New Jersey has made progress reducing the number of opioid prescriptions written and the risks associated with this substance-use disorder. But more must be done to prevent people from turning to addictive drugs and keeping them as safe and healthy as possible if they do become dependent.
That was the general consensus among a panel of experts who joined NJ Spotlight at Rutgers University’s New Brunswick campus Friday to discuss the opioid epidemic in the Garden State, with a focus on prevention and risk reduction. These efforts must look beyond addiction itself, to the underlying causes of the disease, including poverty, lack of safe housing, emotional and physical traumas, and other social determinants of health, participants agreed.
The panelists — Health Commissioner Dr. Shereef Elnahal; Kathy Ahearn-O’Brien, executive director of the Hyacinth Foundation Dr. Mark Rosenberg of St. Joseph’s Heath, and Hackensack Meridian Health’s Dr. Roman Solhkhah — generally supported similar strategies for advancing prevention goals, but diverged on one issue in particular: the role of medicinal marijuana in addressing addiction. (Elnahal favors expanding access; Solhkhah raised concerns it too is addictive.) Sen. Joseph Vitale (D-Middlesex) was also scheduled to attend but was unable to make it at the last minute.
A combination of awareness, stricter regulation, and new clinical protocols has helped drive down opioid prescription levels — a nearly 20 percent decline since 2015 in New Jersey, Elnahal noted. But close to 1,400 residents have died of overdose-related causes so far this year, putting the Garden State on track to surpass last year’s mortality figures by up to 1,000 lives, state data suggests.
Building on gains
The state must now build on its gains so far, Elnahal said, calling for an expansion of a protocol created by St. Joseph’s that has helped cut the use of addictive drugs in the Garden State’s busiest emergency room by more than 80 percent in two years. In addition, improvements are needed to better integrate the opioid prescription database with electronic health records and statewide health-related data, he said.
“Some early leading indicators have improved,” Elnahal told the audience, which included healthcare advocates, industry representatives, and government officials, “but not the one we care about most: opioid overdose deaths.”
The event was the first of three in a series NJ Spotlight is hosting on this topic in an effort to explore the current state of addiction in New Jersey, as it relates to healthcare; a discussion of treatment is scheduled for September and recovery will be the focus of an October roundtable.
Former Republican Gov. Chris Christie directed public attention and new resources to the issue, and, with help from key lawmakers like Vitale, launched an array of responses, including some of the nation’s most restrictive prescription limits.
Under Gov. Phil Murphy, a Democrat who took office in January, the state has redirected resources away from public relations to target specific best practices, in a variety of departments. Murphy’s budget proposal for fiscal year 2019, which starts in July and has been challenged by the state’s Democratic-led Legislature, calls for $100 million in funding for treatment, prevention, data systems, and other efforts.
Ashley Koning, director of Rutgers University’s Eagleton Center for Public Interest Polling, kicked off the event with data from a recent survey that showed nearly half of state residents had been prescribed opioids in the past year. But almost the same percentage did not recall discussing the dangers of these drugs with their doctors. The vast majority of those queried (94 percent) agreed opioids were a serious problem, but only three in four thought it was a serious problem in their own neighborhood.
Stemming the flow of opioids
One key in reducing the impact of addiction is curbing the flow of prescription opioids, the panelists agreed. National data suggests four out of five recent heroin addicts first became hooked on prescription drugs, although these pills may have been obtained illegally, panelists said.
In many cases, patients get that first prescription in the emergency room, as a result of a car crash or work injury that results in severe pain. The St. Joseph’s program, ALTO, or Alternatives to Opioids, is designed to force ER doctors to select other options — nerve blockers or nonaddictive meds — before turning to opioids. The program, which members of New Jersey’s federal delegation are now seeking to expand nationally, cut opioid prescriptions by 57 percent the first year and 82 percent in the second, according to Rosenberg, who founded the initiative.
“If I don’t give you an opioid, you don’t get addicted,” Rosenberg said.
Addiction has been fueled in past decades by the growing availability of pain pills and the fact that doctors were encouraged to treat pain more aggressively. In New Jersey, the trauma left by superstorm Sandy is also an important underlying factor, stressed Solhkhah, who founded the psychiatry department at Jersey Shore Medical Center, in Neptune, and serves several other Shore hospitals. Better diagnosing and treating mental health issues are also an important part of reducing addiction, he said.
Slamming the doors on addiction
Elnahal described addiction as a hallway with a series of doors leading to bad outcomes; the state can help an individual by keeping them from going through these doors, which may lead to homelessness, jail, disease, or death. Any door the state can shut gives a resident suffering from addiction a better chance to survive, and each extra day provides another chance to re-asses and potentially connect with treatment.
“We want the fewest number of people possible going through those doors,” Elnahal said. “We need to think much more about bringing people into stability.”
That was good news to O’Brien, with Hyacinth, a 33-year-old nonprofit that works with individuals with HIV/AIDS and advocated for legal syringe exchange programs in New Jersey. That process took years, but there are now five programs up and running statewide, helping to reduce the spread of HIV, hepatitis-C, and other diseases spread by sharing dirty needles.
“This is a true public-health measure,” O’Brien said, noting that — despite its conservative politics, Kentucky has 35 needle-exchange programs, which critics complain only exacerbate addiction. “We’re looking to expand and invest in it because we really know how it works.”
Elnahal agreed syringe access is a critical risk-reduction tool and said the $100 million committed by Murphy for addiction programs would include $2.1 million for this effort —the same amount budgeted this year. This program was not identified by name in Murphy’s original budget plan.
While needle exchange has been controversial among some members of the public, O’Brien and Elnahal agreed an even more robust risk-reduction strategy would also include safe-injection sites, or indoor locations where IV drug users can get clean syringes and shoot up in the presence of medical professionals. Data from Canada suggests these programs can go a long way toward reducing overdose deaths.
Elnahal said, when asked, that his staff has explored this concept already. But he and O’Brien agreed that, despite the benefits, launching such a program would require overcoming significant political and public opposition.