To truly curb the opioid epidemic, both here in New Jersey and nationally, we must realize former U.S. Surgeon General Vivek Murphy’s vision of doctors, nurses and other healthcare providers, truly being "the first line of defense in the battle against addiction.”
New Jersey’s recently adopted comprehensive law to combat opioid addiction, incorporating common sense measures that Partnership for a Drug Free New Jersey, addiction experts and impacted families have long advocated, provides the tools for doctors and other medical practitioners to become an active part of the solution.
This new law limits initial prescriptions to five pills and mandates all prescribers receive ongoing training in current best prescribing practices as a condition of being allowed to prescribe opiate-based painkillers. The new law also requires a conversation between all patients and their doctor before an opiate is prescribed about the risks of addiction and potential alternatives. This requirement for a conversation before an opiate is prescribed expands to all patients the provisions of a recently adopted law targeted specifically at the parents of children and teenagers. Taken together, these measures enable us to go after the opioid epidemic right at its source: the over-prescribing of opioid based painkillers.
To ensure the best possible results, however, requires the medical community to embrace the spirit of the new law and put its provisions into practice. That is why the continued resistance of the Medical Society of New Jersey, which opposed the legislation, is so problematic. Contrary to Centers for Disease Control and Prevention (CDC) and other medical and addiction experts who understand that the main cause of the current epidemic is over-prescribing and as a result emphasize the need to employ alternative non-addictive treatments, which for most kinds of pain are just as effective as opioid-based pain relievers, the Medical Society of New Jersey remains stuck in the old paradigm. In an all-too-typical comment, Chief Operating Officer Mishael Azam recently said “”Since the CDC guidelines were released and (S3
) was signed, patients feel like criminals for needing pain medication."
In a state and nation where 4.59 million prescriptions and 216 million prescriptions, respectively, were written for opioid-based pain relievers last year, the problem I respectfully submit is not under-prescribing. Despite some welcome modest reductions in the number of prescriptions issued each year, it is still over-prescribing. A recently released John Hopkins University School of Public Health Report on the Opiate Epidemic, which strongly recommends tightening up prescribing practices, notes, “Doctors often prescribe pain medications in quantities and for conditions that are excessive, and in many cases, beyond the evidence base.” And 85 percent of doctors themselves say that opiate-based pain medications are over-prescribed, according to national surveys.
Additionally, research demonstrates that people who abuse or are dependent on prescription opiate painkillers are 40 times more likely to abuse or be dependent on their illegal street cousin, heroin. They contain the same underlying ingredient. And a recent University of Michigan study showed that high school students who use prescription opioids, like OxyContin, Vicodin and other pain relievers, are 33 percent more likely to abuse opioids by the age of 23.
The impacts of the old ways of prescribing are being felt every day in our state. More than 100,000 New Jersey residents are already addicted to prescription opiates or heroin. More than 5,000 people have died from overdoses in our state in the past decade alone. And the overdose antidote, Narcan, is employed more than 20 times a day
Fortunately, despite the attitude of the Medical Society, there are doctors, nurses and medical practitioners throughout New Jersey stepping up and embracing current best practices. One encouraging example is a ground-breaking pilot program, Alternatives to Opiates (ALTO), underway at St Joseph’s Regional Medical Center Emergency Room. This successful program demonstrates that most patients can be given effective pain relief without the use of opiates. So far, three out of every four patients needing treatment to reduce pain were successfully treated by alternative medications and therapy, forgoing the use of highly addictive opioid-based painkillers
I urge the Medical Society of New Jersey to turn the page and embrace and publicize efforts like the ones at St. Joseph’s and proactively educate all New Jersey doctors on how they can affirmatively implement the provisions of the new law. That would be a real public service, paying off in saved lives.
Elaine Pozycki is Co- Chair of Partnership for a Drug-Free New Jersey