Ocean County Targets Opioid Overdoses, Hopes Others Will Follow Its Lead

Andrew Kitchenman | November 19, 2014 | Health Care
New approach stresses saving lives, then intervening to break cycle of addiction

Ocean County Prosecutor Joseph Coronato, at left, takes part in roundtable discussion about ways to combat the problem of opioid addiction and overdose deaths.
Naloxone – marketed under the trade name Narcan – can save the life of someone who has overdosed on heroin or another opioid drug, sending their body into instant withdrawal.

The drawback of the antidote, however, is that the person who has been saved is left craving their next hit.

Drug policy experts say that those who survive overdoses are too often released after being treated in a hospital emergency department, only to immediately return to the drug use that put them there. But law enforcement and health officials in Ocean County are working on a way to break this cycle – one that could have statewide or even national repercussions.

Last week, the county began a new emergency intervention pilot program for overdose victims. After their conditions are made stable, they meet with a drug treatment interventionist – often a former addict in recovery or another expert trained in such interventions.

“Hopefully, at that point in time, they will realize this is the time to change, to break from the cycle of addiction,” and will agree to enter a detoxification facility for one or two days, said Ocean County Prosecutor Joseph D. Coronato.

Following detox, the patient will undergo one of four possible treatments. They will either stay in an inpatient treatment facility, or begin outpatient treatment using one of three medications: methadone, buprenorphine or naltrexone.

Ocean County has had 77 overdose deaths so far this year, a marked decrease from the 99 deaths at the same point last year. Coronato noted that a key reason for the decline is the 115 people who have received naloxone, people he described as “saves.”

Based on discussions he had during a meeting regarding naloxone in Washington, D.C., Coronato believes there isn’t a similar approach to immediately providing overdose victims with treatment anywhere else in the country. He described providing treatment as the “back half of Narcan.”

Sen. Joseph F. Vitale (D-Middlesex) described the approach as “What’s next when someone comes back to life.” He said that as more evidence is accumulated to prove that the program is successful, it can be integrated with other ways the state is responding to the opioid epidemic, which has led to drug overdoses becoming the leading cause of accidental death both in New Jersey and the nation.

Vitale has been shepherding through the Legislature a 21-bill package that addresses addiction prevention, education, treatment and recovery. He helped convene a roundtable discussion among law-enforcement and medical and treatment providers yesterday at Kean University in Union, where Coronato and others discussed the Ocean County program.

Hospitals have seen a surge in addiction and other behavioral-health emergency visits over the past seven years, reaching more than 520,000 cases in 2013, according to Mary Ditri, director of professional practice for the New Jersey Hospital Association.

“It’s a really broad spectrum across the board — the age ranges are from kids right through to geriatric patients,” Ditri said of those with addictions.

When these patients are released without inpatient stays, either the patient’s unwillingness to seek treatment or problems accessing outpatient treatment “creates a revolving door for folks and we see the same people presenting over and over again.”

Ditri said many young drug users return to the same emergency departments every six to 10 days, then head back to the living situation that is contributing to their drug use.

She noted that the federal Medicaid program covers detox but not inpatient drug rehabilitation.

That’s why the New Jersey Hospital Association is working with Ocean County hospitals, state officials, emergency doctors and behavioral health specialists on potential solutions that draw from Ocean County’s approach.

“We’re really excited about that conversation and seeing where it goes and how we can partner to move this forward,” Ditri said.

Coronato said he’s concerned that some doctors frequently prescribe large quantities of opioids to patients. When patients who are addicted to these drugs no longer can receive prescriptions, they turn to heroin, since illegal prescription pills can cost $10 to $25, while heroin can be as little as $3 to $5 a hit. Heroin available in New Jersey is, by some measures, the cheapest and purest in the country, and can be laced with fentanyl that increases its effects and lethality, Coronato noted.

Coronato said that within two weeks after he became county prosecutor in March 2013, there were eight overdose deaths in Ocean County in a seven-day period. They included an 18-year-old who used 50 packs of heroin in one day. “For me, as a dad, I was astounded and it was beyond belief,” he said.

Even if the Ocean County approach is successful and can be expanded, legislators have noted that addiction prevention and treatment – whether inpatient or outpatient – is expensive and hasn’t been receiving the funding from public or private insurance programs that is needed to meet the demand for treatment.

Vitale has supported providing an additional $5 million annually for drug prevention programs, as well as additional Medicaid reimbursements for substance-abuse and mental-health treatments that have been proven effective.

Vitale said that until society treats addiction like other illnesses, it won’t make the investment needed to address it. He noted how family members swap stories about their injuries and ailments on holidays like Thanksgiving, but admitting to addiction will stop conversation cold. He added that Medicaid underpays providers for addiction treatment sessions, put low-income patients with unequal access compared with wealthier residents.

“Until we acknowledge it as a community – whether it’s law enforcement or the medical community or regular citizens, we’re never going to address the problem the way we do with every other physical illness,” Vitale said. “We won’t make the investment in money, in infrastructure and in treatment.”