Op-Ed: New Jersey’s Opioid Strategy Is Missing an Important Component

F. Leland McClure III | October 17, 2018 | Opinion
Physicians must be allowed to prescribe opioids, but we need regulations that support drug testing of patients before and during such therapy

F. Leland McClure III
Throughout my career, I have closely studied prescription drug use and misuse, particularly relating to opioids. As director, medical science liaison, and medical affairs at the large New Jersey-based company, Quest Diagnostics, the nature of our current opioid epidemic is particularly disturbing, and it’s hitting much too close to home.

I analyze and follow massive data sets based on de-identified patient test results, including drug monitoring. The anonymous nature of these data sets puts a degree of separation between the human impact and the need to identify trends at a high level. However, the reality on the ground is devastating.

Drug misuse can happen to anyone and is likely already occurring in your neighborhood among friends, neighbors, and loved ones. NJ Spotlight recently reported that New Jersey lost more than 1,600 residents to the spreading epidemic in 2016 alone.

More comprehensive, aggressive

I am especially dismayed by a recent report showing the number of people in New Jersey who died from opioid overdoses climbed 22.7 percent — to nearly 3,000 deaths — over just the last year. This tragic loss of lives is unacceptable. And preventable.

Addressing the opioid drug problem in New Jersey requires a more comprehensive and aggressive approach.

While I applaud New Jersey’s multi-faceted strategy in addressing this problem, such as requiring a discussion between the patient and practitioner about the risks, as well as alternatives, of the medication prior to prescription, there remain fundamental areas that do not receive the policy focus this crisis requires.

The fact is, individuals most at risk are those who do not yet have a substance use disorder, but could develop one, or who practice other dangerous forms of drug misuse. These are often victims of daily chronic pain for which long-term use of prescription opioids is the best source of relief.

Assumptions often wrong

As is the case with most states, strategies to increase medication-assisted treatment (MAT) programs and limiting overprescribing of opioids for transient pain are worthwhile goals. Yet too often these measures focus on the extremes — on individuals already grappling with substance use disorders or those for whom an opioid prescription is given for transient pain.

The problem is that physicians may believe that they can tell if a patient will misuse a prescribed therapy without definitive evidence. Misuse includes supplementing, substituting, or abstaining from taking their prescriptions. However, these assumptions are often wrong.

For example, insights from a 2018 analysis of more than 3.9 million de-identified aggregated drug monitoring tests by Quest revealed a shocking truth: More than half of patients who take prescription opioids, amphetamines, and other therapies show signs of misuse when tested. Forms of misuse include dangerous drug combinations with other drugs like fentanyl (a powerful opioid) and benzodiazepines (a widely used class of anti-anxiety medications). Use of illicit drugs, such as heroin, is also a growing national problem.

The role of physicians

Physicians that monitor prescription drug use can play an important role in identifying statewide misuse trends. Their efforts complement state-based databases that track prescription data to help reveal possible concerns, such as the New Jersey Prescription Monitoring Program (NJPMP).

New Jersey’s state leaders can make it easier for physicians to keep patients safe by adopting regulations and policies, such as those included in the CDC Guidelines for Prescribing Opioids for Chronic Pain, which supports the use of drug testing before commencing opioid therapy, and at least annually thereafter, to assess for prescribed medications, other controlled prescription drugs, and illicit substances. This includes such measures as ensuring that drug monitoring is both medically appropriate and covered by insurance.

For many New Jersey residents, the pain is a very real component of their everyday lives, and physicians must be allowed to consider opioids for relief when other measures won’t do. For these patients, drug monitoring can aid the delivery of appropriate care while reducing risks of overdose. If physicians don’t have access to all viable means to protect these patients, it’s all but certain that prescription drug misuse — and overdose deaths — will continue.