State Seeks to Apply Population Health Goals to Opioid Addiction

Treatment and recovery are a start, but more is needed, including investing in wellness and building safer communities

Credit: Office of Attorney General / Tim Larsen
Former Gov. Jim McGreevey
New Jersey must focus more on population health and prevention — not just treatment and recovery — by collaborating across government and with community partners to invest in wellness and build safer neighborhoods to make a real dent in the deadly opioid epidemic.

That was the takeaway from the state Department of Health’s third annual population health summit, which focused on an integrated approach to addressing opioid addiction, and drew hundreds of healthcare providers, community leaders, and recovery advocates to the Bridgewater Marriott on Tuesday.

The event featured federal and state officials — including five cabinet members; state Sen. Joseph Vitale, the chair of the health committee; and former Gov. Jim McGreevey, an advocate for prisoner re-entry services — as well as a wide range of addiction specialists, plus a pastor and family members who have personal experience with drug abuse.

Credit: Office of Attorney General/Tim Larsen
State Sen. Joe Vitale
Speakers agreed that while the state has made significant progress reducing access to prescription opioids and expanding access to treatment, more must be done to tackle the underlying social determinants of health — issues like safe housing, healthy food, and easy access to care for mental health and medical concerns. The DOH is committed to using this approach to reduce health disparities and address chronic health issues like addiction, health commissioner Dr. Shereef Elnahal said.

A disease of the poor and vulnerable

While opioid addiction has exploded in middle- and upper middle-class communities in recent years, Dr. David B. Nash, founding dean of the Jefferson College of Population Health, in Philadelphia, said the disease still predominantly impacts poor, vulnerable people. One half of addicts are unemployed, one-quarter permanently disabled, and six in 10 below the federal poverty line, he said, and combating the disease will require us to invest in poor communities and prevention, not just focus on treatment options.

“This is a disease of despair. It’s also a disease of racism,” Nash said in his keynote address, stressing the need to address the underlying factors. “We need to shut off the faucet before we start mopping up the floor.”

More than 2,000 Garden State residents died of drug-related issues last year and more than 1,200 have been logged so far this year, according to state data compiled by the attorney general’s office. Roughly 76,000 people were admitted to substance-abuse treatment in 2016, Elnahal said, including 33,000 heroin addicts — some 7,000 more than received care the previous year. The epidemic is also taking a growing toll on the next generation; nearly 700 babies were born addicted in 2016, twice the number that tested positive in 2008.

“These deaths of despair” — which include addiction deaths and suicide — “are actually changing the epidemiology of the lifespan in our country, with the opioid epidemic at the center of the storm,” Nash said, warning that in some parts of the country population is now shrinking as a result of these overdoses.

Revealing the full scope of the problem

In addition to a greater focus on underlying social factors, Nash said solving this problem requires better data to illustrate the full scope of the epidemic and standardized interventions and treatments based on best practices. In addition, he said, reimbursement systems must pay for prevention programs and long-term care for those who are addicted, including medically assisted treatment — the use of prescribed medications to ease addictive behavior — when appropriate.

Elnahal said the state is now moving in this direction. Former Gov. Chris Christie, a Republican, made the opioid epidemic a signature cause and called for hundreds of millions of dollars to be spent on programs to expand treatment and recovery options. But Gov. Phil Murphy, a Democrat who took office in January, has reassessed these efforts and redirected $100 million to fund specific evidence-based programs, support community providers, address social determinants, and improve the quality of the state’s data on addiction.

“I don’t think we’re going to get out of this problem just by providing more treatment beds. It has to be a much more comprehensive, much more strategic approach,” said Michael Santillo, executive director of operations at John Brooks Recovery Center, a leading network of care in the state, and a former addict who has been in recovery for nearly three decades. “We need to have pre-treatment services, recovery services, and ways to help (patients) navigate the treatment system,” he added.

Efforts to protect and strengthen at-risk youth are particularly important, according to Pam Capaci and Morgan Thompson of Prevention Links, a nonprofit that helped found the Raymond J. Lesniak Experience Strength and Hope Recovery High School in 2014 — one of two, soon to be three, such facilities statewide. Nine out of 10 addicts begin using drugs as adolescents, they said, and 12 percent of youngsters live with a parent facing substance-use issues. Ensuring that these kids have a safe school environment, with counseling and support services in addition to academics, is essential to keeping them healthy.

Earlier intervention

Credit: Office of Attorney General / Tim Larsen
State Attorney General Gurbir Grewal
Attorney General Gurbir S. Grewal said more could also be done to intervene earlier when drug users come in contact with law enforcement — even before they are charged with a crime that makes them eligible to access treatment through the state’s drug-court system, designed to divert nonviolent offenders from the criminal justice system. He launched such an effort as Bergen County prosecutor and plans to roll out structured municipal drug-court programs in the months to come.

“Why do we have to wait until someone is charged with an indictable (criminal) offense to get them the treatment that they need?” Grewal asked. “A warm handoff from a cop to a (addiction) professional can be very successful.”

When it comes to treatment, presenters agreed clinicians can also do better in addressing addiction. Unlike protocols for stroke or heart attack, which are documented and standardized, doctors don’t always work from the same playbook when it comes to detoxing and treating opioid abuse, Nash and others said, resulting in a wide variety of outcomes.

Stigma remains a problem, even for providers, several speakers noted. Dr. Louis Baxter, an assistant medical professor at Rutgers New Jersey Medical School who heads the Professional Assistance Program of New Jersey, which works with addiction professionals, said that, for example, too many doctors still treat diabetics differently from opioid addicts, although both are suffering from a chronic health condition.

“We don’t say, ‘See you later, get sugar free,’” when we discharge a diabetes patient from the emergency room, Baxter said. While some addiction providers try to limit a patient’s access to medically assisted treatment — which involves prescribed drugs designed to curb withdrawal symptoms and addictive behaviors — “No one ever says, ‘hurry up and get that (diabetic) patient off insulin,’” he added. “If we did the same for people with chronic substance abuse we would go a long way toward addressing the crisis.”

Caring for those with substance-use issue requires well-coordinated, truly integrated care, panelists noted. Many addicts struggle with other chronic health conditions as well, mental illness in particular, which often get overshadowed by drug use and left untreated by clinicians. Seton Hall Law School Professor John V. Jacobi talked about his research on integration and the work he is doing to assist state officials, including reforms to the licensing process that is part of the state’s shift of the Division of Mental Health and Addiction Services from the Department of Human Services to DOH, which regulates most aspects of medical care.

One-stop treatment

At the Henry J. Austin Health Center, a federally qualified heath clinic in Trenton, leaders have sought to create a one-stop facility where patients can get screened and treated for substance-use or mental health issues, while also visiting their family doctor for routine care, explained Dr. Rachael Evans, the chief medical officer.

While there is a greater need for clinical standards, connecting addicts with treatment often requires the touch of someone who has shared their experience, several speakers noted. That’s where Adrienne Petta, a peer-recovery specialist in Mercer County, a former drug user who now works for a state program that dispatches her to the emergency room to visit with overdose victims.

Petta sits at their bedside, sharing her story and listening to theirs, and, if they are willing, helping them — in big and small ways — advance toward treatment. She also checks back regularly for at least eight weeks and said nothing is more rewarding than the simple text messages she gets thanking her for being there when they needed help the most.

“The proof is in the messages I get from people and family members,” she said. “You’re not some doctor that just read something out of a book. You’ve lived that experience.”