Murphy Outlines Expanded, Multiagency Approach to Opioid Addiction

Lilo H. Stainton | January 24, 2019 | Health Care
Governor’s new initiative will increase reliance on medication-assisted treatment, which he calls a ‘proven strategy’

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New Jersey will roll out additional efforts to further reduce the number of prescriptions written for opioids; make it easier for Medicaid patients to access addiction care; allow patients with addictions to qualify for medicinal marijuana as part of wider treatment; and expand job training, family supports, and other services.

Gov. Phil Murphy outlined a diverse range of targeted initiatives Wednesday while flanked by a half-dozen cabinet members during a visit to Cooper University Medical Center, in Camden, a city that has been particularly hard hit by the state’s growing opioid epidemic.

Cooper will also be the site of one of two new academic centers of excellence in the Garden State, with the other to be launched in Newark, with Rutgers New Jersey Medical School, Murphy said, noting the state plans to invest $4 million total in these projects.

Murphy said the new work — which will involve at least $40 million in state and federal spending, although details on the costs were scarce yesterday — will build on the outcomes of a $100 million commitment his administration made last spring to reducing the impact of opioid addiction.

The latest programs are a continuation of this investment, funded by money allotted to each department under the current budget, as well as more than $30 million provided by the federal government in September.

40 percent fewer opioid prescriptions

The previous initiatives, and changes made under former Gov. Chris Christie, have helped to reduce opioid prescriptions by nearly 40 percent in four years, eliminate insurance restrictions for some patients, and expand treatment options. But the death toll has continued to rise — albeit much more slowly than in the past. A record 3,000-plus New Jerseyans lost their lives to drug-related issues last year.

“None of us are here to claim any sort of victory,” Murphy said. “There is a real unfortunate wild card in these numbers and it is fentanyl,” he added, describing the cheap synthetic opioid that is many times the strength of heroin and is increasingly being mixed with the drug to increase its strength and cut production costs.

“I will not mince words: This is a public health emergency,” said state Department of Health Commissioner Dr. Shereef Elnahal.

To help meet these challenges, Murphy said the Department of Human Services will make changes to the Medicaid program to reduce insurance barriers to medication-assisted treatment, or MAT. This is a proven strategy that uses specific opioid-based medications and regular therapy to reduce cravings and addictive behaviors.

Attracting primary-care physicians

The DHS also plans to invest $15 million, which is expected to attract another $15 million in federal dollars, to expand reimbursement rates for primary-care doctors who provide MAT, an effort to encourage more providers to join their ranks.

“We’re never going to turn the tide on this epidemic unless we build a more accessible community of care,” said DHS commissioner Carole Johnson. “And we’re going all in on medication-assisted treatment to do it.”

In an effort to provide drug users with additional treatment options, Murphy said the DOH has now added opioid addiction as a qualifying condition for New Jersey’s medical marijuana program. In the past, addicts could enroll if they suffered from chronic pain, but not for the addiction itself.

Murphy said the hope is that greater access to medicinal cannabis may help keep some people from trying opioids, which experts generally consider far more dangerous. Further, marijuana could also act as a bridge for those trying to wean themselves from heroin or other opiates.

Elnahal, who has become a strong advocate for the medical marijuana program, said medical marijuana patients with opioid addictions would also be enrolled in a MAT program, and the corresponding therapy. “It’s part of a broad, government-wide push for the most effective treatment we know of,” he said of MAT.

Working with hospital ERs

The health department is also planning to work with hospital staff around the state to further reduce opioid prescriptions in emergency rooms, based in part on a successful model championed by St. Joseph’s Medical Center, in Paterson. Elnahal said nearly half of those who got a prescription last year were given opioids and one in five ER patients was discharged with some form of these highly addictive pills. The state seeks to cut this to 12 percent of emergency-room discharges by 2020, he said.

In addition, the DOH will collaborate with the state attorney general’s office to enhance New Jersey’s prescription-monitoring program, or PMP, a database that helps officials identify people who are trying to obtain extra drugs — and the doctors who are heavy prescribers.

Attorney General Gurbir Grewal said the system will soon be integrated with the electronic health records used by hospital networks, a change that Elnahal said will help doctors and nurses in caring for individuals in a crisis, while also allowing the state to target hot spots with high levels of drug use.

“We’ve made great progress, but as recent data makes clear, our fight is far from over,” Grewal said.

Murphy stressed that his approach is data driven and results oriented, and could evolve in the future. “We believe the components of this program will have the best chance to address this fight,” he said, “but we’re not too proud to change course if needed.”

Other elements of Murphy’s anti-addiction efforts include:

  • new resources from the DOH to support and enhance needle-exchange programs, now operating in a handful of cities particularly hard-hit by the epidemic;
  • an additional $1 million from the AG’s office to help communities create multifaceted opiate-response teams. This comes on top of a $1 million investment the office made in October to expand law-enforcement programs to divert nonviolent drug offenders to treatment programs;
  • efforts by the Department of Corrections to expand access within state prisons to MAT and other treatment programs, including care for hepatitis-C, a blood-borne infection that is not uncommon among intravenous drug users;
  • a $1.5 million commitment from the DOC to help county jails implement similar MAT programs, with peer-counseling specialists to provide support;
  • continued support for a Department of Children and Families program that has kept nearly 450 families intact while one of the parents undergoes drug treatment or other behavioral health services. According to DCF commissioner Christine Norbut Beyer, thanks to programs like this, New Jersey has bucked the national trend that shows an uptick in foster care cases;
  • a $3.9 million investment by the Department of Labor in programs to help individuals with addictions get training, job skills, and support — including childcare, transportation, licensing help, and appropriate clothing — so they can get and keep a job.