how it is used. He supports having all providers registered in the PMP, but he has opposed requiring that it be checked each time an opioid prescription is issued.

“It certainly reminds me that people don’t stand in the shoes of a physician,” Conaway said of those proposing a mandate, noting that it raises concerns over medical liability lawsuits. He added that doctors generally discuss the negative side effects of prescriptions, while all pharmacies provide patients with information on the side effects.

The Medical Society of New Jersey, the state’s largest physicians group, is encouraging doctors to use the PMP, but also opposes a mandate.

Vitale said he was interested in having further discussions with Conaway and doctors about the issue. He said there might be other ways to make the PMP more effective, such as improving the technology so that prescriptions are updated throughout the system instantly, and incorporating the PMP into patients’ electronic medical records.

Assemblywoman Valerie Vainieri Huttle (D-Bergen) said she has firsthand experience — as a funeral home director in Bergen County — in dealing with the effect of opiate overdoses. She noted that her county had 28 deaths from opiate overdoses in 2013.

Assemblywoman Mary Pat Angelini (R-Monmouth), the CEO of behavioral health provider Prevention First, cited statistics that for every $1 spent on evidence-based prevention efforts, there is a long-term savings of $15 in costs to society, while a similar ratio exists for drug treatment, with $10 in savings for every $1 spent.

“This is an investment that our children — our communities — deserve,” Angelini said.

Last year, Vitale had promised a legislative package that would address a number of aspects of the problem, ranging from prevention to treatment and recovery.

He and other legislators delivered on that promise yesterday at a press conference that drew family members of overdose victims who have been leading advocates for government action.

The measures would require healthcare practitioners to inform patients of the addiction potential of controlled dangerous substances before prescribing them; require that public school curriculums incorporate current evidence-based standards and practices for teaching students about drugs; spend $5 million in the current fiscal year for evidence-based substance abuse prevention programs; require placement of bins for discarded prescriptions in some law- enforcement locations; require both prescribers and pharmacies to inform patients on how to dispose of unused prescriptions; appropriate $500,000 to establish a clearinghouse for information on drug overdoses; report on trends and provide information on how to safely store and dispose of medicine; and establish a Statewide Opioid Law Enforcement Coordinating Task Force.

In addition, bills would require the state to publish an annual substance-abuse treatment provider performance report; license outpatient facilities that integrate behavioral healthcare in their services; start a grant program for remote medical consultations; direct four-year state colleges to start campus housing programs for students in recovery from substance abuse; extend the provisions of the Overdose Prevention Act by allowing pharmacists to provide naloxone without prescriptions; start a pilot program to allow defendants who are awaiting court hearings and have posted bail to be enrolled in Medicaid; require the Department of Human Services to share regulatory authority with the Department of Corrections regarding prison-based mental-health and substance-abuse treatment programs; and require drug-treatment programs operating in prisons and jails to offer medication-assisted treatment.

Previously introduced bills included in the package are S-2029/A-1015, which would permit students to participate in voluntary surveys if they have parental approval; S-2047, which would increase state regulation of what are known as sober living homes; and S-324/A-2266, which would start a state program to advocate on behalf of people with behavioral health problems and help them navigate the health insurance system