Poison-Education Center Would Get Expanded Role in Fighting Drug Deaths

Andrew Kitchenman | October 30, 2014 | Health Care
Differences emerge over how quickly doctors would have to report crucial information on overdoses to statewide network

drugs substance abuse
When outbreaks of infectious diseases like Ebola or enterovirus occur, doctors are required to make timely reports to the state on cases they have treated.

Legislators are now considering taking the same approach with drug overdoses.

Doctors would be required to report overdoses to the New Jersey Poison Information and Education System, expanding its scope so that it would also serve as a clearinghouse for overdose information. For instance, it could serve as an early-warning system when tainted or particularly potent street drugs affect an area.

However, differences are already apparent in the two versions of the bill advancing in each house of the Legislature.

The Senate version, S-2371, would require reporting within 24 hours. The Assembly version, A-3715, would require reporting within 10 days, or when reports or analyses are available, whichever is sooner.

Dr. Steven M. Marcus, executive director of the poison-information network, said he strongly supports the shorter reporting deadline.

The longer it takes for an overdose case to be reported to the state, Marcus said, the longer it will take his office to inform local police and drug-treatment providers when particularly dangerous drugs hit the streets.

Sen. Richard J. Codey (D-Essex and Morris) suggested expanding the reporting deadline in the Senate bill to 48 hours, noting that doctors rarely sign death certificates in less than 24 hours. Codey, who owns a funeral home, said the 24-hour deadline is “totally unrealistic.”

But Marcus said doctors are already experienced with reporting infectious diseases quickly and that many emergency departments already promptly report drug-related overdoses to the poison-information system.

“Should some drug hit the street that today causes a whole bunch of problems, and we don’t hear about it for 48 hours, that could mean lives expended,” Marcus said.

While this would be the first time that the state requires healthcare providers to report overdoses to the poison-information office, Marcus has already played an important role in identifying problems with drugs.

For example, his office first identified the emergence of new, dangerous synthetic cannabinoid drugs, and notified local police departments. In addition, the poison-information office determined that a series of overdoses in southern New Jersey involved a dangerous batch of the synthetic opioid fentanyl, rather than heroin as originally suspected, and helped local authorities stop that outbreak.

In addition, Marcus was credited with alerting Somerset Medical Center to a series of suspicious overdoses in 2003, which led authorities to serial killer Charles Cullen, who killed roughly 40 patients while working as a nurse at hospitals in New Jersey and Pennsylvania.

Marcus said his poison-information system, which has been in place since 1983, didn’t originally mandate reporting because of concerns over whether healthcare providers would comply.

“I’ve wondered how many clusters we must have missed because we didn’t require mandatory reporting,” said Marcus, whose office is located at Rutgers Biomedical and Health Sciences’ Newark campus.

The bill would provide $500,000 for operating the information clearinghouse. Marcus said this money would be used in part to hire an epidemiologist — a public health professional who investigates the patterns and causes of diseases and injuries – to monitor overdose information.

The legislation would also require the also mandate expanded public-information efforts, such as warnings about the problem of family members, friends or neighbors who steal unlocked prescription drugs.

Bill sponsor Sen. Joseph F. Vitale (D-Middlesex) cited a recent surge in overdose deaths in Ocean County, which was traced to heroin laced with an opioid, as example of a situation in which local public health and law-enforcement officials would have benefited from mandatory 24-hour reporting.

“We wanted to make sure we did all we could to get this overdose information to healthcare professionals as quickly as possible,” Vitale said.

The longer reporting timeframe in the Assembly version is rooted in the logistical challenge of reporting overdoses before a doctor or emergency room knows for sure whether an overdose has occurred.

Assemblyman Herb Conaway Jr. (D-Burlington), a doctor and the primary sponsor of the Assembly bill, noted that hospitals frequently send out drug screenings for testing.

“We’re trying to sort of respect the limitations of testing and the speed with which results can be returned to the institution or physician,” Conaway said.

The Medical Society of New Jersey, the state’s largest doctors group, shared Conaway’s concern. They described the timeframe in the Assembly version as “more realistic and meaningful” than a 24-hour requirement.

The Assembly Health and Senior Services Committee released the Assembly version of the bill on a 9-0 vote, including two Republican members who voted in favor of the measure. Assemblyman Erik Peterson (R-Hunterdon, Somerset and Warren) abstained from the vote, citing his concern with the $500,000 cost. Some Republican legislators – as well as Gov. Chris Christie – frequently raise concerns when bills include appropriations outside of the annual budget process.

The Senate Health, Human Services and Senior Citizens Committee released the Senate version on a 6-0 vote, with both Republicans who were present abstaining. Sen. Diane Allen (R-Burlington), one of the abstainers, asked Vitale if the money would be provided in the state budget. Vitale replied that he’s been talking with Christie administration officials and that he’s hopeful that Christie will agree to keep the funding in the bill.

At the same hearing, the Senate committee released seven other bills that are part of a package intended to reduce the rising number of overdose deaths in the state by improving drug prevention, treatment and recovery programs. Among those bills was a measure that would allow federally qualified health centers to provide behavioral healthcare along with other healthcare through a single state license.