The latest New Jersey data on opioid use and related mortality is a mixed bag of good and bad, with prescriptions for the highly addictive medications declining but overdose deaths continuing to rise across the Garden State.
Attorney General Gurbir S. Grewal shared new figures that show nearly eight residents died of drug overdoses each day in 2017, according to preliminary reports from the Office of the Chief State Medical Examiner. Made public last week, the numbers are up from an average of six daily ODs in 2016. And, based on 2018 data to date, Grewal and others expect the drug-related death toll will top 3,000 New Jerseyans this year.
At the same time, legal prescriptions for opiates are declining in New Jersey, as they have nationwide. Figures from the state’s prescription-monitoring program, designed to help providers track potential abuse, show doctors prescribed and dispensed nearly 40 percent fewer opioid orders as of July than they had in January 2014. Prescribing has dropped by 28 percent since March 2017 alone, when New Jersey adopted what may be the nation’s strictest patient limits on these drugs.
Grewal and other experts suggest the disparity in these trends is largely due to an increase in the availability of fentanyl and analog substances, powerful synthetic drugs developed for severe pain that can be 100 times more potent than their “cousins” morphine and heroin, according to the federal Centers for Disease Control and Prevention. In 2017, fentanyl or its analogs were involved in half of the ODs recorded, up from 44 percent in 2016, state figures show.
“In the Murphy Administration, we are committed to being transparent and educating the public about the costs that the opioid epidemic has imposed on our State,” Grewal said Tuesday when he shared the data during a symposium on addiction at the George Street Playhouse in New Brunswick.
Prescribers are changing their practices
“We still lose too many of our residents to drug overdoses, and the death toll continues to rise. But, if we look at the numbers, there are reasons for hope,” Grewal said in advance of a production of Anytown, a new musical about the opioid crisis, presented by the playhouse’s Educational Touring Theatre and sponsored in part by the Horizon Foundation for New Jersey and RWJBarnabas Health, the state’s largest provider network.
New Jersey has directed growing public resources toward curbing the state’s opioid epidemic. The issue was a primary focus for former Gov. Chris Christie during his last few years in office; Christie also pushed for the landmark prescription-limit law, which permits new acute-pain patients to obtain only five days’ worth of opioids at first. He also orchestrated reforms that expanded access to treatment and insurance coverage for this care.
Prescribers — who frequently have been blamed for their role in the crisis — are also changing their practices. A program developed by St. Joseph’s Medical Center in Paterson has helped emergency physicians there decrease opioid scrips by 80 percent in two years; state Department of Health Commissioner Dr. Shereef Elnahal has pledged to spread the program statewide and U.S. Sens. Robert Menendez and Cory Booker (both D-NJ), have sponsored federal legislation to launch a nationwide pilot program based on this work.
The impact of these changes drew praise from Sharon Joyce, director of the Office of the New Jersey Coordinator for Addiction Responses and Enforcement Strategies (NJCARES). Grewal launched NJCARES to work with multiple departments to track the impact of the epidemic and the state’s efforts to address the crisis. (Grewal also joined Christie and other experts Tuesday in a panel discussion on opioids organized by the U.S. District Court and held in East Brunswick.)
“The decreasing rate of prescription opioids dispensed in New Jersey shows that a smart approach to the opioid epidemic can help turn the tide. If we persist in our efforts to prevent addiction and overdoses, we can save lives,” Joyce said. Studies have shown that four out of five recent heroin addicts first became hooked on prescription pills, but eventually migrated to street drugs that are cheaper and, in some cases, easier to obtain.
So many ‘broken links’ in system
Gov. Phil Murphy, who took office in January, has actually dialed back some of the spending Christie had outlined in his final months, instead targeting some $100 million toward efforts to improve data collection and analysis, expand community-based care, and enhance critical support services like housing, transportation and job training, efforts that experts believe can improve well-being and reduce the overall demand for opioids and other drugs.
At a recent NJ Spotlight roundtable on opioid treatment, state Human Services Commissioner Carole Johnson outlined the Murphy administration’s commitment to investing in clinically proven care, including Medication Assisted Treatment or MAT, now viewed as the gold standard for addressing opioid addiction. But, despite the gains, she and others agreed more must be done to support existing providers — especially those caring for Medicaid members — and expand training in MAT throughout the state.
“There are so many broken links in the system,” said panelist Dr. Erin Zerbo, an assistant professor at Rutgers and a practicing psychiatrist who treats patients with substance use disorders in Newark. “We need policies to make this seamless for people.”
The medical examiner’s data released by Grewal — and posted on NJCARES — showed that 2,750 New Jersey residents died of drug overdoses in 2017, up nearly 24 percent from the 2016 death toll of 2,221 people. A high of 362 ODs were recorded last year in Essex County, versus 271 in 2016; Salem County had the lowest number, with 20 deaths in 2017 and 18 the previous year.
As of September 24, a record 2,152 people had OD’d so far this year statewide, with Essex, Mercer and six counties in South Jersey experiencing the highest death rates.
On track for record use of naloxone
The NJCARES site also tracks the use of naloxone, the overdose reversal agent now carried by many emergency responders and a growing sector of the public — which is also on track for record high numbers this year. Naloxone was given more than 9,000 times through July, suggesting usage this year will top the 14,400 doses administered in 2017. The substance, which is provided as a shot in a muscle or a nasal spray, was dispensed nearly 5,200 times in 2014, 7,200 times in 2015, and more than 10,300 times in 2016.
When it comes to opioid prescriptions, NJCARES shows the number of prescriptions dispensed by doctors and pharmacies in New Jersey ticked up from nearly 5.3 million in 2013 to almost 5.4 million in 2014 and topped 5.6 million in 2015. But then it began to decline, thanks in part to the growing awareness of the epidemic and its causes, and stricter federal prescribing guidelines. In 2016, 5.3 million scrips were written in the Garden State; by 2017 it had dropped further to 4.9 million.
And as of September 13, just over 3 million opioid prescriptions had been issued to New Jerseyans in 2018, according to state records.