Lawmakers Seek to Expand Access to Overdose Antidote

Lilo H. Stainton | March 22, 2018 | Health Care
Schools and prisons are the targets of two measures meant to save lives and block opioid use

Assemblyman Herb Conaway Jr., Democratic incumbent for District 7
Democratic legislators are seeking to expand efforts to address opioid addiction and overdoses through new programs in two very different public institutions — New Jersey’s public schools and state prisons.

An Assembly committee is scheduled today to consider a proposal to require all schools to train school nurses and other officials in administering opioid antidotes, like naloxone or Narcan; high schools would also be required to maintain a supply of these substances. The goal is to reduce the chance of overdose death on school grounds for students, teachers, staff, and visitors.

“The harsh reality is that opioids are killing thousands of people in this country, many of them young people,” the bill’s sponsor, Assemblyman Vince Mazzeo (D-Atlantic), said earlier this month. “Narcan has been proven to save lives. Having it readily available in schools can help ensure that our schools are ready to respond in every emergency situation.”

Opioid blocking behind bars

Another panel is slated to review a proposal that would ensure prisoners dealing with addictions are provided with an opioid-blocking injection, naltrexone or Vivitrol, when they are released — in an effort to help them stay sober. They would also be armed with a naloxone shot in case they, or someone else, end up overdosing instead.

This measure is designed to reduce the high recidivism rate among inmates — more than three-quarters of whom are likely to end up back in jail, according to the bill’s sponsor, Assemblyman Herb Conaway Jr, often as a result of drug issues. Conaway said naltrexone has been proven “highly effective” and is now used in many programs in at least 30 states, including New York and Pennsylvania; inmates in these programs are less than 10 percent likely to return to jail within five years, he said.

“Opioid dependence disproportionately affects the U.S. criminal justice system population, and relapse and overdose deaths occur at high rates after release from incarceration,” said Conaway (D-Burlington), a practicing physician. He was speaking this past May, when a previous version of the bill was passed by the Assembly health committee, which he chairs. “If we want to truly break the cycle of dependency and recidivism, we should be employing this as a state corrections policy.”

The opioid explosion

Opioid addiction has exploded in New Jersey across diverse demographics. More than 2,200 residents died of drug overdoses in 2016, a 40 percent increase over the previous year, according to a website maintained by the attorney general’s office. Heroin ODs rose more than 50 percent and deaths from fentanyl, a powerful synthetic that experts blame for the rise in mortality, more than doubled. While data for 2017 is still pending, more than 650 people have already overdosed in 2018.

Use of overdose antidotes, naloxone in particular, has also shot up. Former Gov. Chris Christie expanded use of the substance, arming local responders and state officials with the injection or newer, nasal spray form; encouraging it to be sold at chain drugstores and local pharmacies; and allowing emergency officials to administer up to three doses, if needed, to help combat the effects of newer, stronger blends of heroin and fentanyl. The antidote has been administered more than 15,000 times in recent years and over 2,000 times this year alone, according to the attorney general.

Mazzeo, who represents Atlantic City, which has been hard hit by addiction, and other sponsors of the school-based bill, believe it is time to expand this safety net to education institutions. “Schools should be equipped to deal with overdoses in the same way they are prepared to deal with life-threatening incidents like allergic reactions and cardiac arrest,” said sponsor Joseph Lagana (D-Passaic). “If we have a means to save a child, there is no reason why we shouldn’t use it.”

The bill (A-542), which is sponsored by more than a half-dozen Democrats, would require officials at all local schools — including public, private, charters, and other institutions — to develop a policy on administering the antidote to anyone suffering an overdose on school grounds. High schools would be required to keep a form of naloxone on hand; primary grades would have the option of maintaining such a supply.

Immunity from prosecution

The proposal would make the school nurse the primary individual responsible for the program and for administering the antidote, but would grant the nurse legal immunity. It would also require other officials to be trained to administer the substance and for it to be kept in a safe, but easily accessible, location.

According to a fiscal estimate supplied by the nonpartisan Office of Legislative Services earlier this month, while the cost of the antidote varies significantly, schools can purchase the medicine for as little as $20 per dose. As a result, the OLS believes it would only cost $10,000 to $20,000 to supply all high schools in the state. The bill will be reviewed by members of the Assembly Appropriations Committee today.

The other measure, (A-3169), is slated for a hearing before the Assembly Health and Human Services Committee, which Conaway chairs. It would expand the long list of items and services the state Department of Corrections now requires inmates be offered when they are released: records of their criminal history, information about programs and training, nondriver identification card and other documents, two-week supply of their prescription medications, and bus or rail pass.

Under the proposal, prison officials would also be required to offer inmates with a history of addiction and were medically cleared for the treatment, a naltrexone injection, which lasts for several weeks, and a to-go dose of naloxone in case they get off track.

Conaway has said that a national addiction study has shown individuals in recovery who get monthly doses of naltrexone can remain opiate-free 90 percent of the times. Federal justice officials and experts on prison re-entry and inmate health all recommend the program, he said, and it is already in use in more than 100 prisons nationwide.